北京市64家医院癌痛治疗相关药学服务质量水平分析
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摘要
目的:了解北京市医疗机构药学部门在癌症疼痛(简称"癌痛")治疗中的药学服务水平,为医疗机构提高癌痛治疗药学服务质量和各级卫生行政部门制定癌痛治疗决策提供参考。方法:回顾性分析2018年2-3月北京市疼痛治疗质量控制和改进中心的癌痛规范化诊疗督导检查结果,统计"药学服务"部分(共20分)及其5个分项目(药师参与、药品配备、药品管理、门诊处方点评、住院处方点评,每项4分)的评分结果,根据医院等级和评分结果进行分类,分析影响医院癌痛治疗药学服务质量的因素。结果:北京市共有64家医院参与此次检查,其中三级甲等医院27家(42.19%)、三级乙等医院21家(32.81%)、二级及以下医院16家(25.00%)。所有受检医院的药学服务部分均能达到检查要求,合格率为100%,其中评分为"优秀"的有52家(81.25%)、"合格"的有12家(18.75%)。在"药师参与""药品配备""药品管理""门诊处方点评""住院处方点评"这5个分项目中,平均得分最高的是"药品配备"项目,为(3.83±0.05)分;平均得分最低的是"药师参与"项目,为(2.93±0.13)分。三甲医院[(17.80±0.28)分]和三乙医院[(17.78±0.30)分]的药学服务总分显著优于二级及以下医院[(16.16±0.50)分](P<0.01或P<0.05),其5个分项目中仅"门诊处方点评"项目得分差异有统计学意义(P=0.026)。药学服务总分为"优秀"的医院在"药师参与""门诊处方点评""住院处方点评"这3个分项目的得分显著高于"合格"医院(P<0.01或P<0.05)。按"药师参与"项目检查结果分组,优秀组、合格组和不合格组医院之间的药学服务检查结果差异有统计学意义(P<0.01或P<0.05)。结论:北京地区医疗机构的癌痛治疗药学服务质量总体合格,但在临床药师参与癌痛治疗和门诊处方点评方面仍存在不足。加强临床药师的培养和麻醉药品管理的信息化建设将有助于提高癌痛治疗药学服务的整体质量。
OBJECTIVE:To investigate pharmaceutical care of cancer pain therapy in medical institutions from Beijing area,and to provide reference for improving the quality of pharmaceutical care for cancer pain in medical institutions and formulating cancer pain therapy decision by public health administration departments at different levels. METHODS:Inspection results of standardized diagnosis and treatment for cancer pain were analyzed retrospectively in Beijing Pain Therapy Quality Control and Improvement Center during Feb.-Mar. 2018. Scoring results of pharmaceutical care(20 points) and its 5 sub-items(personnel participation,drug supply,drug management,outpatient prescription comment and inpatient prescription comment,4 points each item)were analyzed statistically and classified according to hospital level and pharmaceutical care inspection results. RESULTS:A total of 64 hospitals in Beijing participated in the inspection,including 27 tertiary A hospitals(42.19%),21 tertiary B hospitals(32.81%),16 secondary hospitals or first-level hospitals(25.00%). Pharmaceutical care in all hospitals met the inspection requirements with qualified rate of 100%. 52 hospitals performed excellently(81.25%),and 12 hospitals were qualified for pharmaceutical care(18.75%). Among 5 sub-items of personnel participation, drug supply, drug management, outpatient prescription comment and inpatient prescription comment,the average score of drug supply item was the highest(3.83±0.05);the lowest was the personnel participation item(2.93 ± 0.13). The results of pharmaceutical care inspection in tertiary A hospitals(17.80 ± 0.28) and tertiary B hospitals(17.78 ± 0.30) were significantly better than those in secondary hospitals or first-level hospitals(16.16±0.50)(P<0.01 or P<0.05);there was statistical significance only in the score of outpatient prescription comment among 5 sub-items(P=0.026). Total scores of the hospitals with excellent pharmaceutical care were significantly higher than those of the hospitals with qualified pharmaceutical care in terms of personnel participation,outpatient prescription comment and inpatient prescription comment(P<0.01 or P<0.05). There was significant difference in the inspection results of pharmaceutical care among the excellent group,the qualified group and the unqualified group classified by the results of personnel participation item(P<0.01 or P<0.05). CONCLUSIONS: The quality of pharmaceutical care for cancer pain therapy in medical institutions from Beijing area has reached the qualified level,but the participation of clinical pharmacists in cancer pain therapy and outpatient prescription comment still need improvement in further. The training of clinical pharmacists and information construction of narcotic drug management should be strengthened so as to improve the overall quality of pharmaceutical care for cancer pain.
OBJECTIVE:To investigate pharmaceutical care of cancer pain therapy in medical institutions from Beijing area,and to provide reference for improving the quality of pharmaceutical care for cancer pain in medical institutions and formulating cancer pain therapy decision by public health administration departments at different levels. METHODS:Inspection results of standardized diagnosis and treatment for cancer pain were analyzed retrospectively in Beijing Pain Therapy Quality Control and Improvement Center during Feb.-Mar. 2018. Scoring results of pharmaceutical care(20 points) and its 5 sub-items(personnel participation,drug supply,drug management,outpatient prescription comment and inpatient prescription comment,4 points each item)were analyzed statistically and classified according to hospital level and pharmaceutical care inspection results. RESULTS:A total of 64 hospitals in Beijing participated in the inspection,including 27 tertiary A hospitals(42.19%),21 tertiary B hospitals(32.81%),16 secondary hospitals or first-level hospitals(25.00%). Pharmaceutical care in all hospitals met the inspection requirements with qualified rate of 100%. 52 hospitals performed excellently(81.25%),and 12 hospitals were qualified for pharmaceutical care(18.75%). Among 5 sub-items of personnel participation, drug supply, drug management, outpatient prescription comment and inpatient prescription comment,the average score of drug supply item was the highest(3.83±0.05);the lowest was the personnel participation item(2.93 ± 0.13). The results of pharmaceutical care inspection in tertiary A hospitals(17.80 ± 0.28) and tertiary B hospitals(17.78 ± 0.30) were significantly better than those in secondary hospitals or first-level hospitals(16.16±0.50)(P<0.01 or P<0.05);there was statistical significance only in the score of outpatient prescription comment among 5 sub-items(P=0.026). Total scores of the hospitals with excellent pharmaceutical care were significantly higher than those of the hospitals with qualified pharmaceutical care in terms of personnel participation,outpatient prescription comment and inpatient prescription comment(P<0.01 or P<0.05). There was significant difference in the inspection results of pharmaceutical care among the excellent group,the qualified group and the unqualified group classified by the results of personnel participation item(P<0.01 or P<0.05). CONCLUSIONS: The quality of pharmaceutical care for cancer pain therapy in medical institutions from Beijing area has reached the qualified level,but the participation of clinical pharmacists in cancer pain therapy and outpatient prescription comment still need improvement in further. The training of clinical pharmacists and information construction of narcotic drug management should be strengthened so as to improve the overall quality of pharmaceutical care for cancer pain.
引文
[1]HAUMANN J,JOOSTEN E,EVERDINGEN M.Pain prevalence in cancer patients:status quo or opportunities for improvement?[J].Curr Opin Support Palliat Care,2017,11(2):99-104.
[2]北京市疼痛治疗质量控制和改进中心癌痛专家组.北京市癌症疼痛管理规范:2017年版[J].中国疼痛医学杂志,2017,23(12):881-889.
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[5]索艳英,张丽嬴,刘琳琳,等.疼痛评估管理信息化在癌痛规范化示范病房中的应用效果评价[J].中国医药指南,2016,14(27):38-39.
[6]王伟娜,荚卫东,宋瑰琦,等.无痛病房管理模式在肝癌患者围术期的应用[J].中国全科医学,2014,17(27):3256-3260.
[7]于世英.癌痛诊疗规范及示范病房的自评标准解读[J].中国疼痛医学杂志,2012,18(12):706-708.
[8]刘晶晶,袁易.临床药师开展患者药物咨询和用药教育新模式探讨[J].临床合理用药杂志,2018,11(2A):117-119.
[9]林建昌.临床药学服务在癌症规范化治疗示范病房中的应用探讨[J].今日药学,2013,23(3):168-170.
[10]刘静,徐玲玲,朱金刚.临床药师在癌痛规范化治疗示范病房中的工作模式探讨[J].药学服务与研究,2016,16(4):323-325.
[11]闫加庆,张远远,任夏洋,等.我国医疗机构疼痛管理药学服务现状及工作模式调查[J].临床药物治疗杂志,2018,16(10):75-77.
[12]任振宇.疼痛治疗药师的工作模式探讨与展望[J].中国疼痛医学杂志,2015,21(11):859-861.
[13]王薇,曹邦伟,宁晓红,等.北京市癌痛控制20年进步与挑战:北京市多中心癌痛状况调查(FENPAI4090)[J].中国疼痛医学杂志,2014,20(1):5-17.
[14]李小兵,白礼西,胡渝,等.重庆市16家市属医疗机构处方集中点评情况分析[J].中国药房,2018,29(18):2458-2462.
[15]龚晓英,马晶晶,虞勋,等.门诊癌痛和慢性疼痛患者信息化管理平台的建立与实践[J].中国药房,2018,29(4):450-454.
[16]王宾,龚岳均.门诊电子化处方点评系统的开发与应用[J].中国药房,2016,27(4):455-458.
[2]北京市疼痛治疗质量控制和改进中心癌痛专家组.北京市癌症疼痛管理规范:2017年版[J].中国疼痛医学杂志,2017,23(12):881-889.
[3]VAYNE-BOSSERT P,AFSHARIMANI B,Good P,et al.Interventional options for the management of refractory cancer pain:what is the evidence?[J].Support Care Cancer,2016,24(3):1429-1438.
[4]巴衣尔策策克,孙建波,彭明强,等.北京地区疼痛学科发展现状调查分析[J].中日友好医院学报,2018,32(1):54-55.
[5]索艳英,张丽嬴,刘琳琳,等.疼痛评估管理信息化在癌痛规范化示范病房中的应用效果评价[J].中国医药指南,2016,14(27):38-39.
[6]王伟娜,荚卫东,宋瑰琦,等.无痛病房管理模式在肝癌患者围术期的应用[J].中国全科医学,2014,17(27):3256-3260.
[7]于世英.癌痛诊疗规范及示范病房的自评标准解读[J].中国疼痛医学杂志,2012,18(12):706-708.
[8]刘晶晶,袁易.临床药师开展患者药物咨询和用药教育新模式探讨[J].临床合理用药杂志,2018,11(2A):117-119.
[9]林建昌.临床药学服务在癌症规范化治疗示范病房中的应用探讨[J].今日药学,2013,23(3):168-170.
[10]刘静,徐玲玲,朱金刚.临床药师在癌痛规范化治疗示范病房中的工作模式探讨[J].药学服务与研究,2016,16(4):323-325.
[11]闫加庆,张远远,任夏洋,等.我国医疗机构疼痛管理药学服务现状及工作模式调查[J].临床药物治疗杂志,2018,16(10):75-77.
[12]任振宇.疼痛治疗药师的工作模式探讨与展望[J].中国疼痛医学杂志,2015,21(11):859-861.
[13]王薇,曹邦伟,宁晓红,等.北京市癌痛控制20年进步与挑战:北京市多中心癌痛状况调查(FENPAI4090)[J].中国疼痛医学杂志,2014,20(1):5-17.
[14]李小兵,白礼西,胡渝,等.重庆市16家市属医疗机构处方集中点评情况分析[J].中国药房,2018,29(18):2458-2462.
[15]龚晓英,马晶晶,虞勋,等.门诊癌痛和慢性疼痛患者信息化管理平台的建立与实践[J].中国药房,2018,29(4):450-454.
[16]王宾,龚岳均.门诊电子化处方点评系统的开发与应用[J].中国药房,2016,27(4):455-458.