我国推行临床药剂师制度动力阻力分析
摘要
目的:
为了更好适应国际药学服务发展趋势,促进临床合理用药,提高诊疗服务质量,改变传统药学服务的被动地位,本文对我国推行临床药师制度动力阻力进行分析,以对今后该制度的完善及推广起到一定的借鉴作用。
资料与方法:
本次研究以理论研究为主,调查研究为辅进行资料收集、整理、分析、资料收集方法文献法:通过图书馆、Internet等方式查阅图书、期刊等获取临床药学服务、国内外临床药剂师政策及实施情况等相关资料,重点收集国内临床药剂师推行案例、经验总结等资料;现场调查法:本次研究共调查了10所医院,20名医生,20名护士及30名药师。其中医院深圳、武汉各5家,医生各10名,护士各10名,药师各15名。主要采取面谈、电话访谈和电子邮件的方式,对临床药剂师制度有无、临床药剂师职责、落实情况、临床药剂师制度实施条件及建议:实施临床药师制度(可能)遇到的动力阻力,及其来源等资料进行收集、整理;
资料分析方法主要采取定性分析的方法,包括案例分析、利益集团分析、SWOT分析等。
研究结果:
通过对国内外临床药师制度实行的相关理论基础、实践基础及现存差距、典型案例等进行比较分析,总结了我国目前推行临床药师制度存在的主要动力阻力因素,具体体现在:
1.动力分析
较为雄厚的理论基础将指导该制度的推行。如国际上七星药剂师、药学保健、循证药剂学、自我药疗等理念的提出,其核心思想是:以病人为中心,由药师向医务人员、病人及其家属提供全面的负责任的药学服务,保证病人安全、有效、经济用药。这为我国顺应国际化药学发展指明了方向,奠定了理论基础。
较丰富的实践资料为该制度的实施提供具体方法。美国1970年国家卫生工作研究发展中心就提出的“综合卫生人员训练条例”并获得通过,使药学生到临床训练得到保障;1974年药学教育委员会颁布新标准,Pharm.D.学位需进行1500小时的“临床实习生”训练;药师下临床具体工作的开展普遍实行了规范化要求,如每周下几次,主要分布在哪些科室,具体做哪些工作等。我国部分医院(如上海长海医院)在学习国外较为先进的临床药学经验基础上,在临床药师的培养、药师下临床如何开展工作方面取得了突出成绩。据本次调查,我国目前在全国范围已有42个临床药师培养试点,各试点单位均结合自身条件逐步开展临床药学工作,如不良反应监测,血药浓度监测、参与查房、指导护理人员、病人及其家属合理用药等,虽然还未规范化,但在一定程度上为推行临床药师制度铺开了道路。
现存的理论与实践差距激发该制度推行的决心。我国推行临床药师制度起步早但发展较缓慢,国际上提出七星药剂师、药学保健、自我药疗等理念,而我国相关的理论研究成果非常少;美国早在1962年就通过法律的形式保障了临床药学教育的规范性,而我国至今只是通过部门规章的形式强调了临床药学工作的重要性;自2000年起美国全面实行临床药学博士教育,而我国至今临床药师的培养仅有42个试点医院,等等。这些方面我国与国外存在较大差距。应当努力发展,更好的与国际接轨。
可能产生的积极效果将提高该制度受重视程度。临床药师工作主要包括:药师下临床、血药浓度监测、不良反应监测等,从药学专业角度对处方行为和诊疗行为进行一定的补充和监督,完善该制度不仅可以有效降低医疗成本,还能更加规范诊疗服务行为,促进合理用药,使医疗服务质量向更科学的方向发展。通过本次调查,培养试点医院医务人员均对该制度给予了高度评价,尤其是护理人员,认为临床药师在临床用药方面给予了他们很大的指导作用,并能举出实例,其他被调查医护人员等也认为实施该制度对提高医疗服务质量有很大作用。
国内成功案例及其产生的积极效果将推动该制度进一步发展。像上海长海医院这样大力推行临床药师制度的医院在我国虽然为数不多,但为该制度今后的广泛推广起到了很好的引导作用。通过本次调查,临床药师培养试点单位均在逐步探索推行临床药师制度各种有效方法途径,虽然还不能达到长海医院的规范化水平,但是随着各项工作的不断完善与经验积累,会逐步走向成熟,最终与国际接轨。
2.阻力分析
我国临床药师制度相关政策法律保障程度不足阻碍了该制度的推行。《医疗机构药事管理暂行规定》属于部门规章,其效力层面较低,且对临床药师职责规定的较简单,很大程度上阻碍了临床药师制度在我国的发展。本次调查发现:要在全国范围推行临床药师制度,没有相关的政策法律保障或者保障程度不够,是很难实现的。如调查的六所三甲医院中只有两家试点单位专门设置了临床药师的岗位,而另外四家基本上是由一般的药学工作者开展不良反应监测、药动学监测等工作,而下临床参与查房、会诊等工作基本未涉及。这在很大程度上阻碍了临床药师制度的推行。
传统培养及管理模式不能适应临床药师制度的推行。过度注重培养促进经济发展型人才,轻药学服务型人才培养。药学教育脱离临床,忽略了临床药物治疗、合理用药相关知识和技能的教育与培养;药学教育至今仍沿用以化学课程为主的教育模式。其培养目标和课程设置不符合医疗卫生改革深入发展所赋予医疗机构药师的职责与任务。本次调查此类问题反映较突出。医院管理者普遍认为我国推行临床药师制度的最大阻力来自卫生部与药监局多头管理导致政策要求不相一致,各项工作不能正常开展;药师普遍没有接受过再教育培训,只有培养试点单位的临床药师有相应的再教育培训要求,其原来在校药学教育课程均是以化学课程为主,即使临床药学专业的课程设置也不能使其适应临床药剂师的工作,必须经过后期的临床学习与调整方能适应。可见我国目前的临床药学在培养模式管理模式方面还存在较大困难。
传统权威及就诊观念将阻碍该制度的推行。“药师就是发药的”,误将药师当药品推销员等传统观念的影响,使得病人对药师不信任;而大量药师仅满足于在药房的调配工作而不接受知识的更新,其不能站在一定高度为医护人员提供用药方面的建议,这些均严重影响了其在临床的地位及临床药学服务前期的开展。本次调查表明:医生虽然对实行临床药师制度表示高度认同,但在实际工作中(如对问题处方的处理),遇到影响到其工作习惯及安全感的情况时,其仍然会产生抵触情绪,这对目前处在相对劣势的护理人员及临床药师会造成一定的心理压力,会间接影响到临床药师制度的前期开展。
政策建议:
充分利用各项动力因素,推动我国临床药师制度高效高质量发展。经过本次研究分析,我国推行临床药师制度的动力因素包括:临床药师制度现有的理论基础、实践经验、我国与国外现存的差距、可提高医疗服务质量、我国成功案例。提高相关政策法律的保障水平。我国目前关于临床药师制度的相关规定还停留在
部门规章层面,还未上什到行政法规及法律的高度,其效力层面有限,不能起到广泛的约束作用,而且其内容过于简单,不能对实践起到指导作用,因此,呼吁国家相关政府部门应该逐步建立和完善我国临床药师制度的相关政策法律体系,并提高法律层面。
建立适宜的临床药学培养模式及管理模式,使其适应临床药学服务的发展。首先是进行专业设置和课程调整,制定符合中国国情的教学计划和教学大纲。使学生在药学教育的基础上加强医学和临床课程教育,主要学习临床药学各主要分支学科的基本理论和技能,接受基本训练,使其具备从事体内药物测试、分析,药物合理利用的能力;具有临床药学研究和指导临床合理用药的初步能力。管理模式的转变并没有固定的模式,主要目的是使临床药师制度在我国医药系统得到充分重视并得到足够的发展空间。
明确临床药师的定位,树立良好形象,逐步转变传统权威及就诊观念。临床药师走人临床要紧紧围绕“药物与病人”这一个定位点,临床药师不应是指导者也不是检查者,而是参与者。临床药师走人临床既不是干扰更不是取代医师的日常治疗工作,而是要为临床提供全新的药学技术服务,解决治疗疾病用药方案中的具体技术问题。
Object:
In order to adapt the developing of the world pharmacy care,to promote safe、economic、rational clinical use of drugs,perfect medicine care,change the used of the negative function of the pharmacy.The study of the dynamics and resistance in the implementation of clinical pharmaceutical in china in this paper,will be good to the policy improvement and extension in the future.
Data and Methods:
Theoretical research is the mainly method in the data collection、data reduction and data analysis,and the investigation play an assisted function in the study.
Data collection method literature method:through library、internet to search books、journals、electronic resource、learn more about clinical pharmaceutical care、clinical pharmaceutical policy in or out of china and the data of the situation of the policy implementation.Mainly collect the cases and the experience data. Field survey:this study investigate 10 hospitals、20 doctors、20 nurses and 30 pharmacists in total,half of the hospitals、doctors、nurses、pharmacists are in Wuhan,and the other half are in Shenzhen.The interview、e-mail、and telephone are used in this investigation to get some data about whether the clinic pharmacist policy were implemented,the responsibility of the pharmacists,the situation of the policy implementation,the condition of the policy implementation and the suggestions,the resistance may be come across during the policy implementation and the analysis of the source.
Data analysis method mainly used literature method,include case analysis、interest group analysis、SWOT analysis and so on.
Results and Conclusions:
The study was base on the theory、practice and the distance of the implementation of the clinical pharmacist policy domestic and overseas,and the significant cases.And it conclude the main dynamic and resistant factors in the implementation of the clinical pharmacists policy,especially in:
1.Dynamic analysis:
China has a very strong theory basis in the implementation of the clinical pharmacists policy.The concept such as the seven star pharmacists、pharmaceutical care evidence-based pharmacy、self-medication were proposed,the core idea is:take the patients as the centre of the medicine,the pharmacists provide the pharmaceutical care to the medical staff、patients and their families,ensure the safety、effectiveness and economic use of drugs. There is abundant of data in the clinical pharmacists policy practice.The united medicine research developing centre proposed and passed“the regulation of the training of the comprehensive medicine staff”of America in 1970.Ensure the clinical practice of the pharmacy students;The new standard was promulgated by the committee in 1974,Pharm.D.degree must have being 1500 hours training of”clinical pharmacy intern students”;The standard of clinical pharmacy specific was widely implemented,such as how many times they do clinical work every week、which departments they mainly work in、what they always do specifically and so on.Some hospitals in china have get much more from the training of the clinical pharmacy and their work development,which based on the learning of the developed practice abroad,and then take them in,so to be a good example to the next work of china.In the investigation,there have been 42 clinical pharmacists training pilots in the present in china,each pilot develop the work combines to self characteristics,such as adverse reaction monitoring、therapeutic drug monitoring、rounds by clinical pharmacists、direction of medication usage,though it has not been standard,spread even road for the implementation of the clinical pharmacist policy.
We still have a long distance on the theory and practice of clinical pharmacy policy with many developed country.The policy developed very slow in china even though it started quite early,the concept such as seven star pharmacist、pharmaceutical care、self-medicine were provided overseas,but there are few were proposed in china;Clinical pharmacy care education was standardized by the way of law in America as early as 1963,but it was only mentioned in the department rule till now in china;The Pharm.D.degree were widely implemented in America from 2000,but there are only 42 training pilots here in china today,and so on.We still have a long way to go,we have to work hard so as to catch the high level of the world.
The clinical pharmacy care implementation can improve the qualification of the medical care effectively.The important work of the clinical pharmacists include:clinical work、therapeutic drug monitoring、adverse drug reaction monitoring and so on,the pharmacy must be a supplement and monitoring to the prescription behavior,perfect this policy not only can decrease the medical cost,but also can regulate the medical care and promote rational drug used,make the medical care quality improved more rational.In the investigation,the medicine staff of the pilots have a good evaluation to the clinical pharmacists policy,the nurse especially believe that the pharmacists give then much help in drug usage,and they have many cases,other objects of the investigation holds that the implementation of the policy will improve the quality of the medicine care greatly. The significant cases in china that implemented the clinical pharmacist policy will be the guide of the work.Even though there are few hospitals pushed the policy as hard as Changhai hospital in china,they must be a good guidance to the future work.They accumulate so much experience in the clinical pharmacist training and the clinical work and so on,they made the policy well implemented in china quite possible.
2.Resistant analysis
The extent of the clinical pharmacist policy related law guarantee is not enough.《Temporary Regulations of Pharmacy Affairs for Medical Institutions》just a department rule,the function is quite limited,and the content is simple,it hindered the policy developing in china in some extent.It is find in the investigation that:the absent or not enough of the law guarantee can hardly implement the policy in the whole china.The only two pilots in the sis highest cent hospitals set the professional post of the clinical pharmacists,the other four let the normal pharmacists work in some clinical pharmacy work,such as adverse reaction monitoring,but the work such as ward around has already not being develop.
The traditional training and management system are not adapt to the implementation of the clinical pharmacist policy.Paying too much attention to training the model of economic development,and look down upon the model of pharmaceutical care,the education is far away from the real clinic,neglect clinic drug therapy,and the of the training of rational drug used;Pharmacy education still take more importance in chemistry.The training object and the curriculum are not adapt to the responsibility that given by the medicine care further development.This problem reflect more in this investigation,the hospital managers hold that the most resistance is the multiple management make the policy differently, the work can’t develop normally;the pharmacists have nor been educated and trained further,the curriculum they accept in the university mainly consist of the chemistry,the clinical pharmacists can’t adapt to the clinical pharmacy work,they must have been trained further in the hospital.
The policy may threaten the traditional medical concept.The traditional idea such as”the pharmacist is the man who sent the drug”、mistake the pharmacist to salesman,make the patient distrust the pharmacist;many pharmacists are satisfy to the recent work in the pharmacy and don’t accept renewal their knowledge,they can’t provide useful advice to the doctor and the nurse in a high level,these all lower the development of the pharmaceutical care in the beginning.It is showed in the investigation that the doctor evaluate highly to the clinical pharmacist policy implementation,but when there is something affect their safety and habitation,they always express resistant emotion,it may suffered by the nurse and the new clinical pharmacists,and affect the implementation of the clinical pharmacist policy indirectly.
Suggestion
Make full use of the dynamic factors to implement the clinical pharmacist policy effectively and quality.
Improve the level of the law guarantee.
Set up the new pharmacy education system and management system to adapt to the clinical pharmacist policy development.
Make clear the position of the clinical pharmacist,build up good reputation,change the traditional concept of the authority and medicine step by step.
为了更好适应国际药学服务发展趋势,促进临床合理用药,提高诊疗服务质量,改变传统药学服务的被动地位,本文对我国推行临床药师制度动力阻力进行分析,以对今后该制度的完善及推广起到一定的借鉴作用。
资料与方法:
本次研究以理论研究为主,调查研究为辅进行资料收集、整理、分析、资料收集方法文献法:通过图书馆、Internet等方式查阅图书、期刊等获取临床药学服务、国内外临床药剂师政策及实施情况等相关资料,重点收集国内临床药剂师推行案例、经验总结等资料;现场调查法:本次研究共调查了10所医院,20名医生,20名护士及30名药师。其中医院深圳、武汉各5家,医生各10名,护士各10名,药师各15名。主要采取面谈、电话访谈和电子邮件的方式,对临床药剂师制度有无、临床药剂师职责、落实情况、临床药剂师制度实施条件及建议:实施临床药师制度(可能)遇到的动力阻力,及其来源等资料进行收集、整理;
资料分析方法主要采取定性分析的方法,包括案例分析、利益集团分析、SWOT分析等。
研究结果:
通过对国内外临床药师制度实行的相关理论基础、实践基础及现存差距、典型案例等进行比较分析,总结了我国目前推行临床药师制度存在的主要动力阻力因素,具体体现在:
1.动力分析
较为雄厚的理论基础将指导该制度的推行。如国际上七星药剂师、药学保健、循证药剂学、自我药疗等理念的提出,其核心思想是:以病人为中心,由药师向医务人员、病人及其家属提供全面的负责任的药学服务,保证病人安全、有效、经济用药。这为我国顺应国际化药学发展指明了方向,奠定了理论基础。
较丰富的实践资料为该制度的实施提供具体方法。美国1970年国家卫生工作研究发展中心就提出的“综合卫生人员训练条例”并获得通过,使药学生到临床训练得到保障;1974年药学教育委员会颁布新标准,Pharm.D.学位需进行1500小时的“临床实习生”训练;药师下临床具体工作的开展普遍实行了规范化要求,如每周下几次,主要分布在哪些科室,具体做哪些工作等。我国部分医院(如上海长海医院)在学习国外较为先进的临床药学经验基础上,在临床药师的培养、药师下临床如何开展工作方面取得了突出成绩。据本次调查,我国目前在全国范围已有42个临床药师培养试点,各试点单位均结合自身条件逐步开展临床药学工作,如不良反应监测,血药浓度监测、参与查房、指导护理人员、病人及其家属合理用药等,虽然还未规范化,但在一定程度上为推行临床药师制度铺开了道路。
现存的理论与实践差距激发该制度推行的决心。我国推行临床药师制度起步早但发展较缓慢,国际上提出七星药剂师、药学保健、自我药疗等理念,而我国相关的理论研究成果非常少;美国早在1962年就通过法律的形式保障了临床药学教育的规范性,而我国至今只是通过部门规章的形式强调了临床药学工作的重要性;自2000年起美国全面实行临床药学博士教育,而我国至今临床药师的培养仅有42个试点医院,等等。这些方面我国与国外存在较大差距。应当努力发展,更好的与国际接轨。
可能产生的积极效果将提高该制度受重视程度。临床药师工作主要包括:药师下临床、血药浓度监测、不良反应监测等,从药学专业角度对处方行为和诊疗行为进行一定的补充和监督,完善该制度不仅可以有效降低医疗成本,还能更加规范诊疗服务行为,促进合理用药,使医疗服务质量向更科学的方向发展。通过本次调查,培养试点医院医务人员均对该制度给予了高度评价,尤其是护理人员,认为临床药师在临床用药方面给予了他们很大的指导作用,并能举出实例,其他被调查医护人员等也认为实施该制度对提高医疗服务质量有很大作用。
国内成功案例及其产生的积极效果将推动该制度进一步发展。像上海长海医院这样大力推行临床药师制度的医院在我国虽然为数不多,但为该制度今后的广泛推广起到了很好的引导作用。通过本次调查,临床药师培养试点单位均在逐步探索推行临床药师制度各种有效方法途径,虽然还不能达到长海医院的规范化水平,但是随着各项工作的不断完善与经验积累,会逐步走向成熟,最终与国际接轨。
2.阻力分析
我国临床药师制度相关政策法律保障程度不足阻碍了该制度的推行。《医疗机构药事管理暂行规定》属于部门规章,其效力层面较低,且对临床药师职责规定的较简单,很大程度上阻碍了临床药师制度在我国的发展。本次调查发现:要在全国范围推行临床药师制度,没有相关的政策法律保障或者保障程度不够,是很难实现的。如调查的六所三甲医院中只有两家试点单位专门设置了临床药师的岗位,而另外四家基本上是由一般的药学工作者开展不良反应监测、药动学监测等工作,而下临床参与查房、会诊等工作基本未涉及。这在很大程度上阻碍了临床药师制度的推行。
传统培养及管理模式不能适应临床药师制度的推行。过度注重培养促进经济发展型人才,轻药学服务型人才培养。药学教育脱离临床,忽略了临床药物治疗、合理用药相关知识和技能的教育与培养;药学教育至今仍沿用以化学课程为主的教育模式。其培养目标和课程设置不符合医疗卫生改革深入发展所赋予医疗机构药师的职责与任务。本次调查此类问题反映较突出。医院管理者普遍认为我国推行临床药师制度的最大阻力来自卫生部与药监局多头管理导致政策要求不相一致,各项工作不能正常开展;药师普遍没有接受过再教育培训,只有培养试点单位的临床药师有相应的再教育培训要求,其原来在校药学教育课程均是以化学课程为主,即使临床药学专业的课程设置也不能使其适应临床药剂师的工作,必须经过后期的临床学习与调整方能适应。可见我国目前的临床药学在培养模式管理模式方面还存在较大困难。
传统权威及就诊观念将阻碍该制度的推行。“药师就是发药的”,误将药师当药品推销员等传统观念的影响,使得病人对药师不信任;而大量药师仅满足于在药房的调配工作而不接受知识的更新,其不能站在一定高度为医护人员提供用药方面的建议,这些均严重影响了其在临床的地位及临床药学服务前期的开展。本次调查表明:医生虽然对实行临床药师制度表示高度认同,但在实际工作中(如对问题处方的处理),遇到影响到其工作习惯及安全感的情况时,其仍然会产生抵触情绪,这对目前处在相对劣势的护理人员及临床药师会造成一定的心理压力,会间接影响到临床药师制度的前期开展。
政策建议:
充分利用各项动力因素,推动我国临床药师制度高效高质量发展。经过本次研究分析,我国推行临床药师制度的动力因素包括:临床药师制度现有的理论基础、实践经验、我国与国外现存的差距、可提高医疗服务质量、我国成功案例。提高相关政策法律的保障水平。我国目前关于临床药师制度的相关规定还停留在
部门规章层面,还未上什到行政法规及法律的高度,其效力层面有限,不能起到广泛的约束作用,而且其内容过于简单,不能对实践起到指导作用,因此,呼吁国家相关政府部门应该逐步建立和完善我国临床药师制度的相关政策法律体系,并提高法律层面。
建立适宜的临床药学培养模式及管理模式,使其适应临床药学服务的发展。首先是进行专业设置和课程调整,制定符合中国国情的教学计划和教学大纲。使学生在药学教育的基础上加强医学和临床课程教育,主要学习临床药学各主要分支学科的基本理论和技能,接受基本训练,使其具备从事体内药物测试、分析,药物合理利用的能力;具有临床药学研究和指导临床合理用药的初步能力。管理模式的转变并没有固定的模式,主要目的是使临床药师制度在我国医药系统得到充分重视并得到足够的发展空间。
明确临床药师的定位,树立良好形象,逐步转变传统权威及就诊观念。临床药师走人临床要紧紧围绕“药物与病人”这一个定位点,临床药师不应是指导者也不是检查者,而是参与者。临床药师走人临床既不是干扰更不是取代医师的日常治疗工作,而是要为临床提供全新的药学技术服务,解决治疗疾病用药方案中的具体技术问题。
Object:
In order to adapt the developing of the world pharmacy care,to promote safe、economic、rational clinical use of drugs,perfect medicine care,change the used of the negative function of the pharmacy.The study of the dynamics and resistance in the implementation of clinical pharmaceutical in china in this paper,will be good to the policy improvement and extension in the future.
Data and Methods:
Theoretical research is the mainly method in the data collection、data reduction and data analysis,and the investigation play an assisted function in the study.
Data collection method literature method:through library、internet to search books、journals、electronic resource、learn more about clinical pharmaceutical care、clinical pharmaceutical policy in or out of china and the data of the situation of the policy implementation.Mainly collect the cases and the experience data. Field survey:this study investigate 10 hospitals、20 doctors、20 nurses and 30 pharmacists in total,half of the hospitals、doctors、nurses、pharmacists are in Wuhan,and the other half are in Shenzhen.The interview、e-mail、and telephone are used in this investigation to get some data about whether the clinic pharmacist policy were implemented,the responsibility of the pharmacists,the situation of the policy implementation,the condition of the policy implementation and the suggestions,the resistance may be come across during the policy implementation and the analysis of the source.
Data analysis method mainly used literature method,include case analysis、interest group analysis、SWOT analysis and so on.
Results and Conclusions:
The study was base on the theory、practice and the distance of the implementation of the clinical pharmacist policy domestic and overseas,and the significant cases.And it conclude the main dynamic and resistant factors in the implementation of the clinical pharmacists policy,especially in:
1.Dynamic analysis:
China has a very strong theory basis in the implementation of the clinical pharmacists policy.The concept such as the seven star pharmacists、pharmaceutical care evidence-based pharmacy、self-medication were proposed,the core idea is:take the patients as the centre of the medicine,the pharmacists provide the pharmaceutical care to the medical staff、patients and their families,ensure the safety、effectiveness and economic use of drugs. There is abundant of data in the clinical pharmacists policy practice.The united medicine research developing centre proposed and passed“the regulation of the training of the comprehensive medicine staff”of America in 1970.Ensure the clinical practice of the pharmacy students;The new standard was promulgated by the committee in 1974,Pharm.D.degree must have being 1500 hours training of”clinical pharmacy intern students”;The standard of clinical pharmacy specific was widely implemented,such as how many times they do clinical work every week、which departments they mainly work in、what they always do specifically and so on.Some hospitals in china have get much more from the training of the clinical pharmacy and their work development,which based on the learning of the developed practice abroad,and then take them in,so to be a good example to the next work of china.In the investigation,there have been 42 clinical pharmacists training pilots in the present in china,each pilot develop the work combines to self characteristics,such as adverse reaction monitoring、therapeutic drug monitoring、rounds by clinical pharmacists、direction of medication usage,though it has not been standard,spread even road for the implementation of the clinical pharmacist policy.
We still have a long distance on the theory and practice of clinical pharmacy policy with many developed country.The policy developed very slow in china even though it started quite early,the concept such as seven star pharmacist、pharmaceutical care、self-medicine were provided overseas,but there are few were proposed in china;Clinical pharmacy care education was standardized by the way of law in America as early as 1963,but it was only mentioned in the department rule till now in china;The Pharm.D.degree were widely implemented in America from 2000,but there are only 42 training pilots here in china today,and so on.We still have a long way to go,we have to work hard so as to catch the high level of the world.
The clinical pharmacy care implementation can improve the qualification of the medical care effectively.The important work of the clinical pharmacists include:clinical work、therapeutic drug monitoring、adverse drug reaction monitoring and so on,the pharmacy must be a supplement and monitoring to the prescription behavior,perfect this policy not only can decrease the medical cost,but also can regulate the medical care and promote rational drug used,make the medical care quality improved more rational.In the investigation,the medicine staff of the pilots have a good evaluation to the clinical pharmacists policy,the nurse especially believe that the pharmacists give then much help in drug usage,and they have many cases,other objects of the investigation holds that the implementation of the policy will improve the quality of the medicine care greatly. The significant cases in china that implemented the clinical pharmacist policy will be the guide of the work.Even though there are few hospitals pushed the policy as hard as Changhai hospital in china,they must be a good guidance to the future work.They accumulate so much experience in the clinical pharmacist training and the clinical work and so on,they made the policy well implemented in china quite possible.
2.Resistant analysis
The extent of the clinical pharmacist policy related law guarantee is not enough.《Temporary Regulations of Pharmacy Affairs for Medical Institutions》just a department rule,the function is quite limited,and the content is simple,it hindered the policy developing in china in some extent.It is find in the investigation that:the absent or not enough of the law guarantee can hardly implement the policy in the whole china.The only two pilots in the sis highest cent hospitals set the professional post of the clinical pharmacists,the other four let the normal pharmacists work in some clinical pharmacy work,such as adverse reaction monitoring,but the work such as ward around has already not being develop.
The traditional training and management system are not adapt to the implementation of the clinical pharmacist policy.Paying too much attention to training the model of economic development,and look down upon the model of pharmaceutical care,the education is far away from the real clinic,neglect clinic drug therapy,and the of the training of rational drug used;Pharmacy education still take more importance in chemistry.The training object and the curriculum are not adapt to the responsibility that given by the medicine care further development.This problem reflect more in this investigation,the hospital managers hold that the most resistance is the multiple management make the policy differently, the work can’t develop normally;the pharmacists have nor been educated and trained further,the curriculum they accept in the university mainly consist of the chemistry,the clinical pharmacists can’t adapt to the clinical pharmacy work,they must have been trained further in the hospital.
The policy may threaten the traditional medical concept.The traditional idea such as”the pharmacist is the man who sent the drug”、mistake the pharmacist to salesman,make the patient distrust the pharmacist;many pharmacists are satisfy to the recent work in the pharmacy and don’t accept renewal their knowledge,they can’t provide useful advice to the doctor and the nurse in a high level,these all lower the development of the pharmaceutical care in the beginning.It is showed in the investigation that the doctor evaluate highly to the clinical pharmacist policy implementation,but when there is something affect their safety and habitation,they always express resistant emotion,it may suffered by the nurse and the new clinical pharmacists,and affect the implementation of the clinical pharmacist policy indirectly.
Suggestion
Make full use of the dynamic factors to implement the clinical pharmacist policy effectively and quality.
Improve the level of the law guarantee.
Set up the new pharmacy education system and management system to adapt to the clinical pharmacist policy development.
Make clear the position of the clinical pharmacist,build up good reputation,change the traditional concept of the authority and medicine step by step.
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[20]李彬.赴加拿大安大略省考察药剂师学会的情况与体会.上海医药,1999,20(3):29-30.
[21]20万人用药不当死亡,药店该为患者建档案, http://www.shouxi.net/zhuanti/200512/5486_93760.aspx
[22]金秀范.执业药师工作概况[J].中国药师,2000;3(3): 1491
[23]张维纯.我国实施药品分类管理面临的困难.中国卫生事业管理,2001(7):445-446.
[24]我国药学服务现状和任务http://www.smeiclub.net/news/ReadNews.asp?NewsID=830
[25]严治良.浅谈执业药师制度实行后存在的问题及建议.湖南医学高等专科学校学报,2001,3(2):73-74.
[26]优良药房工作规范http://www.smeiclub.net/news/ReadNews.asp?NewsID=832
[27]以病人为中心、做好药学服务http://www.smeiclub.net/news/ReadNews.asp?NewsID=263
[28]GPP:全面提升药店服务水平http://www.smeiclub.net/news/ReadNews.asp?NewsID=132
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[1]张新平,李少丽主编.药物政策学[M].第一版.北京:科技出版社,2003: 130-155美国医务人员素质高,管理规范,用药错误及危害尚且这么严重
[2]新华社.八万人滥用抗生素导致死亡
[3]药学服务内涵和背景http://www.smeiclub.net/news/ReadNews.asp?NewsID=829
[4]谢敏强,许国荣,赵美琴.关于零售药店执业药师地位与作用问题的探讨.上海医药,2003,24(5):203-205.
[5]药店药学服务为何难尽如人意http://www.whda.gov.cn/webportal/portal.po?UID=DWV1_WOUID_URL_68728&TOC=COLUMN_68728&OBJ=173354
[6]李荣英,刘丽凤.零售药店执业药师作用发挥的探讨.山西医药杂志,2006,35(9):853-854.
[7]田晓燕,郭秋桂,李红霞,李晓槐,刘振龙,安娜.制约执业药师合理流动的因素及对策.中国药师,2003,6(9):540-541.
[8]金丽英.零售药店执业药师知识结构浅述.中国药事,18(6):354
[9]王巍.中美两国执业药师制度的比较与借鉴.药学进展,2003,27(2):118-121.
[10]American Public Health Association. Pharmaceutical Care [ EB/OL ].http://www.aphanet.org/pharmcare/pharmcare.html ,2002212202.
[11]The State Board of Pharmacy , Pennsylvania1Pharmacy Act ,Pennsylvania ( 1962101 ) [ EB/ OL ] . http://www.dos.state.pa.us/bpoa/lib/bpoa/20/10/pharmacy2act.pdf ,2002210208
[12]丁川,杨劭明.国内外执业药师制度的比较和思考.海峡药学,2002,14(4):101-103.
[13]顾玉麒.美国的药剂师工作.药学实践杂志,2002,20(5):315-316.
[14]李翔,邵蓉.美国用药审查制度介绍.中国药房,2004,15(4):249-251.
[15] ASHP.ASHP Guidelines on the pharmacist’s role immunization [J]. Am J Health - Syst Pharm ,2003 ,60 :1371
[16]方宇,黄泰康,杨世民.我国药店药学服务的法规建设研究.中国药房,2005,16(19):1516-1519.
[17]陈建华,张莹.日本药剂师国家考试制度的认识与思考.药学教育,1999,15(4):51-53.
[18]吴利雅.匈牙利的药剂师和药房管理掠影.中国药师,2004,7(8):597-598.
[19]法国药师的活动和作用http://www.smeiclub.net/news/ReadNews.asp?NewsID=156
[20]李彬.赴加拿大安大略省考察药剂师学会的情况与体会.上海医药,1999,20(3):29-30.
[21]20万人用药不当死亡,药店该为患者建档案, http://www.shouxi.net/zhuanti/200512/5486_93760.aspx
[22]金秀范.执业药师工作概况[J].中国药师,2000;3(3): 1491
[23]张维纯.我国实施药品分类管理面临的困难.中国卫生事业管理,2001(7):445-446.
[24]我国药学服务现状和任务http://www.smeiclub.net/news/ReadNews.asp?NewsID=830
[25]严治良.浅谈执业药师制度实行后存在的问题及建议.湖南医学高等专科学校学报,2001,3(2):73-74.
[26]优良药房工作规范http://www.smeiclub.net/news/ReadNews.asp?NewsID=832
[27]以病人为中心、做好药学服务http://www.smeiclub.net/news/ReadNews.asp?NewsID=263
[28]GPP:全面提升药店服务水平http://www.smeiclub.net/news/ReadNews.asp?NewsID=132
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