Page 104 - 2022-28-中国全科医学

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pharmacists into a family doctor team for delivering such services. Methods This study was conducted from September to
December in 2020. Multistage sampling was used to select 349 elderly patients with chronic diseases in the community and
855 main members of family doctor teams〔general practitioners（n=481），nurses（n=234），and public health doctors
（n=140）〕 for questionnaire survey. The questionnaire for the patients mainly includes demographics，chronic condition，
use of medications，needs and utilization of community-based pharmaceutical care. And the questionnaire for family doctor
team members mainly contains demographics，understanding of community-based pharmaceutical care，and pharmaceutical
services preferred to be involved in as a provider. Results According to the survey results，the prevalence of three or more
chronic diseases，and needing to take medications two or more times a day was 35.8%（125/349），and 87.4%（305/349），
respectively. Among medication management services，"medication re-prescribing and follow-up" was the most needed〔14.9%
（52/349）〕，and "medication follow-up" was the most used〔14.0%（49/349）〕. Among medication education services，
"universal education on medication cautions for chronic conditions" was the most needed〔70.8%（247/349）〕，and "healthy
lifestyle promotion" was the most used〔9.4%（33/349）〕. Among family doctor team members，440（91.5%） general
practitioners，202（86.3%） nurses and 112（80.0%） public health doctors expressed that they had an understanding of
pharmaceutical care. In terms of the level of trust in pharmacists，the self-reported level of 302（62.8%）general practitioners，
183（78.2%） nurses，and 103（73.6%） public health doctors was high. The number of general practitioners，nurses，and
public health doctors wanting to be involved in "assisting physicians in providing medication selection and use services" was 359
（74.6%），112（47.9%），and 81（57.8%），respectively. The number of general practitioners，nurses，and public health
doctors wanting to be involved in "providing nurses with guidance on medication use and management" was 190（39.5%），
153（65.4%） and 57（40.7%），respectively. Conclusion Elderly patients with chronic diseases were in urgent need of
medication management services，and more medication education services. However，the strength of pharmaceutical professional
workforce in the community was weak，and family doctor team members had limited understanding of community-based
pharmaceutical services. To efficiently provide residents with such services，it is suggested to train family doctor team members
with relevant trainings by pharmaceutical professionals to improve their understanding level and service capability regarding
pharmaceutical services at the individual and team levels.
【Key words】 Community health services；Pharmaceutical services；Health services needs and demand；Family
doctor team；Shanghai

“十三五”以来，上海市患者就诊下沉明显，社区 1 对象与方法
卫生服务门诊量一直保持在全市三分之一以上，家庭医 1.1 调查对象 于 2020 年 9—12 月，采用多阶段抽样
生签约居民社区就诊率达到六成以上 ［1］ 。因此，联合 法，首先参考上海市辖区分类方法，根据中心城区、近
家庭医生团队开展的社区药学服务也逐渐成为解决患者 郊区和远郊区社区卫生服务机构的数量比例 ［4］ ，抽取
安全合理用药问题的重要途径。上海市高度重视社区药 中心城区 6 所、近郊区 8 所、远郊区 6 所共计 20 所社
学服务的开展，《上海市卫生健康发展“十四五”规划》 区卫生服务中心作为调查机构；然后于调查当日在机构
（沪府发〔2021〕10 号）提出要建立临床用药药师、 内方便选取年龄≥ 65 周岁、有≥ 2 种慢性病、对本研
医师、护士衔接机制；2020 年底发布的《关于加强本 究知情同意且自愿参加的老年慢性病患者为调查对象。
2
市医疗机构药事管理促进合理用药的实施意见》（沪卫 Z α/2 π（1-π）
样本量计算公式为：n= 2 。老年人不遵医
药政〔2020〕5 号）要求积极发展居家社区药学服务， δ
嘱服药行为的发生率取 24.5% ［5］ ，置信水平取 95%，
鼓励资深临床药师加入家庭医生团队，开展用药咨询、
容许误差取 5%，计算得 n=284。考虑 10% 的无效问卷
药物治疗管理、合理用药科普宣传等服务。虽然现有研
究提示存在社区居民对药学服务理念认知不足 ［2］ 、患 和拒访率，计算最低样本量为 313，平均分配至已确定
者的药学服务需求有待满足 ［3］ 等问题，但如何发挥家 的调查机构，每家机构需调查 15~16 例老年慢性病患者。
本研究最终共发放问卷 349 份，实际收回有效问卷 349
庭医生团队作用以满足患者社区药学服务需求仍有待进
份，回收有效率为 100.0%。同时纳入调查机构内取得
一步探索。受上海市卫生健康委员会药政管理处的委托，
相应执业资格证书并注册登记的家庭医生团队全部主要
本研究采用自制调查表，对上海市社区内的患者及家庭
成员（全科医生、护士、公共卫生医生）为调查对象，
医生团队进行调查，了解并分析评价上海市社区药学服
共发放问卷 855 份，实际收回有效问卷 855 份，回收有
务需求现状，为改进社区药学人员参与家庭医生团队开
效率为 100.0%。
展服务的方式提供参考建议。