药师参与病区药事管理质量考核的实践与效果

为探讨提高病区药事管理质量的方法和途径,文章介绍了云南省某医院通过合理用药审查、抗菌药物合理使用、药品不良反应上报、病区小药柜药品管理四个方面的实践经验。并提出通过实施药事管理质量考核制度,更加规范药事管理体系的建立,推动医疗质量整体水平的提高。     

医院药事管理质量评价体系分析

近年来,我国的医疗体制改革不断深化,医院的药事管理也面临着极大的变革.如今的药事管理模式已从传统单纯的药品供应转到以病人为中心的模式.这一方面是为了适应现代医院药学事业的发展要求,另一方面,进行药事管理的改革,也为了提高药学人才的素质,以整体提升医院药事的管理质量.本文主要围绕保证药品质量、保障合理用药以及实施药学服务等探讨医院药事管理质量评价体系,以促进药学服务工作能够顺利进行,并获得显著成就.     

我院药事管理的发展研究

<正>医院药事管理是指医疗机构内以服务病人为中心,临床药学为基础,促进临床科学、合理用药的药学技术服务和相关的药品管理工作。自国务院文件《关于加强医药管理的决定》实施后,医院药事管理内容发生了较大变化,其重心已从前期以制剂为主转为临床药学为主。我院在这几年发展迅速,但药事管理的发展已远远落后于医院的发展水平,所以, 加强我院药剂科的职能建设、开展各职能工作也显得尤其重要。我认为,我院的药事管理应重点在以下几方面加强职能工作的实施。     

新形势下的医院药事管理

药事管理是医院管理的重要组成部分。一个医院的医疗质量如何 ,不仅取决于医疗技术水平、护理技术水平 ,还在很大程度上取决于合理用药的水平。 1999年国务院在上海召开的城镇医药体制和医疗保险制度的改革会议 ,下发了医药卫生体制改革等九个配套文件 ,实行药品收支两条线管理 ,这对医院的药事管理工作提出了新的挑战 ,医药药事管理又将面临新的课题。为此我们在这方面做了一些尝试。一年多来的实践证明 ,只要认识到位 ,措施得当 ,就能实现降低药品收入比例 ,促进合理用药 ,减轻患者负担的目的。1　严格新药引进程序 ,调整药品结构1.1　规…     

医院药品质量管理中存在的几个问题和对策

把好药品质量关是提高医疗质量不可忽视的环节。本文针对医院药品质量管理中存在的药事管理组织不健全,药品质量管理制度不落实,强调经济利益、忽视药品采购质量,药品保管不善的问题,提出了加强药品质量管理工作的领导,依法管药,发挥药事管理组织作用等建议。     

我国三级综合医院药事管理的亮点与不足

目的促进医疗机构加强自身建设与管理水平,提高医院药事管理质量。方法以《三级综合医院评审标准实施细则（2011年版）》为依据,基于全国117家三级综合医院的评价数据进行分析。结果医院药事管理虽有一些亮点,但仍存在规章制度建设和落实亟待改进、药事管理专业人员紧缺等问题。结论药事管理工作者应以医院评价为契机,针对问题进行持续改进,切实保障患者用药安全,提高服务水平。     

对医师处方医嘱进行适宜性审核的探讨

建立人工医嘱审核程序,并合理用药监测软件（PASS）应用,全面规范医师医嘱,拦截不合理医嘱,同时加强药师与医师的沟通。提高了药品管理质量,体升了药学服务水平,体现了本院药事管理的科学化、规范化和信息化。对提升医院管理水平,促进医院发展,保障患者安全具有重要的意义。     

基于信息化精细化的药品控费管理实践与探索

为减少不合理医疗费用支出,加强临床用药合理性,自2009年起苏北人民医院采取了一系列信息化精细化的药品控费管理措施,积极开展药品使用全过程监管,有效降低了药占比,优化了患者的费用支出结构。医院在管理模式上由粗放式行政化管理逐步向多维度的信息化、精细化管理转变,促进了以合理用药管理为核心的药学服务转变和药学服务的高质量发展,实现了从传统的药事管理向全面参与医院的效率、效益提升的转变。     

开展基层医院药学质控，提高区域药事管理水平

目的：通过加强无锡市惠山区辖区内各基层医院药品使用的监督管理,开展区级药事质控,提升全区各基层医疗机构药事管理水平,促进临床医生合理用药,保证用药安全、有效、经济,减轻患者负担。方法：区医药协会下设区药学质控小组,质控小组确定每年的区级药学质控重点,设计质控检查表;将资料检查与现场检查相结合,每年规范开展2次质控,由区医药协会发布区药事质控通报,责令医院限期整改并复查整改情况。结果：2018年起连续开展了三年的区级药学质控工作,质控的11家医疗机构中有8家医疗机构抗菌药物使用强度呈明显下降趋势,处方和病历合理率均显著提升。2020年精麻药品处方合理率提升至100%,I类切口病历合理率达到95.29%。结论：健全区级合理用药管理体系,开展区级药学质控工作,强化区级药学部门的协同管理,为行政管理和监察提供实时数据,极大提升了辖区基层医疗机构药事管理质量及合理用药水平。     

加强病区备用药品管理降低护理风险

目的：规范病区备用药品管理制度,降低给药护理风险发生的几率,保障患者治疗安全.方法：对病区备用药品存储状况及管理中存在的风险问题及发生的原因进行分析总结,采取预见性护理措施并完善病区药品管理制度,安排专人负责、规范药品存放、加强效期管理、准确药品数量、合理存储管理、麻精类药品“五专”管理、严格高危药品管理等.结果：护士提高了对药品管理重要性的认识,增强责任心,规范备用药品管理方法,提高职业防护能力.结论：有效提高病区备用药品管理质量,确保临床安全用药;提高护士安全用药能力,降低给药引起的护理风险.     

Opinion of health professionals and drug users before the forthcoming opening of the first drug consumption room in Paris: a quantitative cross-sectional study

Background

On the brink of the opening of the first French drug consumption room in Paris, the general opinion of the local involved health care professionals and drug users was not known. The objective of this study was to determine their expectations and to search for influencing factors.

Method

We carried out a quantitative cross-sectional study. A multiple choice questionnaire was proposed to the surrounding willing general practitioners (GPs) and pharmacists, to the emergency doctors of Lariboisière hospital, and to the professionals of the harm reduction facilities and their drug users (PWUD). For each question, there was a choice between seven answers, from “??3” (very negative impact) to “+?3” (very positive impact). The influence of the characteristics of each group on its mean answers was explored by Mann-Whitney, Kruskal-Wallis, and Spearman’s tests.

Results

The median expectations among the groups of responding GPs (N =?62), other health care professionals (N =?82), and PWUD (N =?57) were mainly positive. They thought that the drug consumption room (DCR) would improve the health of PWUD, reduce their at-risk behaviors, would not increase drug use or drug dealing in the neighborhood, and would reduce nuisance in the public space. Only the group of GPs expressed that the DCR could decrease the quietness of the neighborhood, and only the group of PWUD had higher expectations that the DCR would decrease the number of arrests and the number of violent behavior. GPs’ expectations were significantly better in terms of health improvement of PWUD and reducing their precariousness if they had a previous experience in addiction medicine (Mann-Whitney, p =?0.004 and p =?0.019), with a longer practice (Spearman’s rho, p =?0.021 and p =?0.009), and if they were currently prescribing opioid substitution treatments (Mann-Whitney, p =?0.030 and p =?0.002).Among non-GPs, those who were working in addiction medicine centers had significantly better expectations than pharmacists, and the professionals of the local emergency department had intermediate expectations.

Conclusions

Health care professionals and drug users had a positive opinion of the to-be-created Parisian drug consumption room. Experience in addiction medicine influenced positively health professionals’ expectations.

     

高血压患者服药依从性影响因素及护理干预的研究进展

通过系统文献查阅、归纳、整理与分析,发现影响高血压患者服药依从性主要有四大因素,包括患者、药物、社会精神因素及护患关系.护理人员针对性地对高血压患者服药依从性采取干预措施,可以有效提高患者的服药依从性.准确把握高血压患者服药依从性的影响因素,制定相应的干预措施,提出系统性、科学性的方案仍是今后研究的重点.     

张冰教授治疗肿瘤术后患者经验

近年来,全球肿瘤发病率和死亡率快速增长.虽然目前手术切除、术后放化疗可有效治疗肿瘤,但患者术后正气受损、情志低落,放化疗副作用大,患者耐受差,严重影响到患者依从性和治疗效果.针对肿瘤术后患者,张冰教授在临床上常采用"调情志、筑长城、平内乱、护肝肾"的治疗原则,根据患者疾病的所处阶段进行辨证论治,结合现代医学研究,选择药...     

“互联网+”背景下网上药店市场经营现状与监管对策探讨

目的:通过总结我国网上药店经营现状,并重点归纳总结近两年来我国政府颁布的涉及网上药店的政策规章,总结现阶段我国网上药店市场经营存在的问题,提出完善我国网上药店监管的对策。方法:以"互联网+""网上药店"为关键检索词,检索近三年的知网、万方数据库,以及市场监督管理总局、米内等专业网站。并了解欧美等发达国家网上药品销售的先进经验。针对我国的问题进行深入分析,寻求解决方法。结果:我国目前网上药店相关法律法规体系不完善,立法层级低;网上药店的工作人员准入门槛低,新媒体平台监管薄弱;网上药店提供信息真假难辨,用药安全存在隐患;尚未形成网售药报销系统,未与医保系统对接。结论:我国目前网上药店经营尚存在问题,建议完善相关法律法规体系;做好全过程监管;加强社会监督与行业监督;完善网上药品支付体系。     

An application of a proposed framework for formulary listing in low-income countries

Background

The General Mutual Benefit Fund for Civil Servants and State Employees of Côte d’Ivoire (MUGEFCI; Mutuelle Générale des Fonctionnaires et Agents de l’État de Côte d’Ivoire) is a health mutual fund providing coverage (medical consultations, laboratory tests and treatment) for its enrolees (government officials and agents). This organization aims to improve its current drug reimbursement process because of budgetary constraints. One method of achieving this is to implement a formulary-listing framework specifically developed for low-income countries.

Objective

The aim of this study was to evaluate the feasibility of developing a new formulary for the MUGEFCI in Côte d’Ivoire, by implementing a formulary-listing framework specifically designed for under-researched settings.

Methods

The application of this formulary-listing framework (based on multi-criteria decision analysis [MCDA]) consisted of four steps. First, relevant formulary-listing criteria and their levels of variation were identified and weighted according to their importance in the decision making around drug reimbursement. Second, a set of priority treatments to be assessed was determined. Once the treatments eligible for reimbursement were determined, scores were assigned to these treatments according to their performance on the formulary-listing criteria levels. Finally, a composite league table (weighted matrix) was constructed to rank the set of treatments by priority order of reimbursement. A budget-impact analysis (BIA) was also conducted to appraise the economic implications of the new composite drugs league table. The extent to which the new priority list of reimbursable drugs was affordable for the MUGEFCI was then measured.

Results

Policy makers in Côte d’Ivoire considered severity of disease and cost effectiveness of treatment to be the most significant criteria for priority reimbursement of drugs. This translated into a general preference for antimalarials, treatments for asthma and antibacterials for urinary tract infection. Moreover, the results of the BIA suggest that the new priority list of reimbursable drugs would be affordable if the real economic impact of drugs per member is less than $US66. Over this threshold, the MUGEFCI would have to select reimbursable drugs according to their rank in the priority list and their respective budget impact per patient (cost per patient). This selection would start from the first treatment, going down the list until the $US66 per patient is exhausted.

Conclusion

It was possible to use MCDA to simultaneously consider different decision criteria for drug reimbursement in Côte d’Ivoire; therefore, it is feasible to use MCDA to establish a formulary for low-income countries. The application of this method is a step towards transparency in policy making.     

“两围绕”服务活动持续改善医疗服务实践

医院持续开展医护人员围绕病人转、行管科室围绕临床一线转"两围绕"服务活动,探索改善医疗服务模式。不断优化就诊流程、就诊环境,持续提高医疗服务水平,逐步完善绩效考核指标体系,并充分利用信息互联网技术推进智慧医院服务建设。有效地改善了患者就医体验,提高了患者满意度,促进了医院的精细化管理水平。     

A population perspective to evidence based medicine: "evidence for population health"

We explore the notion that the public health community could learn lessons from the success of evidence based medicine (EBM) and develop a public health counterpart called "Evidence for Population Health". While EBM focuses on individual patients, its public health counterpart would aim to improve the health of communities effectively and efficiently.     

甘肃省分级诊疗对慢性病管理的效果评价:以高血压和糖尿病为例

目的探讨分级诊疗政策对高血压和糖尿病住院患者的优化管理的实际效果。方法抽取2016年甘肃省新农合平台住院患者信息,根据报销方式分为普通住院患者和分级诊疗住院患者,挖掘有价值的数据信息。结果实施分级诊疗后,有效控制了住院患者的住院费用和药品费用。但药品费用依然是该省高血压和糖尿病住院患者的主要负担。结论“全面干预”与“分级诊疗”协同的甘肃慢病管理新模式降低了高血压、糖尿病患者的就医负担。下一步应从药占比相关指标入手,完善分级诊疗考核体系。