Page 110 - 2022-28-中国全科医学

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services implemented in Shanghai，providing a reference for improving community pharmaceutical services. Methods We
conducted a survey in Shanghai with 235 pharmaceutical professionals selected by use of phased sampling from September to
December 2020 with a questionnaire named as "Community Pharmacists Questionnaire" developed by us based on the results
of previous literature review and on-site visits. In November 2020，we conducted a focus group interview with 82 stakeholders
（including one pharmaceutical professional，one general practitioner and one community administrator selected from each
community，two or three administrators selected from the health commission of each district） in Shanghai guided by an outline
named as "Rational Drug Use for the Elderly" developed by us based on the results of previous literature review and on-site visits.
The allocation of community pharmaceutical care resources，implementation and management of community pharmaceutical care
involved in the interview were extracted as supplements to the survey results. Results Among the 235 community pharmacists
surveyed，the prevalence of providing prescription dispensing，prescription review，pharmaceutical drive-thru window services
or outpatient consultation and guidance，and prescription comment services was 94.0%（221/235），82.6%（194/235），
64.3%（151/235），and 51.9%（122/235），respectively. Among these services，prescription dispensing and prescription
review were ranked as the top two in terms of average comprehensive score，indicating that implementing these two services
required longer working hours of community pharmacists. In terms of the delivery methods of community pharmaceutical services，
community pharmacists mainly used consultation windows〔226 cases（96.2%）〕，pharmaceutical clinics〔119 cases（50.6%）〕
and publicity lectures〔109 cases（46.4%）〕. Only 53（22.6%） participated in the family doctor team，among whom 22
（41.5%）had the qualification of clinical pharmacist；47（88.7%） mainly provided public education on rational drug use，
and 45（84.9%） mainly provided medication guidance and consultation services for patients. In terms of training，180 cases
（76.6%） participated in a training in the past one year，while other 55（23.4%） cases did not. The number of trainings for
most of cases was one or two times〔105（58.3%）〕. The way of trainings for most of cases was continuing education〔155
（86.1%）〕. Both the questionnaire survey and interview results revealed that the main problems existing in the provision of
community pharmaceutical services were heavy workload of dispensing/prescription review，lack of clinical knowledge patients'
insufficient trust in pharmacists，and lack of performance incentives. Conclusion To meet the pharmaceutical needs of elderly
patients with multiple chronic conditions，actions need to be taken to reduce the heavy workload of delivering traditional services
in pharmacists，strengthen the clinical training of in-service pharmacists，and encourage pharmacists to join the family doctor
team. Through providing pharmaceutical consultations and trainings for other family doctor team members by pharmacists，the
scope of influence of pharmaceutical services will be expanded，which contributes to the ensuring of rational drug use.
【Key words】 Community health services；Pharmaceutical services；Family doctor team；Shanghai

慢性病是威胁人类健康的主要疾病。老年人作为慢 1 对象与方法
性病的高危人群，多患有两种以上的慢性病，存在多重 1.1 研究对象 于 2020 年 9—12 月，采用分阶段抽样
用药的问题 ［1］ 。促进多病共存老年患者合理用药已成 法从上海市抽取药学人员参与问卷调查。首先，依据辖
为人们关注的重要课题。社区卫生服务机构因其便捷的 区分类方法，根据中心城区、近郊区和远郊区社区卫生
［9］
特性和功能定位，已成为解决老年慢性病患者用药问题 服务机构的数量比例 ，抽取中心城区6所、近郊区8所、
的关键。现有研究已发现社区卫生服务机构存在临床药 远郊区 6 所共计 20 所社区卫生服务机构，其次采用整
师数量不足、药学人员日常工作繁忙等问题 ［2-3］ 。近年 群抽样法将各个社区卫生服务机构中从事药学工作的全
来，上海市在提高社区药学服务水平和药学人员服务能 部药学人员纳入。另外，2020 年 11 月，邀请每所机构
力方面开展了积极的探索和实践，如 2016 年率先开展 社区药学人员、全科医生和社区管理人员各 1 人，以及
了社区临床药师在职规范化培训工作，符合条件的药学 各区卫生健康委员会分管人员 2~3 人，共计 82 人，参
人员可以报名参加学习和考核 ［4］ ，随后相关培训基地 加焦点小组访谈。
数量不断增加 ［5-7］ ，研究显示该政策实施后效果良好 ［8］ 。 1.2 研究方法 基于文献研究和现场考察，本课题组
为进一步了解上海市系列政策施行背景下的社区药学服 自行设计“社区药学人员调查问卷”，经过预调查和专
务现状，从而更好地利用现有资源提升社区药学服务水 家论证后完善，形成正式的调查问卷。问卷内容包括社
平，上海市卫生健康委员会药政管理处委托复旦大学课 区药学人员基本信息、对于多病共存老年患者用药指导
题组，采用问卷调查和访谈的方法，对上海市社区药学 的认知情况、社区药学服务开展情况、在家庭医生团队
服务的开展现状进行调查和评价，以期为制定针对性的 中的服务开展情况、培训情况等。问卷的 Cronbach's α
建议提供依据。 系数为 0.85，信度较好。共发放问卷 235 份，有效回收