健康管理模式下药学服务的实践

通过论述与比较药学服务和健康管理的理念,分析两者在提出背景、实施过程中的内在联系,探讨如何结合健康管理模式,拓宽药学服务的内容,加强药学服务的实践。     

Perceived discrimination among racial and ethnic minority drug users and the association with health care utilization

ABSTRACT

People who use drugs (PWUDs) are at increased risk for several medical conditions, yet they delay seeking medical care and utilize emergency departments (EDs) as their primary source of care. Limited research regarding perceived discrimination and PWUDs’ use of health care services exists. This study explores the association between interpersonal and institutional racial/ethnic and drug use discrimination in health care settings and health care utilization among respondents (N?=?192) recruited from methadone maintenance treatment programs (36%), HIV primary care clinics (35%), and syringe exchange programs (29%) in New York City (n?=?88) and San Francisco (n?=?104). The Kaiser Family Foundation Survey of Race, Ethnicity, and Medical Care questionnaire was utilized to assess perceived institutional racial/ethnic and drug use discrimination. Perceived institutional discrimination was examined across race/ethnicity and by regular use of ERs, having a regular doctor, and consistent health insurance. Perceived interpersonal discrimination was examined by race/ethnicity. Perceived interpersonal drug use discrimination was the most common type of discrimination experienced in health care settings. Perceptions of institutional discrimination related to race/ethnicity and drug use among non-Hispanic Whites did not significantly differ from those among non-Hispanic Blacks or Hispanics. A perception of less frequent institutional racial/ethnic and drug use discrimination in health care settings was associated with increased odds of having a regular doctor. Awareness of perceived interpersonal and institutional discrimination in certain populations and the effect on health care service utilization should inform future intervention development to help reduce discrimination and improve health care utilization among PWUDs.     

基层医疗机构药品流通现状与对策分析

通过对当前基层医疗机构药品流通现状进行分析,深入剖析基层医疗机构药品流通环节存在的问题。提出利用现代化手段,加强基层医疗机构药品流通监管的对策,从而根治药品非法流通,保证基层医疗机构用药安全。     

Delivering direct acting antiviral therapy for hepatitis C to highly marginalised and current drug injecting populations in a targeted primary health care setting

BackgroundThe Kirketon Road Centre (KRC) is a community-based public health facility in Sydney, Australia, that provides healthcare to people who inject drugs (PWID), including hepatitis C virus (HCV) treatment. From March 2016, the Australian Government has provided access to direct-acting antivirals (DAA) for adults with chronic HCV, without liver disease stage or drug and alcohol use restrictions. The aim of this study was to report DAA treatment outcomes among highly marginalised PWID treated at KRC.MethodsAll individuals initiating DAA treatment at KRC and due for sustained virological response (SVR12) testing by end 2016 were included. Demographic, drug use behaviour, clinical parameters, adherence support and HCV treatment outcomes, including SVR12 were recorded. Factors associated with SVR12, loss-to-follow-up (LTFU) and delayed SVR12 testing (>SVR16) were assessed by multivariate analysis. SVR12 was assessed by intention-to-treat (ITT) and modified ITT, the latter excluding individuals with an end-of-treatment response (ETR) but no SVR12 assessment, or who postponed their SVR12 date due to treatment interruption.ResultsA total of 72 individuals commencing DAAs were included, of whom 67% were male, 30% homeless, and 32% Aboriginal. All had a lifetime history of injecting drug use, with 75% having injected within the last six months, and 44% injecting at least weekly; 25% were also enrolled in opioid substitution therapy. Twenty-five (35%) individuals elected to receive an enhanced adherence-support package. Fifty-nine of 72 (82%) individuals due for SVR12 attended for testing, of whom 59/59 (100%) achieved SVR, providing an ITT SVR of 82%. A further six individuals had undetectable HCV RNA at ETR, but no SVR12 assessment, and one interrupted treatment, providing a mITT SVR of 91%. Homelessness was associated with delayed SVR12 testing (OR 24.9 95%CI 2.9–212.8, p = 0.003). There was no association between LTFU and frequency of drug injection, last drug injected, or planned treatment duration.ConclusionThis study confirms that PWID can be successfully treated for HCV in a real-world setting using an integrated primary health care model. It also demonstrates feasibility to upscale DAA therapy in high-risk PWID populations, with potential individual and population-level public health benefits. Enhanced efforts are required to optimise post-treatment follow-up.     

医院门诊药房药品盘点工作质量改进措施

目的提高药品管理质量,加强门诊药房规范化管理。方法选取医院门诊药房2012年7月至2013年6月的药品盘点数据,从药品盘点数量符合率等方面进行统计分析。结果针对盘点中账物不符的原因,通过实施完善药品管理制度、编排药品货位码、合理设计盘点表、实行双盲盘点制度、充分利用计算机网络系统等措施,药房盘点数量符合率由60．59％上升到92．88％。结论通过完善药品管理制度,合理安排盘点工作的各个环节,借助信息系统的支持,可显著提高门诊药房的盘点效率和药品的数量符合率。     

采用ABC库存结构分析法优化我院贵重药品管理

目的：制定贵重药品管理制度,提高医院药品管理水平和效率,实现药品的精细化管理。方法：采用ABC库存结构分析法,确定贵重药品目录,制定贵重药品管理制度,设立贵重药品专用帐卡,实时监控使用情况。结果与结论：采用ABC库存结构分析法对我院库存药品进行分类整理,有效确立了贵重药品的范围和具体目录,使我院贵重药品管理工作更加科学化、合理化、规范化。     

库存周转率用于自动片剂摆药机药品库存管理的探讨

目的：探讨利用合理设定库存周转率改善自动片剂摆药机内药品库存管理的方法。方法：统计河南省许昌市中心医院住院药品调剂室2017年5月1日至2017年5月31日自动片剂摆药机中每种药品的摆药量和库存数量,计算出药品库存周转天数并进行统计描述。结果：我院利用摆药机自动摆药的药品品种共247种,其中64.37%的品种库存能够在30天内周转使用完毕,35.63%的品种需要30天以上的时间才能完成周转,存在库存上限和下限设定不合理的问题。结论：通过制订以库存周转天数为量化基础的管理策略,提高了库存管理的直观性和有效性,对合理控制库存药品周转周期、提高加药效率有积极作用。     

Differences in antidiabetic drug utilisation between three different health systems in the same national region

Summary The consumption of antidiabetic drugs in a Spanish region (Extremadura) in the period 1986–1987 has been investigated by the defined daily dose (DDD) method.The study was done in three health care systems in the region: civil servants (Mutualidad de Funcionarios Civiles del Estado: MUFACE) armed forces group (Instituto Social de las Fuerzas Armadas: ISFAS) and the national system (Instituto Nacional de la Salud: INSALUD). The total consumption of antidiabetic drugs varied three-fold, ranging from 5,73 DDD per 1000 inhabitants per day (3,71 DDD per 1000 inhabitants per day for oral antidiabetic drugs and 2,02 DDD per 1000 inhabitants per day for insulin) in the civil servant group to 15,82 DDD per 1000 inhabitants per day (12 DDD per 1000 inhabitants per day for oral antidiabetic drugs and 3,82 DDD per 1000 inhabitants per day for insulins) in the armed forces. The differences were more pronounced for oral antidiabetics than for insulins. The utilization of insulin among the civil servants was about half of that by the two other groups. Of oral antidiabetics, sulphonylureas were the most frequently used by the three groups, and within them glibenclamide accounted for more than half of the DDDs, while biguanides were scarcely used in any group. The differences are difficult to assess, since they could be due to several factors, such as age-differences in the population studied, different prescribing habits, and differences in sociocultural level. The results justify further comparative studies of drug utilization in different health systems within the same region.     

把握好药品运行环节，做好药品实库存管理

科学严格的管理是提高药品帐物相符率的前提和重要手段。药品实库存管理既为现代药房管理带来了新的挑战,同时也促进了药房管理水平不断提高。本文对药房管理中药品的领退、基数药的管理、调剂差错管理、盘点管理等几个方面进行了阐述。     

上海凉城新村街道外来儿童保健10年效果分析

目的：了解虹口区凉城新村街道外来儿童系统保健管理现状,为外来儿童全覆盖管理提供依据。方法：资料来自凉城新村街道社区卫生服务中心儿保门诊2003．2012年0-6岁儿童保健的各项登记表册,对管理人数、系统管理数、体格检查、母乳喂养、营养性疾病发生等情况进行综合分析。结果：2012年外来儿童保健建卡率为98．8％,系统管理率为95．6％,比2003年建卡率48．1％,系统管理率38．7％显著上升,差异有统计学意义（P〈0．01）,母乳喂养率保持在90％以上,营养性疾病的发生率显著下降。结论：本社区外来儿童系统保健管理取得一定效果。     

Development of an algorithm to identify pregnancy episodes and related outcomes in health care claims databases: An application to antiepileptic drug use in 4.9 million pregnant women in France

Purpose

Access to claims databases provides an opportunity to study medication use and safety during pregnancy. We developed an algorithm to identify pregnancy episodes in the French health care databases and applied it to study antiepileptic drug (AED) use during pregnancy between 2007 and 2014.

Methods

The algorithm searched the French health care databases for discharge diagnoses and medical procedures indicative of completion of a pregnancy. To differentiate claims associated with separate pregnancies, an interval of at least 28 weeks was required between 2 consecutive pregnancies resulting in a birth and 6 weeks for terminations of pregnancy. Pregnancy outcomes were categorized into live births, stillbirths, elective abortions, therapeutic abortions, spontaneous abortions, and ectopic pregnancies. Outcome dates and gestational ages were used to calculate pregnancy start dates.

Results

According to our algorithm, live birth was the most common pregnancy outcome (73.9%), followed by elective abortion (17.2%), spontaneous abortion (4.2%), ectopic pregnancy (1.1%), therapeutic abortion (1.0%), and stillbirth (0.4%). These results were globally consistent with French official data. Among 7 559 701 pregnancies starting between 2007 and 2014, corresponding to 4 900 139 women, 6.7 per 1000 pregnancies were exposed to an AED. The number of pregnancies exposed to older AEDs, comprising the most teratogenic AEDs, decreased throughout the study period (?69.4%), while the use of newer AEDs increased (+73.4%).

Conclusions

We have developed an algorithm that allows identification of a large number of pregnancies and all types of pregnancy outcomes. Pregnancy outcome and start dates were accurately identified, and maternal data could be linked to neonatal data.

     

Obstacles to carrying out brief intervention for heavy drinkers in primary health care: a focus group study

The objective of this study was to identify possible obstacles to carrying out competent early identification and brief intervention (EIBI) of heavy drinkers in primary health care. Qualitative focus group discussion method study applying the deductive framework approach. Six focus groups involving 18 general practitioners and 19 nurses were recruited from primary health care of the City of Tampere, Finland. Possible obstacles are: (1) confusion regarding the content of early-phase heavy drinking, (2) lack of self-efficacy among primary health care professionals, (3) sense of lacking time needed for carrying out brief intervention, (4) not having simple guidelines for brief intervention, (5) sense of difficulty in identifying of early-phase heavy drinkers, and (6) uncertainty about the justification for initiating discussion on alcohol issues with patients. The main actions to be taken to promote brief intervention are to educate professionals about the content of early-phase heavy drinking and to produce directing, but not excessively demanding guidelines for carrying out EIBI. Probably successful personal experiences carrying out EIBI can improve professionals' self-efficacy and give to them final justification for discussion alcohol issues with their patients.     

全人护理理念对手术室优质护理服务的影响

目的 以香港医院全人护理理念为启示,为手术患者提供多角度、全方位的优质护理服务.方法 优化护理质量管理运行机制,完善工作指引及服务流程,重视手术患者的评估,通过术前、术后访视流程,提供个性化的护理,将全人护理理念全面渗透人手术室护理各工作环节,让优质护理贯穿手术全期.结果 开展优质护理服务活动以来,科室满意度从87.1%上升到98.7%.护理不良事件的发生率从0.12%下降至0.03%.结论 开展全人护理理念能有效提高手术患者对护理工作的满意度,提高护理管理质量和服务品质,保障护理安全.     

A review on the analysis of ingredients with health care effects in health food in Taiwan

This review article discusses the analysis of ingredients with health care effects in health food in Taiwan. The top 10 items on the list of registered health food products up to 2014 in Taiwan are described, including monocolin K, ω-3 fatty acids (eicosapentaenoic acid and docosahexaenoic acid), β-glucans, inulin, catechins, oligosaccharides, resistant maltodextrin, amino acids, medium chain fatty acids, and polysaccharides. Some analytical methods for the analysis of ingredients with health care effects are announced to the public on the website of health food section of the Taiwan Food and Drug Administration for the application and the postmarket surveillance of health food. Each application of health food should include the appropriate analytical method for the analysis of the ingredient or specific compound that has the health care effect, for the sake of quality assurance. Self-management of each applicant is required for regulation, the reputation of its own, and social responsibility to the consumers.