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Precision medicine has become a new mode of modern medicine, and personalized medication is the important embodiment of clinical application of precision medicine. The advances of life science technologies greatly facilitated precision medicine, and also promoted the shift of the mode of clinical pharmacy care from rational drug use and individualized medication to precision medication. To achieve"one person, one mode" clinical dosage regimens,it is necessary to rely on the supports of advanced life science technologies and precisely analyzing and accurately characterizing the biomarker clusters related to individual differences among patients, pathological differences of disease, and disease progression. This article illustrated the recent advances in the application of pharmacokinetics/pharmacodynamics, omics technology and liquid biopsy to the design of dosage regimen, prediction of therapeutic effect and adverse drug reactions, etc. in the era of precision medicine. Furthermore, the development direction of the new model of clinical pharmaceutical care faced on the precision medicine is prospected.
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OBJECTIVE:To provide policy selection for pharmacy service fee reform in China under New Health Reform that drug addition in public hospitals is abolished completely throughout the country. METHODS:The situation and general characteristics of pharmacy service fee reform were summarized since New Health Reform. The multi-dimension of pharmacy service fee was analyzed to define the connotation of pharmacy service fee again. The solution to pharmacy service fee and clinical pharmaceutical care fee reform were put forward. RESULTS:There were many theoretical discussions on the establishment of pharmacy service fee since New Medical Reform,but no achievements had been made in reform practice. The connotation of pharmacy service fee should be subdivided,and the"pharmacy service fee"should be used as the content of the cost compensation for the public service provided by the hospital;"clinical pharmaceutical care fee"should be set up as the cost compensation content of the professional technical service;according to the different natures of the service,the corresponding policy could be designed. CONCLUSIONS:It is suggested that"pharmacy service fee",as lump sum fee,could be solved in the dynamic adjustment of medical service price;"clinical pharmaceutical care fee"should be approved independently and included in the standard charge items according to the individual project.At the same time,local pilot is encouraged,the charge of clinical pharmaceutical care is included in the national charge catalogue,and national standards are studied and formulated. The performance management model of pharmaceutical personnel can be adjusted to promote the healthy development of pharmacy subject.
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The clinical pharmaceutical care in Japan is patient-centered and professional .Their policies of pharmaceutical service fee encourage clinical pharmaceutical care development , and embody values of pharmacists as well .The pharmaceutical service management in Japan indicates its attention on practical outcomes , serving as a useful reference for China in both service mode and management policies .
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OBJECTIVE: To assess the cost-effectiveness of clinical pharmaceutical care in the H. pylori(HP) eradication in outpatients with peptic ulcer. METHODS: Ninty-six Outpatients with HP positive peptic ulcer from July 2015 to June 2016 were prospectively collected, and randomly divide into control group and intervention group. Patients in the control group were given the traditional outpatient service. The intervention group patients were given with pharmaceutical education and follow-up by clinical pharmacist. The score of compliance with medication, HP eradication rate and the improvement of gastrointestinal symptom were selected as outcome indicator. Time cost of intervention and fee of clinical pharmacist training were estimated and recorded as the cost of clinical pharmacy intervention. RESULTS: (1)Improvement of the score of compliance with medication of intervention group patients was significantly higher than the control group (1.71 vs. 0.44, P<0.01). Forty-four patients of the intervention group, while 36 patients in the control group reported less gastrointestinal symptoms (91.67% vs. 75.00%, P=0.028). The HP eradication rate of the intervention group was significantly higher than the control group (91.67% vs. 72.92%, P=0.016). (2)For the hospital, the cost of pharmacy service of control group was 292.31 yuan, and 821.61 yuan of the intervention group. (3)The cost-effectiveness ratio of the score of compliance with medication of control group was 664.34, while the intervention group was 480.47, which was superior to the control group. It was cost-effective. However, the cost-effectiveness ratio of HP eradication rate and the improvement of gastrointestinal symptom of the intervention group were both higher than the control group. CONCLUSION: Clinical pharmaceutical care increase the cost of the hosipital. However, clinical pharmaceutical care can result in cost-effective improvement of the medication compliance.
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OBJECTIVE:To investigate the application effect of PDCA circulation method in clinical pharmaceutical care. METHODS:According to the method of PDCA cycle,clinical pharmaceutical care quality and satisfaction degree of physicians, nurses and patients in 2013 were investigated to find out the problems;the reasons were analyzed and countermeasures were made out,checked and implemented. Finally,the quality of clinical pharmaceutical care,the medical staff and patient's satisfaction with clinical pharmaceutical care were compared before and after the implementation of PDCA circulation. RESULTS:Due to the poor quality of clinical pharmaceutical care and low satisfactory degree of our hospital,we formulated related countermeasures,such as enhancing the medication service skill of clinical pharmacists in obstetrics and gynecology department,extending the coverage of pharmaceutical ward round,developing the pharmaceutical care for patients with high risk pregnancy or underwent assisted repro-duction,strengthening communication and propaganda of medical staff and patients. After the implementation of countermeasures, the quality indicators of clinical pharmaceutical care were improved in 2014,compared to 2013,such as the number of patients in-cluded in pharmaceutical ward round increased from 445 to 1 780;total number of reasonable medication intervention suggestion in-creased from 14 to 29;that of pharmaceutical consultation increased from 8 to 23;the satisfaction degree of medical staff and pa-tients improved from 55.93% and 45.95% to 100% and 92.10%,respectively. CONCLUSIONS:PDCA circulation can significant-ly improve the quality of clinical pharmaceutical care and satisfactory degree of our hospital,and promote pharmaceutical care of our hospital.
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OBJECTIVE:To explore the role of clinical pharmacists in tumor pain management for patients receiving tumor pain palliative radiotherapy. METHODS:In prospective randomized controlled study, 60 patients with tumor pain who received palliative radiotherapy in radiotherapy department of our hospital from June 1,2013 to May 31,2014,according with the selection criteria,were randomized into observation group(30 cases)and control group(30 cases). Clinical pharmacists participated in the treatment of observation group;provided pharmaceutical care for doctors;and recorded drug treatment,pain evaluation,medica-tion compliance,Karnofsky Performance Status(KPS)and quality of life(QOL)of 2 groups. RESULTS:On the 5th day,the pain remission rate of observation group reached 63.3%,and was significantly higher than that(36.7%)of control group(P0.05). At the same time,KPS, QOL and medication adherence were all improved significantly,compared with before treatment(P<0.01 or P<0.05),and medi-cation adherence of observation group was obviously better than that of control group(P<0.01). CONCLUSIONS:The participa-tion of clinical pharmacists in the pain management can obviously improve medication compliance,relieve pain more effectively, and promote rational drug use.
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OBJECTIVE:To discuss the contents and importance of clinical pharmaceutical care.METHODS:Our experiences in carrying out clinical pharmaceutical care in our hospital were analyzed through exemplification.RESULTS & CONCLUSION:Clinical pharmaceutical care can help improve the medical quality and reduce medical risks.Pharmacist system should be established in hospital to support the work of clinical pharmacists.
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OBJECTIVE:To investigate the cognition of medical staff's cognition on clinical pharmaceutical care.METHODS:A total of 105 questionnaires collected from the doctors and nurses were subjected to an aggregate analysis in terms of their ultimate educational background,professional title,working lifetime,cognition on clinical pharmaceutical care etc.RESULTS & CONCLUSIONS:Doctors and nurses had positive attitude toward clinical pharmacy care and it is greatly demanded in drug use.Clinical pharmaceutical staff should keep improving their expertise level and strengthen cooperation with medical staff so as to facilitate the development of clinical pharmaceutical care.