clinical services

临床服务
  • 文章类型: Journal Article
    在沙特阿拉伯王国,越来越需要社区药剂师提供最高水平的临床知识和服务。然而,关于沙特公众对社区药房(CPs)提供的临床服务的认识以及使用这些服务的障碍的证据是有限的。在这项横断面研究中,我们使用了通过调整实施研究综合框架而开发的在线问卷。共有273名参与者完成了调查。一半的参与者通常知道某些CP服务的可用性,但没有被告知所提供的全部服务。例如,药物评论(84%)和在线咨询(89%)。大多数参与者(69.6%)没有发现社区药剂师与医院药剂师提供的护理差异(P=0.02)。通常报告的使用CP服务的障碍是其他医疗保健专业人员寻求药物帮助的普遍偏好(85.7%)。还报告了许多其他障碍,影响参与者使用这些服务。决策机构应考虑改进,以提高患者对临床服务的认识和利用,并提高社区药剂师在以临床为导向的药学服务中的表现。
    In the Kingdom of Saudi Arabia, there is an increasing demand for community pharmacists to provide the highest level of clinical knowledge and services. However, evidence regarding Saudi public awareness of the clinical services offered by community pharmacies (CPs) and the barriers to using them is limited. In this cross-sectional study, we used an online questionnaire developed by adapting the Consolidated Framework for Implementation Research. A total of 273 participants completed the survey. Half the participants were generally aware of the availability of some CP services but were not informed about the full range on offer, eg, medication reviews (84%) and online counseling (89%). Most of the participants (69.6%) did not identify differences in the care provided by community pharmacists versus hospital pharmacists (P = 0.02). A commonly reported barrier to using CP services was a general preference for other healthcare professionals to seek pharmaceutical help (85.7%). Many other barriers were also reported, impacting the participants\' use of these services. The decision-making authorities should consider improvements to increase patients\' awareness and utilization of clinical services and enhance community pharmacists\' performance in clinical-oriented pharmaceutical care.
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  • 文章类型: Journal Article
    背景:在远程医疗快速整合后,许多专职医疗服务现在同时提供远程医疗和当面服务,以应对COVID-19大流行。然而,关于如何决定通过远程医疗与亲自提供哪些临床预约,人们知之甚少。
    目的:本研究的目的是探索临床医生在考虑为客户提供远程医疗时的决策,包括他们考虑的因素以及他们如何权衡这些不同的因素,以及临床医生对COVID-19封锁以外的远程医疗公用事业的看法。
    方法:我们使用反身性主题分析,从焦点小组收集的数据与来自语言病理学学科的16名儿科社区专职健康临床医生,职业治疗,社会工作,心理学,和咨询。
    结果:研究结果表明,决策复杂,涉及4大类:技术,客户和家庭,临床服务,和临床医生。三个主题描述了他们对COVID-19封锁之外的远程医疗使用的看法:“灵活的远程医疗使用,远程医疗可以优于面对面治疗,\"和\"担心亲自服务可能会被替换。
    结论:研究结果强调了社区相关健康环境中决策的复杂性,以及临床医生在将经验证据与自己的临床经验进行协调时遇到的挑战。
    BACKGROUND: Many allied health services now provide both telehealth and in-person services following a rapid integration of telehealth as a response to the COVID-19 pandemic. However, little is known about how decisions are made about which clinical appointments to provide via telehealth versus in person.
    OBJECTIVE: The aim of this study is to explore clinicians\' decision-making when contemplating telehealth for their clients, including the factors they consider and how they weigh up these different factors, and the clinicians\' perceptions of telehealth utility beyond COVID-19 lockdowns.
    METHODS: We used reflexive thematic analysis with data collected from focus groups with 16 pediatric community-based allied health clinicians from the disciplines of speech-language pathology, occupational therapy, social work, psychology, and counseling.
    RESULTS: The findings indicated that decision-making was complex with interactions across 4 broad categories: technology, clients and families, clinical services, and clinicians. Three themes described their perceptions of telehealth use beyond COVID-19 lockdowns: \"flexible telehealth use,\" \"telehealth can be superior to in-person therapy,\" and \"fear that in-person services may be replaced.\"
    CONCLUSIONS: The findings highlight the complexity of decision-making in a community-allied health setting and the challenges experienced by clinicians when reconciling empirical evidence with their own clinical experience.
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  • 文章类型: Journal Article
    背景:传染病(ID)药剂师是抗菌药物管理团队的关键成员。前瞻性审核和反馈是美国传染病学会抗菌药物管理计划指南(ASP)的强烈推荐。利用自定义的ASP干预文档工具,在Epic中称为“isvents”,我们的目的是通过衡量在5年以上多医院卫生系统中接受的结局与拒绝的结局的比较来评估干预措施的影响.方法:多中心,我们进行了回顾性队列研究,比较了2015年10月至2020年12月5年间接受和拒绝ASP干预的重症监护病房(ICU)和非ICU患者的临床结局.测量的结果包括每1000名患者天的抗生素治疗天数(DOT/1000PD),每1000名患者天的抗生素剂量(剂量/1000PD),住院时间(LOS),住院死亡率,医院获得性艰难梭菌感染(HA-CDI),30天内社区发作的艰难梭菌感染(CO-CDI),30天内再入院。粗化精确匹配(CEM)用作非参数匹配方法,以平衡组间的协变量并控制混杂。结果:ID药剂师的ASP建议在5年内得到了多医院系统提供者的好评,总体接受率为92%。接受ASP干预与抗生素使用的大幅减少相关,而不会对死亡率或再入院产生不利影响。尽管在接受干预措施的非ICU患者中,由于频繁降至头孢曲松,高风险艰难梭菌抗生素的使用显着增加,30天内HA-CDI和CO-CDI的发生率没有恶化.此外,接受干预措施的非ICU患者的平均住院时间明显缩短1天,这导致了7631400美元的大量成本规避。结论:与ID药剂师合作以优化抗菌药物管理与抗生素利用率的显着降低有关。成本,和医院LOS,而不会恶化患者的预后。
    Background: Infectious diseases (ID) pharmacists are pivotal members of antimicrobial stewardship teams. Prospective audit and feedback is a strong recommendation by The Infectious Diseases Society of America Guidelines for Antimicrobial Stewardship Programs (ASP). Utilizing customized ASP intervention documentation tools known as \"ivents\" in Epic, we aimed to assess the impact of interventions by measuring outcomes that were accepted compared to those that were rejected in a multihospital health system over 5 years. Methods: A multicenter, retrospective cohort study was conducted to compare clinical outcomes among intensive care unit (ICU) and non-ICU patients with accepted and rejected ASP interventions over 5 years from October 2015 to December 2020. Outcomes measured included antibiotic days of therapy per 1000 patient days (DOT/1000 PD), antibiotic doses per 1000 patient days (doses/1000 PD), hospital length of stay (LOS), in-hospital mortality, hospital-acquired Clostridioides difficile infection (HA-CDI), community-onset C. difficile infection (CO-CDI) within 30 days, and hospital readmission within 30 days. Coarsened exact matching (CEM) was used as a non-parametric matching method to balance covariates between groups and to control for confounding. Results: ASP recommendations by ID pharmacists were well-received by providers in a multihospital system over 5 years as evidenced by an overall acceptance rate of 92%. Acceptance of ASP interventions was associated with substantial reductions in antibiotic utilization without adversely affecting mortality or hospital readmissions. While high-risk C. difficile antibiotic use increased significantly due to frequent de-escalation to ceftriaxone among non-ICU patients with accepted interventions, rates of HA-CDI and CO-CDI within 30 days did not worsen. Furthermore, hospital LOS was notably shorter by an average of 1 day for non-ICU patients with accepted interventions, which resulted in substantial cost avoidance of $7 631 400. Conclusion: Collaboration with ID pharmacists to optimize antimicrobial stewardship was associated with significant reductions in antibiotic utilization, costs, and hospital LOS without worsening patient outcomes.
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  • 文章类型: Journal Article
    背景:容量超负荷(VO)在重症监护病房(ICU)中很常见,并与负面结果相关。已经研究了减少VO的方法;然而,没有人特别关注药物稀释剂体积优化。目的:探讨药师驱动的药物稀释剂量优化方案对危重患者体液平衡的影响。方法:前瞻性,试点研究于2021年10月至2021年12月(pre)和2022年2月至2022年4月(post)在医疗ICU进行。实施了专注于血管加压药和抗菌稀释剂体积的药剂师驱动的药物稀释剂体积优化方案。在入住ICU至7天期间收集人口统计学和临床数据。主要结果是第3天的液体净平衡。次要结果是给药剂量,净流体平衡,ICU住院时间,和死亡率。结果:供应链短缺导致研究在2022年2月底停止。总的来说,纳入152例患者(123例前置组,29个帖子组)。最常见的入院诊断是急性呼吸衰竭(35%)。47%和66%的患者使用了血管加压药和抗菌药物,分别。第3天的液体净平衡更大,但在术后组(227.1mL[-1840.3至3483.7]vs2012.3mL[-2686.0至4846.0];P=.584)。抗微生物稀释剂体积在后组中显著较少。在其他次要结果中没有发现差异。方案组分配与第3天的净液体平衡无关。结论:尽管抗菌药物体积贡献减少,仅优化稀释剂体积对总体体积状态没有显著影响.未来的研究应集中在药物稀释剂优化和液体管理的综合方法上。
    Background: Volume overload (VO) is common in the intensive care unit (ICU) and associated with negative outcomes. Approaches have been investigated to curtail VO; however, none specifically focused on medication diluent volume optimization. Objective: Investigate the impact of a pharmacist-driven medication diluent volume optimization protocol on fluid balance in critically ill patients. Methods: A prospective, pilot study was conducted in a medical ICU during October 2021 to December 2021 (pre) and February 2022 to April 2022 (post). A pharmacist-driven medication diluent volume optimization protocol focusing on vasopressor and antimicrobial diluent volumes was implemented. Demographics and clinical data were collected during ICU admission up to 7 days. The primary outcome was net fluid balance on day 3. Secondary outcomes were medication volumes administered, net fluid balance, ICU length of stay, and mortality. Results: Supply chain shortages caused the study to stop at the end of February 2022. Overall, 152 patients were included (123 pre group, 29 post group). The most common admission diagnosis was acute respiratory failure (35%). Vasopressors and antimicrobials were utilized in 47% and 66% of patients, respectively. Net fluid balance on day 3 was greater but not significant in the post group (227.1 mL [-1840.3 to 3483.7] vs 2012.3 mL [-2686.0 to 4846.0]; P = .584). Antimicrobial diluent volumes were significantly less in the post group. No differences were seen in other secondary outcomes. Protocol group assignment was not associated with net fluid balance on day 3. Conclusion: Despite decreasing antimicrobial volume contributions, optimizing diluent volumes alone did not significantly impact overall volume status. Future studies should focus on comprehensive approaches to medication diluent optimization and fluid stewardship.
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  • 文章类型: Journal Article
    虚拟初级保健就诊的快速部署是对COVID-19的一线反应,现在可以对其进行深入了解,特别是虚拟护理在患者护理和咨询中发挥着持续的作用。需要直接负责虚拟护理服务的初级保健提供者的投入,以告知有关优质护理和互动的政策和策略。这项研究的总体目标是研究虚拟护理作为初级医疗保健提供机制的使用。一种现象学方法调查了初级保健提供者在COVID-19大流行期间所经历的初级保健服务提供的转变。焦点小组与通过电子邮件招募的初级保健提供者(n=21)进行,广告,和专业组织,探索虚拟护理是如何提供的,好处和挑战,工作流注意事项,以及将来使用的建议。整合虚拟护理具有很大的自主性和责任感,而且绝对依赖于电话。技术,通信,和工作流程灵活性是虚拟护理及其交付的三个关键操作方面。提供商强调了与虚拟护理动态相关的交叉主题,包括平衡优质护理的风险,医生工作/生活平衡,效率,和病人的好处。初级保健提供者认为,虚拟护理选项允许增加灵活性,以满足患者的需求和管理他们的实践工作量。并分享了一些场景,用于虚拟护理可能最适合的时间。然而,他们还认识到需要平衡亲自访问和虚拟访问,这可能需要支持导航各种护理级别的指南。总的来说,虚拟护理被认为是整个“护理包”的一个很好的补充,但持续的发展和完善是对优化和维持未来使用的期望。
    The rapid deployment of virtual primary care visits served as a first-line response to COVID-19 and can now be examined for insights, particularly as virtual care is playing an ongoing role in patient care and consultations. Input from primary care providers directly responsible for virtual care delivery is needed to inform policies and strategies for quality care and interactions. The overarching goal of this research study was to examine the use of virtual care as a mechanism for primary healthcare delivery. A phenomenological approach investigated the shift in primary care service delivery as experienced by primary care providers and initiated during the COVID-19 pandemic. Focus groups were conducted with primary care providers (n = 21) recruited through email, advertisements, and professional organizations, exploring how virtual care was delivered, the benefits and challenges, workflow considerations, and recommendations for future use. Integrating virtual care was performed with a great deal of autonomy as well as responsibility, and overwhelmingly depended on the telephone. Technology, communication, and workflow flexibility are three key operational aspects of virtual care and its delivery. Providers highlighted cross-cutting themes related to the dynamics of virtual care including balancing risk for quality care, physician work/life balance, efficiency, and patient benefits. Primary care providers felt that virtual care options allowed increased flexibility to attend to the needs of patients and manage their practice workload, and a few scenarios were shared for when virtual care might be best suited. However, they also recognized the need to balance in-person and virtual visits, which may require guidelines that support navigating various levels of care. Overall, virtual care was considered a good addition to the whole \'care package\' but continued development and refinement is an expectation for optimizing and sustaining future use.
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  • 文章类型: Journal Article
    简介:尽管建议在大多数患者人群中进行治疗,但无症状菌尿的治疗仍然很普遍。在住院精神病患者中,尿路感染(UTI)的无症状治疗率尚未得到彻底评估。这项研究的目的是描述精神病住院患者无症状UTI的抗生素使用率,并调查导致过度使用的因素。方法:这项IRB批准的回顾性队列研究评估了2021年5月1日至2022年5月1日接受UTI抗生素治疗的住院精神病患者。主要结果评估了无症状治疗的发生率,定义为没有泌尿系统症状的治疗。次要结果评估最常处方抗生素,确定精神状态改变(AMS)对治疗的影响,并将UTI治疗的发病率与原发性精神疾病相关。结果:共确定了109例患者,并纳入了61例进行分析。UTI的无症状治疗率为84%。处方最多的抗生素是呋喃妥因(48%)。所有AMS患者(23%)无症状。精神状态的改变对经验性治疗的发生率没有显著影响(P=.098)。原发性精神疾病对UTI经验性治疗的发生率没有显着影响(P=.696)。这个人群中常见的疾病是抑郁症,精神分裂症,和双相情感障碍,无症状治疗率为79%(n=19),87%(n=13),和78%(n=7),分别。讨论:在该住院精神病学人群中发现了UTI的频繁无症状治疗。这些结果强调了在这种情况下需要抗生素监测和管理。
    Introduction: Treatment of asymptomatic bacteriuria remains prevalent despite recommendations against treatment in most patient populations. Rates of asymptomatic treatment of urinary tract infection (UTI) has not been thoroughly evaluated within the inpatient psychiatry population. The objective of this study is to describe the rate of antibiotic use for the treatment of asymptomatic UTI in psychiatric inpatients and investigate factors contributing to overuse. Methods: This IRB approved retrospective cohort study evaluated adults admitted to inpatient psychiatry from May 1, 2021 to May 1, 2022 that received an antibiotic for UTI. The primary outcome assessed the rate of asymptomatic treatment, defined as treatment without urinary symptoms. Secondary outcomes evaluated most frequently prescribed antibiotics, determined the impact of altered mental status (AMS) on treatment, and correlated the incidence of UTI treatment with primary psychiatric disorder. Results: One hundred nine patients were identified and 61 were included for analysis. The rate of asymptomatic treatment for UTI was 84%. The most prescribed antibiotic was nitrofurantoin (48%). All patients with AMS (23%) were asymptomatic. Altered mental status did not significantly impact the rate of empiric treatment (P = .098). Primary psychiatric disorder did not significantly impact rate of empiric treatment for UTI (P = .696). Common disorders in this population were depression, schizophrenia, and bipolar disorder with rates of asymptomatic treatment of 79% (n = 19), 87% (n = 13), and 78% (n = 7), respectively. Discussion: Frequent asymptomatic treatment of UTI was identified in this inpatient psychiatry population. These results emphasize the need for antibiotic monitoring and stewardship in this setting.
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  • 文章类型: Journal Article
    背景:数字工具有能力补充和加强对有自杀风险的年轻人的临床护理。尽管数字工具迅速崛起,他们融入临床实践的比率仍然很低.对数字工具的吸收不足可能部分是由于缺乏临床医生和服务的最佳实践指南来安全地将其应用于该人群。
    方法:进行了一项Delphi研究,旨在为临床医生和服务提供一套最佳实践指南,以将数字工具整合到有自杀风险的年轻人的临床护理中。首先,制定了一份问卷,其中包括来自同行评审和灰色文献的行动项目,以及与17名参与者的利益相关者访谈。接下来,由专业人士(学者和临床工作人员;n=20)和有使用数字技术支持自杀想法和行为经验的年轻人(n=29)组成的两个独立专家小组在两轮共识中对项目进行了评级。在第二轮结束时达成共识的项目(至少有80%的小组成员被评为“必要”或“重要”)被整理成一套指南。
    结果:在由专家组评级的326个单独项目中,188(57.7%)达成共识,将其纳入指南。认可的项目在与年轻人合作时,就重要议题提供指导,包括何时以及为谁使用数字工具,如何选择数字工具并识别潜在的有害内容,以及识别和管理通过数字工具传达的自杀风险。还认可了一些针对服务(而不是个别临床医生)的项目。
    结论:这项研究为临床医生和服务提供了世界上第一个循证指南,将数字工具整合到有自杀风险的年轻人的临床护理中。实施该指南是重要的下一步,有望在临床实践中提高对潜在有用的数字工具的吸收。
    BACKGROUND: Digital tools have the capacity to complement and enhance clinical care for young people at risk of suicide. Despite the rapid rise of digital tools, their rate of integration into clinical practice remains low. The poor uptake of digital tools may be in part due to the lack of best-practice guidelines for clinicians and services to safely apply them with this population.
    METHODS: A Delphi study was conducted to produce a set of best-practice guidelines for clinicians and services on integrating digital tools into clinical care for young people at risk of suicide. First, a questionnaire was developed incorporating action items derived from peer-reviewed and grey literature, and stakeholder interviews with 17 participants. Next, two independent expert panels comprising professionals (academics and clinical staff; n = 20) and young people with lived experience of using digital technology for support with suicidal thoughts and behaviours (n = 29) rated items across two consensus rounds. Items reaching consensus (rated as \"essential\" or \"important\" by at least 80% of panel members) at the end of round two were collated into a set of guidelines.
    RESULTS: Out of 326 individual items rated by the panels, 188 (57.7%) reached consensus for inclusion in the guidelines. The endorsed items provide guidance on important topics when working with young people, including when and for whom digital tools should be used, how to select a digital tool and identify potentially harmful content, and identifying and managing suicide risk conveyed via digital tools. Several items directed at services (rather than individual clinicians) were also endorsed.
    CONCLUSIONS: This study offers world-first evidence-informed guidelines for clinicians and services to integrate digital tools into clinical care for young people at risk of suicide. Implementation of the guidelines is an important next step and will hopefully lead to improved uptake of potentially helpful digital tools in clinical practice.
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  • 文章类型: Journal Article
    背景:药房主导的用药史收集和核对已证明用药错误减少,增加患者安全,并提高了成本节约。然而,文献缺乏在术前空间实施此类服务的记录努力,在复杂的手术和高术后入院率之后,拥有准确的药物清单至关重要。
    目的:本研究的目的是描述电话药学专业学生和药剂师主导的术前用药和解计划的实施。
    方法:这项服务是由3年级和4年级的药学专业学生为泌尿外科肿瘤患者提供电话用药记录的。每周报告在两周内确定了符合计划程序的合格患者。使用标准化方法进行患者沟通和记录,学生撰写了电话相遇笔记,这些笔记由药剂师受体审查并签署。药剂师还根据学生的发现核对了家庭用药清单。
    方法:开发并实施了标准化的术前用药和解程序,并利用第三和第四年的药学学生。在患者手术当天和潜在的术后入院时,手术人员可获得结果注释。
    方法:进行回顾性图表审查,以评估药学专业学生在药学主导的术前用药和解计划中收集的成功记录的用药史。
    结果:在2021年8月至2022年2月之间确定了46份药物和解说明,其中39份符合纳入标准。在177种药物中,删除,和编辑,删除是最常见的,95%的患者至少有一项用药差异.确定的差异代表了总共33个药物类别,每次相遇平均需要33分钟才能完成。
    结论:术前药物和解服务可以通过电话药学专业学生和药剂师主导的工作流程成功完成。准确的用药历史有助于最大程度地减少用药错误并提高患者安全性。
    BACKGROUND: Pharmacy-led medication history collection and reconciliation have demonstrated decreased medication errors, increased patient safety, and improved cost-savings. However, literature lacks documented efforts to implement such services in the preoperative space, where having accurate medication lists following complex procedures with high postoperative admission rates is critical.
    OBJECTIVE: The purpose of this study was to describe the implementation of a telephonic pharmacy student and pharmacist-led preoperative medication reconciliation program.
    METHODS: The service was piloted using third- and fourth-year pharmacy students to conduct telephonic medication histories for urologic surgical oncology patients. Weekly reports identified eligible patients with scheduled procedures within 2 weeks\' time. Using standardized methods for patient communication and documentation, students authored telephone encounter notes that were reviewed and signed by pharmacist preceptors. Pharmacist preceptors also reconciled home medication lists based on students\' findings.
    METHODS: A standardized preoperative medication reconciliation process was developed and implemented utilizing third- and fourth-year pharmacy students. Resulting notes were available for surgical staff on the day of patients\' procedures and upon potential postoperative admission.
    METHODS: A retrospective chart review was conducted to evaluate successfully documented medication histories collected by pharmacy students within the pharmacy-led preoperative medication reconciliation program.
    RESULTS: Forty-six medication reconciliation notes were identified between August 2021 and February 2022, and 39 met inclusion criteria. Amongst the 177 medication additions, deletions, and edits, deletions were the most common, and 95% of patients had at least 1 medication discrepancy identified. A total of 33 medication classes were represented by the identified discrepancies, and each encounter took an average of 33 minutes to complete.
    CONCLUSIONS: Preoperative medication reconciliation services can be successfully accomplished through a telephonic pharmacy student and pharmacist-led workflow. Accurate medication histories aid in minimizing medication errors and increasing patient safety.
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  • 文章类型: Journal Article
    结论:为了加快文章的发表,AJHP在接受后尽快在线发布手稿。接受的手稿经过同行评审和复制编辑,但在技术格式化和作者打样之前在线发布。这些手稿不是记录的最终版本,将在以后替换为最终文章(按照AJHP样式格式化并由作者证明)。
    目的:本文比较和对比了加利福尼亚州3种不同性和性别少数群体的药剂师主导服务的实施情况,密西西比州,和佛罗里达。
    结论:实施以药剂师为主导的针对性和性别少数群体的服务可能是解决这些人群健康差异的潜在机制。临床药师有潜力提供文化谦逊的护理,并通过优化用药方案改善健康结果,减少不良药物事件,加强药物获取,提高药物依从性。
    结论:临床药师提供的服务因不同地点而异,包括性别确认激素治疗的管理,艾滋病毒抗逆转录病毒药物依从性计划,初级保健和慢性病状态管理,以及参与与心理健康相关的护理,精神病学,和物质使用以及性健康。还确定了各种立法和监管障碍以及药剂师执业范围的差异。本文主张扩大以药房为主导的服务,并采用文化上谦逊的患者护理方法。
    OBJECTIVE: This paper compares and contrasts the implementation of pharmacist-led services for 3 different sexual and gender minority populations across California, Mississippi, and Florida.
    CONCLUSIONS: Implementation of pharmacist-led services tailored to sexual and gender minorities may be a potential mechanism to address health disparities in these populations. Clinical pharmacists have the potential to provide care with cultural humility and improve health outcomes by optimizing medication regimens, reducing adverse drug events, enhancing medication acquisition, and improving medication adherence.
    CONCLUSIONS: The services provided by clinical pharmacists varied across sites and included management of gender-affirming hormone therapy, HIV antiretroviral medication adherence programming, primary care and chronic disease state management, and involvement in care related to mental health, psychiatry, and substance use as well as sexual health. Various legislative and regulatory barriers and differences in scope of practice for pharmacists were also identified. This paper advocates for the expansion of pharmacy-led services and the adoption of a culturally humble approach to patient care.
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  • 文章类型: Journal Article
    传统上,临床医生和研究人员在独立的孤岛中工作,与有限的合作,以迅速将发现转化为临床实践。在机构层面,医院和大学也倾向于独立工作,在利用彼此的优势来改善人口健康方面取得了有限的成功。后果包括临床服务的分散,研究人员和临床医生之间沟通不畅,长期拖延识别的临床问题需要创新的解决方案,通过研究和一代的临床医生谁不具备所有的技能,以满足未来的健康需求。学术健康科学系统(AHSS)已被提出作为推动学术界和临床服务之间有效合作的机制。有完善的AHSS的例子,并且已经阐明了好处。在新加坡,在过去的15年里,已经建立了三个AHSS。国家牙科专业中心和一所牙科学校已嵌入AHSS,并在临床和学术领域建立了完善的多学科合作。本评论的目的是描述AHSS的概念以及通过将关键牙科机构嵌入AHSS中来改变新加坡牙科的一些领域。
    Clinicians and researchers have traditionally worked in independent silos, with limited collaboration to rapidly translate discovery into clinical practice. At institutional level, hospitals and universities have also tended to work independently with limited success in leveraging each other\'s strengths with a view to improving population health. The consequences include fragmentation of clinical services, poor communication between researchers and clinicians, lengthy delays in identification of clinical problems requiring innovative solutions through research and a generation of clinicians who are not well equipped with all the skills to address future health needs. Academic Health Science Systems (AHSS) have been proposed as a mechanism for driving effective collaboration between academia and clinical services. There are examples of well established AHSS and the benefits have been articulated. In Singapore, three AHSS have been established over the past 15 years. National dental specialty centres and one dental school have been embedded in AHSS and have well established multi-disciplinary collaboration across clinical and academic domains. The aim of this commentary is to describe the concept of an AHSS and some of the areas where dentistry in Singapore has been transformed by having key dental institutions embedded in an AHSS.
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