Pharmaceutical Care Services

药学服务
  • 文章类型: Review
    背景:在过去的几十年中,药学服务(PC)发生了显着的发展,在广泛的背景下,更加关注患者的安全性和已证明的有效性。支持这项技术的许多证据来自美国,(PC)的评估和采用在全球范围内差异很大。
    目的:本研究的目的是确定和评估17个中东国家的药学服务在各种药学方面的有效性。
    方法:使用Arkesy和O\'Malley技术进行范围审查。它是使用PubMed/Medline进行的,Scopus,科克伦图书馆,SpringerLink,临床试验,和WebofScience等。VanTulder量表用于随机试验研究,而在非随机试验研究中使用黎明检查表和黑色检查表.对选定的研究进行了描述性和数值分析。符合条件的PC的范围,制药实施者,研究结果,和质量都是通过对研究的主题审查来确定的。
    结果:在这项研究中发现了大约431,753条引文,在分析了271多篇全文文件后,发现129份出版物符合列入标准。研究设计多种多样,43个(33.3%)随机对照试验和86个(66.7%)n-RCTs。33项(25.6%)的研究发表于2020年。乔丹,沙特阿拉伯,土耳其是大多数研究的所在地(25.6%,16.3%,和11.6%)分别。37项研究(19.7%)涉及解决药物相关问题(DRP),而27例(14.4%)与提高生活质量(QOL)相关,23例(12.2%)与改善药物依从性相关.此外,研究显示,向患者提供的活动的平均评分每年都在提高。
    结论:中东的研究继续提供证据支持药学服务对大多数研究测量的硬结果和软结果的积极影响。然而,很少有人关注已实施服务的价值。因此,必须严格评估在中东实施的药学服务的经济影响,并评估其可持续性。
    Pharmaceutical care services (PCs) have evolved significantly over the last few decades, with a greater focus on patient\'s safety and proven effectiveness in a wide range of contexts. Many of the evidence supporting this technique comes from the United States, the evaluation and adoption of (PCs) which differ greatly across the globe.
    The goal of this study was to identify and assess the efficacy of pharmaceutical care services in various pharmaceutical aspects throughout seventeen Middle Eastern nations.
    The Arkesy and O\'Malley technique was used to conduct a scoping review. It was conducted using PubMed/Medline, Scopus, Cochrane Library, Springer Link, Clinical Trials, and Web of Science etc. The Van Tulder Scale was utilized in randomized trials research, whereas the dawn and black checklists were used in non-randomized trials research. A descriptive and numerical analysis of selected research was done. The scope of eligible PCs, pharmaceutical implementers, study outcomes, and quality were all identified by a thematic review of research.
    There were about 431,753 citations found in this study, and 129 publications were found to be eligible for inclusion after analysing more than 271 full-text papers. The study design was varied, with 43 (33.3%) RCTs and 86 (66.7%) n-RCTs. Thirty-three (25.6%) of the studies were published in 2020. Jordan, Saudi Arabia, and Turkey were home to the majority of the studies (25.6%, 16.3%, and 11.6%) respectively. Thirty-seven studies (19.7%) were concerned with resolving drug related problems (DRPs), whereas 27 (14.4%) were concerned with increasing quality of life (QOL) and 23 (12.2%) with improving drug adherence. Additionally, the research revealed that the average ratings of the activities provided to patients improved every year.
    Studies in the Middle East continue to provide evidence supporting the positive impact of pharmaceutical care services on both hard and soft outcomes measured in most studies. Yet there was rare focus on the value of the implemented services. Thus, rigorous evaluation of the economic impact of implemented pharmaceutical care services in the Middle East and assessment of their sustainability is must.
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  • 文章类型: Journal Article
    临床药师在埃塞俄比亚医院环境中的作用仍然是新生的。
    评估药学服务对2型糖尿病(T2DM)患者临床结局和用药依从性的影响。
    一个独来独往,在2020年3月1日至8月30日期间,纳入100例未受控制的T2DM患者,进行了介入研究设计.干预方案包括评估药理学和非药理学需求,在诊所亲自为患者提供咨询,并提供教育材料。
    在最初登记的100名患者中,87(87%)完成了随访,并纳入最终数据分析。干预显示平均FBG下降,收缩压(SBP),低密度脂蛋白胆固醇(LDL-C)47.3mg/dL,22.6mmHg和31.4mg/dL,而高密度脂蛋白胆固醇(HDL-C)和估计的肾小球滤过率(eGFR)分别显着增加了13.4mg/dL和11.5ml/min/1.73m2(p<0.0001)。此外,舒张压,脂质值,肾功能参数,与干预前相比,干预后肝功能参数显着下降(p<0.05)。在6个月随访时,患者的药物依从性显着增加(p<0.001)。
    这些结果还表明,在埃塞俄比亚的多学科医疗团队和糖尿病管理中整合临床药师服务的好处。
    UNASSIGNED: The role of clinical pharmacist in hospital settings of Ethiopia is still new and infant.
    UNASSIGNED: To evaluate the impact of pharmaceutical care on clinical outcome and medication adherence in type 2 diabetes mellitus (T2DM) patients.
    UNASSIGNED: A single cantered, pre-post interventional study design was carried out by enrolling 100 uncontrolled T2DM patients from March 1-August 30, 2020. The intervention package included assessment of pharmacological and non-pharmacological needs, counselling patients in person at the clinic, and providing educational materials.
    UNASSIGNED: Of the 100 patients initially enrolled, 87(87%) completed the follow-up and included in the final data analysis. The intervention showed a decrease in average FBG, systolic blood pressure (SBP), low density lipoprotein cholesterol (LDL-C) by 47.3 mg/dL, 22.6mmHg and 31.4mg/dL, while high density lipoprotein cholesterol (HDL-C) and estimated glomerular filtration rate (eGFR) exhibited significant increase by 13.4 mg/dL and 11.5 ml/min/1.73m2 respectively (p<0.0001). In addition, diastolic blood pressure, lipid values, kidney function parameters, and liver function parameters showed significant decrease in post intervention compared to pre-intervention (p<0.05). Medication adherence of the patients increased significantly at 6-month follow-up (p<0.001).
    UNASSIGNED: These results also suggest the benefits of integrating clinical pharmacist services in multidisciplinary healthcare teams and diabetes management in Ethiopia.
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  • 文章类型: Journal Article
    背景:近年来,在提供专业服务方面,药学专业有了显着发展。这项研究的目的是探索当前的观点药剂师在阿拉伯联合酋长国(阿联酋)的药学服务和使用定性和定量评估方法在实践中遇到的障碍的性质。方法:2021年3月至5月,采用定性和定量评估方法,对医院和社区药师(n=305)进行了横断面研究。在定性阶段,进行了15次访谈,以探索五个主要标准:患者信息,患者咨询不足,处方错误预防和确定与药物有关的问题,缺乏参与健康意识计划,以及实施药学服务的障碍。在定量阶段,305名同意的药剂师完成了关于七个标准的问卷:人口统计概况,药剂师-医师互动,患者咨询评估,不良药物事件的患者报告,药剂师参与健康意识计划,减少处方错误和识别药物相关问题的看法,以及实施适当药物治疗的障碍。结果:研究的定性和定量阶段的结果表明,由于许多因素,药剂师对阿联酋实践的影响是有限的。主要是缺乏时间和患者对药剂师在医疗领域的作用的无知。关于药剂师“患者咨询方法”和患者“药剂师知识”在管理药物不良反应中的作用的平均反应分别为77.1%和59.7%,分别。积极参加健康意识计划的比例为64.8%。参与者在减少处方错误和识别药物相关问题方面的平均积极响应为9.2%。药师的年龄和执业年限是影响药学服务实施的最重要因素。结论:该研究表明,有必要阐明正确实施药学服务,同时与医生保持信任关系。
    Background: The profession of pharmacy has evolved significantly in recent years in terms of professional service delivery. The aim of this study was to explore the current views of pharmacists in the United Arab Emirates (UAE) on pharmaceutical care services and the nature of barriers encountered in practice using qualitative and quantitative assessment methods. Methods: A cross-sectional study was conducted among hospital and community pharmacists (n = 305) between March and May 2021, using qualitative and quantitative assessment methods. In the qualitative phase, 15 interviews were conducted to explore five main criteria: patient information, inadequate patient counseling, prescribing errors prevention and identifying drug-related problems, lack of participation in health awareness programs, and barriers to pharmaceutical care implementation. In the quantitative phase, 305 consenting pharmacists completed a questionnaire on seven criteria: demographic profile, pharmacist-physician interaction, patient counseling assessment, patient reports of adverse drug events, pharmacist participation in health awareness programs, perceptions of reducing prescribing errors and identifying drug-related problems, and barriers to appropriate pharmaceutical care implementation. Results: The results of both the qualitative and quantitative phases of the study revealed that pharmacists\' influence on practice in the UAE is limited due to many factors, mainly lack of time and patients\' ignorance of the pharmacist\'s role in the medical field. The mean responses regarding pharmacists\' approach to patient counseling and patients\' knowledge of pharmacists\' role in managing adverse drug reactions were 77.1% and 59.7%, respectively. Active participation in health awareness programs was 64.8%. The mean positive response of participants in reducing prescribing errors and recognizing drug-related problems was 9.2%. Pharmacists\' age and number of years in practice were the most important factors influencing the pharmaceutical care services implementation. Conclusion: The study has shown the need to shed light on the proper implementation of pharmaceutical care while maintaining a trusting relationship with physicians.
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  • 文章类型: Randomized Controlled Trial
    未经证实:药物相关问题(DRP)是患者因使用或不使用药物而经历的普遍且可避免的疾病。然而,二级预防政策尚未系统化。
    UNASSIGNED:评估二级预防捆绑对因医学相关问题而到急诊科(ED)就诊的患者的DRPs的临床影响。
    UNASSIGNED:从2019年8月28日至2021年1月28日进行单中心随机临床试验,随访1个月。我们纳入了769名成年患者,这些患者接受了与心血管相关的DRP,消化道,和代谢系统药物。对于干预组,DRP预防束,由ED启动的组合策略组成。对照组患者接受标准药学监护。根据因任何原因再次入院30天评估干预措施。
    未经评估:最终分析包括769名患者,其中68例(8.8%)在30天内再次入院(对照组,386人中的40人[累积发病率:10.4%];干预组,383人中的28人[累积发病率,7.3%])。调整慢性心力衰竭模型后,干预组患者再入院发生率低于对照组,比值比:0.59[95%置信区间:0.37-0.97];需要治疗的次数(NNT)=32.在其他结果中没有观察到显著差异。
    未经批准:在这项临床试验中,调整分析中的DRP预防束降低了因DRP就诊的ED患者因任何原因再入院30天的比率。
    UNASSIGNED:ClinicalTrials.gov(标识符:NCT03607097)。
    Drug-related problems (DRPs) are prevalent and avoidable disease that patients experience due to drug use or nonuse. However, secondary prevention policies have not yet been systematized.
    To assess the clinical impact of a secondary prevention bundle for DRPs in patients who visited the emergency department (ED) for medicine-related problems.
    A single-center randomized clinical trial was conducted from August 28, 2019, to January 28, 2021, with 1-month follow-up. We included 769 adult patients who visited ED with a DRP associated with cardiovascular, alimentary tract, and metabolic system medications. For the intervention group, a DRP prevention bundle, consisting of a combined strategy initiated in the ED was applied. Patients in the control group received standard pharmaceutical care. Intervention was evaluated in terms of 30-day hospital readmission due to any cause.
    Final analysis included 769 patients, of which 68 (8.8%) were readmitted within 30 days (control group, 40 of 386 [cumulative incidence: 10.4%]; intervention group, 28 of 383 [cumulative incidence, 7.3%]). After adjustment of the model for chronic heart failure, there was a lower incidence of hospital readmission among patients in the intervention group compared with those in the control group, odds ratio: 0.59 [95% confidence interval: 0.37-0.97]; number needed to treat (NNT) = 32. No significant differences in other outcomes were observed.
    In this clinical trial, DRP prevention bundle in adjusted analysis decreased the rate of 30-day hospital readmission for any cause in patients who visited ED for a DRP.
    ClinicalTrials.gov (Identifier: NCT03607097).
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  • 文章类型: English Abstract
    Interdisciplinary collaboration between health professionals is essential to improve health outcomes. The competences of pharmacists make them professionals capable of contributing to the comprehensive management of pharmacotherapy in collaboration with other healthcare professionals. The Council of Europe adopted resolution CM/Res(2020)3 on implementation of pharmaceutical care for the benefit of patients and health services in order to promote the appropriate and safe use of medicines. One of the activities to be carried out through the pharmaceutical care process is the detection of drug related problems, such as contraindications, duplications, prescription errors, interactions, etc. In many cases, it involves regular patient follow-up and needs an evaluation of the interventions performed, requiring the establishment of an appropriate interprofessional collaboration framework. This article discusses the issues to be addressed to face the change of model towards a care-based pharmacy.
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  • 文章类型: Journal Article
    BACKGROUND: Clinical pharmacist can enthusiastically involve in oncology department through utilizing the skills and knowledge to support wide variety of functions in patient care. The impact of pharmaceutical care services in oncology department were analysed through various approaches including the analysis of knowledge level of patients towards the disease and its management through patient counselling, monitoring of performance status, observing of ADR and drug safety. Incidence of cancer was scrutinized during the study.Methodology: A Prospective interventional study was conducted from November 2019 to March 2020 with the support of institutional ethical approval at oncology department of Lourdes hospital, Ernakulam. 133 patients were included with all type of cancer. Data collected through Performa with KAP questionnaire and direct interview was conducted. Statistical significance was evaluated through p value of <0.001 Result: 123 patients were completed both questionnaire. Among this 69.91% were females and most of the patients belonged to 50 - 65yeras age group and carcinoma was frequently reported type. End of the study showed significant change in the knowledge level of patients after interaction with the clinical pharmacist. 26 ADRs were reported including solitary and multiple ADRs. Recommendations associated with drug reconstitution, administration were frequently given to the nurses. Most of the interventions to improve therapeutic outcome of the patients were accepted by the oncologist.
    CONCLUSIONS: Clinical pharmacist can actively participate in all aspects of the oncology department in association with physician and other health care providers to improve the therapeutic outcome and quality of life of patients.
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  • 文章类型: Journal Article
    BACKGROUND: With the growing burden of mental disorders, pharmacists are ideally positioned to play an important role in supporting people with a mental illness. However, the value of clinical pharmacists within mental health remains unrecognized by other healthcare professionals.
    OBJECTIVE: The purpose of this study was to explore the perceptions and expectations of mental health professionals on the provision of clinical pharmacy services (CPS) at a psychiatric hospital.
    METHODS: A cross-sectional, self-administered, online survey was administered to physicians and nurses working at a psychiatric hospital. Five-point likert scales were used to measure participant\'s perceptions and expectations about the CPS provided. Descriptive and inferential statistical analysis were undertaken.
    RESULTS: Both physicians and nurses reported positive perceptions regarding the CPS provided at the hospital, although physicians agreement with positive statements was higher than those reported by nurses (mean likert scale score 4.76 and 4.45, respectively). There was a statistically significant positive association between participants\' years of experience and agreeing that clinical pharmacy services are essential for achieving hospital accreditation (χ2 = 13.11, φ = 0.41, p = 0.04). A statistically significant positive association was noted between the physicians\' current position and agreeing that pharmacists assist physicians in selecting more cost effective medication regimens (χ2 = 16.55, φ = 0.62, p = 0.04).
    CONCLUSIONS: Physicians and nurses have mostly positive perceptions and expectations from clinical pharmacists at the psychiatric hospital. However, traditional clinical pharmacy services were more favorably viewed than those associated with advanced clinical roles such as prescribing and pharmacist-led medication management clinics.
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  • 文章类型: Journal Article
    Since patients are essential partners in determining priorities and resource allocation in the healthcare system, considerable efforts have been made to shift the focus of pharmacy profession from drug dispensing to patient-oriented care. Accordingly, the assessment of patient-oriented care has become a prominent method to evaluate the quality of the healthcare services delivered and willingness to pay (WTP) to receive them.
    To determine patients\' attitude towards pharmaceutical care services among general population in Jordan and their WTP for this service.
    A cross-sectional study was conducted in a teaching hospital in Jordan over a period of six months. A contingent valuation method was used, with closed-ended questions to elicit participants\' attitudes and WTP for pharmaceutical care services.
    A total of 223 participants were interviewed. Most of the participants showed a positive attitude towards pharmaceutical care services, with an average attitude score of 0.82 (±0.19). Almost 96.0% of participants believed that pharmacists must be committed to more counseling roles than dispensary activities. The majority of participants (194, 87.0%) expressed their interest in pharmacists checking their medications at least once per month. Most of the participants (212, (95.1%) believed that the pharmacist should be reimbursed for providing a pharmaceutical care service that would potentially reduce medication-related problems (MRPs) by 50%. Of these, 208 (93.3%) participants were willing to pay out of their pockets an average maximum amount of $3.95 (±4.23) for the pharmaceutical care services they may receive to reduce 50% of the risk of MRPs.
    This study revealed that Jordanian people have a supportive attitude regarding pharmacists\' abilities in providing pharmaceutical care services in addition to dispensing. Majority of participants in this study were willing to pay for pharmaceutical care services that would reduce the risk of MRPs.
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  • 文章类型: Journal Article
    To assess the impact of a medication management review (MMR) service on treatment-related problems (TRPs) and certain clinical outcomes in outpatients.
    Prospective randomized controlled study.
    Two community pharmacies in Amman, Jordan.
    A total of 160 people who visited the two community pharmacies between September 2009 and June 2010.
    Patients were randomized into two groups: intervention (82 patients) and control (78 patients) groups. The clinical pharmacist conducted a baseline assessment MMR for patients in both groups to determine the prevalence and type of TRPs; however, recommendations regarding the identified TRPs were only submitted to the physicians of patients in the intervention group.
    All patients were followed for an average of 3.39 months after their baseline visit to the pharmacy. The impact of the MMR service for the intervention group was assessed by evaluating the outcomes of the recommendations submitted by the clinical pharmacist to resolve the identified TRPs, physicians\' acceptance of the recommended interventions, and the effect of the intervention on certain clinical outcomes: blood glucose levels, blood pressure, and triglyceride levels. Follow-up assessment of the control group included evaluating the outcomes of the identified TRPs (identified and corrected by physicians without any input from the clinical pharmacist) and comparing glucose level, blood pressure, and triglyceride-level results with baseline values. No significant differences in mean number of medical conditions (3.7 vs 3.42, p=0.134), mean number of medications (4.51 vs 4.96, p=0.135), or mean number of TRPs per patient (5.55 vs 5.17, p=0.42) were observed at baseline in the intervention group versus the control group. Follow-up results revealed a high acceptance rate of recommendations by the physicians (94%). Regarding outcomes of TRPs, almost 70% of the identified TRPs in the intervention group were resolved or improved compared with 2% in the control group (p<0.001). Significant differences were found between the intervention group versus control group with regard to mean ± SD glucose levels (99.08 ± 9.66 vs 115.48 ± 17.34, p<0.001), blood pressure (110.36/81.55 ± 9.45/3.91 vs 125.0/88.73 ± 10.34/4.12, p<0.001), and triglyceride levels (148.53 ± 15.98 vs 170.74 ± 6.26, p=0.001).
    The MMR service resulted in a significantly lower number of TRPs and significantly improved clinical outcomes, and it was highly accepted by the physicians.
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