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Article(id=1248600568667726520, tenantId=1146029695717560320, journalId=1190317699101192196, issueId=1248600564427280576, articleNumber=1001-2494(2024)05-0457-06, orderNo=null, doi=null, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1693756800000, receivedDateStr=2023-09-04, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1775619173447, onlineDateStr=2026-04-08, pubDate=1709827200000, pubDateStr=2024-03-08, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1775619173447, onlineIssueDateStr=2026-04-08, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1775619173447, creator=13701087609, updateTime=1775619173447, updator=13701087609, issue=Issue{id=1248600564427280576, tenantId=1146029695717560320, journalId=1190317699101192196, year='2024', volume='59', issue='5', pageStart='377', pageEnd='468', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1775619172436, creator=13701087609, updateTime=1775619904979, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1248603637019202091, tenantId=1146029695717560320, journalId=1190317699101192196, issueId=1248600564427280576, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1248603637023396396, tenantId=1146029695717560320, journalId=1190317699101192196, issueId=1248600564427280576, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=457, endPage=462, ext={EN=ArticleExt(id=1248600569011659457, articleId=1248600568667726520, tenantId=1146029695717560320, journalId=1190317699101192196, language=EN, title=Advances in International Pharmaceutical Practice Research and Implications for the High-Quality Development of Pharmaceutical Care in China, columnId=null, journalTitle=Chinese Pharmaceutical Journal, columnName=null, runingTitle=null, highlight=null, articleAbstract=

OBJECTIVE To provide suggestions for the further development of pharmacy practice research and high-quality development of pharmaceutical care in China. METHODS With comprehensive literature review, relevant websites and conference reports, this paper reviewed the progress of research on pharmacy practice in the world, and summarized the enlightenment to China. RESULTS Pharmacy practice research belongs to a sub-direction of health service research, which has been developing globally for more than 50 years, and focuses on analyzing and evaluating the value of pharmacy practice with scientific methods, which is of great importance to improve the quality of pharmaceutical work, explore new pharmaceutical care models. China is in the initial stage, we should combine the international development experience, explore the methodology suitable for China, organically combine practice and scientific research. CONCLUSION Pharmacy practice research is the necessary basis for the further development of pharmacy practice. China should keep up with the international pace, gradually establish a standardized pharmacy practice research system, and promote the high-quality development of pharmaceutical care.

, correspAuthors=Bikui ZHANG, Jie PAN, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Jiangyujing BIAN, Hongyan GU, Hao LU, Junjie PAN, Zhanhong HU, Yunli YU, Ping XU, Bikui ZHANG, Jie PAN), CN=ArticleExt(id=1248600571247223514, articleId=1248600568667726520, tenantId=1146029695717560320, journalId=1190317699101192196, language=CN, title=国际药学实践研究进展及对我国药学服务高质量发展的启示, columnId=1190352405612040510, journalTitle=中国药学杂志, columnName=论著, runingTitle=null, highlight=null, articleAbstract=

目的 为我国药学实践研究和药学服务高质量发展提供决策建议。方法 查阅文献、相关网站及会议报道,综述国际药学实践研究的进展,总结对我国的启示。结果 药学实践研究属于卫生服务研究的一个子方向,在国际上已有50多年的发展历程,重点是用科学的方法对药学实践的价值进行分析与评估,对于提升药学工作质量、探索新的药学服务模式、促进药学服务高质量发展至关重要。我国在该领域的发展正处于起步阶段,应结合国际发展经验,探索适合我国的方法论,将实践与科研有机结合。结论 药学实践研究是药学实践进一步发展的必要依据,我国应紧跟国际步伐,逐步建立规范化的药学实践研究体系,促进药学服务高质量发展。

, correspAuthors=张毕奎, 潘杰, authorNote=null, correspAuthorsNote=
*张毕奎,男,博士,主任药师 研究方向:临床药学 Tel:(0731)85295888;
潘杰,男,硕士,主任药师 研究方向:临床药学 Tel:(0512)67783422
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边江瑜婧,女,硕士研究生 研究方向:临床药学

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边江瑜婧,女,硕士研究生 研究方向:临床药学

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边江瑜婧,女,硕士研究生 研究方向:临床药学

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Amsterdam: Oliver Walter, 2019:1-569., articleTitle=null, refAbstract=null), Reference(id=1248642351321731280, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1248600568667726520, doi=null, pmid=null, pmcid=null, year=2016, volume=11, issue=3, pageStart=e0150205, pageEnd=null, url=null, language=null, rfNumber=[29], rfOrder=28, authorNames=ELDRIDGE S M, LANCASTER G A, CAMPBELL M J, journalName=PLoS One, refType=null, unstructuredReference=ELDRIDGE S M, LANCASTER G A, CAMPBELL M J, et al. Defining feasibility and pilot studies in preparation for randomised controlled trials: development of a conceptual framework[J]. PLoS One, 2016, 11(3):e0150205., articleTitle=Defining feasibility and pilot studies in preparation for randomised controlled trials: development of a conceptual framework, refAbstract=null), Reference(id=1248642351405617363, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1248600568667726520, doi=null, pmid=null, pmcid=null, year=2023, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[30], rfOrder=29, authorNames=HOLLAND R, BOND C, ALLDRED D P, journalName=BMJ, refType=null, unstructuredReference=HOLLAND R, BOND C, ALLDRED D P, et al. Evaluation of effectiveness and safety of pharmacist independent prescribers in care homes: cluster randomised controlled trial[J]. BMJ, 2023, 380:e071883., articleTitle=Evaluation of effectiveness and safety of pharmacist independent prescribers in care homes: cluster randomised controlled trial, refAbstract=null), Reference(id=1248642351493697750, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1248600568667726520, doi=null, pmid=null, pmcid=null, year=2023, volume=401, issue=10374, pageStart=347, pageEnd=356, url=null, language=null, rfNumber=[31], rfOrder=30, authorNames=SWEN J J, VAN DER WOUDEN C H, MANSON L E, journalName=Lancet, refType=null, unstructuredReference=SWEN J J, VAN DER WOUDEN C H, MANSON L E, et al. A 12-gene pharmacogenetic panel to prevent adverse drug reactions: an open-label, multicentre, controlled, cluster-randomised crossover implementation study[J]. 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JAMA, 2018, 320(18):1889-1898., articleTitle=Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults: the D-PRESCRIBE randomized clinical trial, refAbstract=null), Reference(id=1248642351762133214, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1248600568667726520, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[33], rfOrder=32, authorNames=DING H H, LU H, GU H Y, journalName=Chin J Hosp Pharm, refType=null, unstructuredReference=DING H H, LU H, GU H Y, et al. Analysis of the Awarded Pharmacy Administration Grants from National Natural Science Foundation of China from 2015 to 2020[J/OL]. Chin J Hosp Pharm(中国医院药学杂志),2023 [2023-09-28]. https://kns.cnki.net/kcms/detail/42.1204.R.20230824.1939.008.html., articleTitle=中国医院药学杂志, refAbstract=null), Reference(id=1248642351850213602, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1248600568667726520, doi=null, pmid=null, pmcid=null, year=2008, volume=299, issue=24, pageStart=2857, pageEnd=2867, url=null, language=null, rfNumber=[34], rfOrder=33, authorNames=GREEN B B, COOK A J, RALSTON J D, journalName=JAMA, refType=null, unstructuredReference=GREEN B B, COOK A J, RALSTON J D, et al. Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial[J]. JAMA, 2008, 299(24):2857-2867., articleTitle=Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial, refAbstract=null), Reference(id=1248642351938293988, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1248600568667726520, doi=null, pmid=null, pmcid=null, year=2023, volume=58, issue=6, pageStart=537, pageEnd=543, url=null, language=null, rfNumber=[35], rfOrder=34, authorNames=ZHANG C G, WU Q, WEI W, journalName=中国药学杂志, refType=null, unstructuredReference=ZHANG C G, WU Q, WEI W, et al. Practice of hierarchical pharmaceutical care model in patients with systemic lupus erythematosus[J]. Chin Pharm J(中国药学杂志), 2023, 58(6):537-543., articleTitle=Practice of hierarchical pharmaceutical care model in patients with systemic lupus erythematosus, refAbstract=null), Reference(id=1248642352022180071, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1248600568667726520, doi=null, pmid=null, pmcid=null, year=2022, volume=57, issue=12, pageStart=986, pageEnd=990, url=null, language=null, rfNumber=[36], rfOrder=35, authorNames=FU Y, SUN X S, FENG X, journalName=中国药学杂志, refType=null, unstructuredReference=FU Y, SUN X S, FENG X. Application of continuous pharmaceutical care in gynecological tumor patients undergoing chemotherapy[J]. 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年份/年 国家 参考依据 定义
1997 英国 英国皇家药学会(RPSGB)
会议报告		 试图宣贯和理解药学及其实践方式的研究,以支持药学实践的目标,并确保药师的知识和技能在解决保健服务问题和满足人口健康需求方面得到最有效的利用
2006 加拿大 期刊文章 药学实践研究被定义为卫生服务研究的1个方向,重点是对药学实践的评估和评价,它包括在多种不同层面上评估药师的角色价值。这些研究包括针对体系的研究、以患者为中心的研究和以社区为基础的研究,涵盖各种健康决定因素及其对患者结果和人群健康的影响[8]
2010 英国 书籍 药学实践研究是药学服务、药物使用、专业实践和教育研究的总称。对药学实践和药物使用的研究被视为卫生服务研究的1个分支[9]
2014 荷兰 综述 药学实践研究可分为两个主要主题:①以药学为数据源的研究(例如,关于处方行为或药物使用的研究);②以药学为研究对象的研究(例如,关于药学部门内部流程、指南依从性或药学服务质量的研究)[3]
2014 冰岛 期刊文章 药学科学领域的研究,将自然科学与社会和人文研究相结合,研究药物、患者和药师在医疗保健部门和整个社会中的作用[10]
2015 卡塔尔 综述 “药学实践研究”是指与药学实践或患者监护有关的任何研究活动,包括但不限于临床和循证研究、卫生服务研究和有效性评价研究[11]
2015 新西兰 书籍 药学实践研究是卫生服务研究中的1个子方向,其重点是探索人们如何以及为什么获得药学服务、药学服务的成本以及这些服务对患者的影响,并将这些成本和结果与其他提供者提供的相同或类似服务进行比较[12]
2016 新西兰 期刊文章 许多药学实践研究者将他们的工作定义为药物使用评价(DUR)、临床药学、社会药学、药物政策、卫生服务研究或卫生经济学的一部分[13]
), ArticleFig(id=1248642348083728465, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1248600568667726520, language=CN, label=表1, caption=

各国对药学实践研究的定义

, figureFileSmall=null, figureFileBig=null, tableContent=
年份/年 国家 参考依据 定义
1997 英国 英国皇家药学会(RPSGB)
会议报告		 试图宣贯和理解药学及其实践方式的研究,以支持药学实践的目标,并确保药师的知识和技能在解决保健服务问题和满足人口健康需求方面得到最有效的利用
2006 加拿大 期刊文章 药学实践研究被定义为卫生服务研究的1个方向,重点是对药学实践的评估和评价,它包括在多种不同层面上评估药师的角色价值。这些研究包括针对体系的研究、以患者为中心的研究和以社区为基础的研究,涵盖各种健康决定因素及其对患者结果和人群健康的影响[8]
2010 英国 书籍 药学实践研究是药学服务、药物使用、专业实践和教育研究的总称。对药学实践和药物使用的研究被视为卫生服务研究的1个分支[9]
2014 荷兰 综述 药学实践研究可分为两个主要主题:①以药学为数据源的研究(例如,关于处方行为或药物使用的研究);②以药学为研究对象的研究(例如,关于药学部门内部流程、指南依从性或药学服务质量的研究)[3]
2014 冰岛 期刊文章 药学科学领域的研究,将自然科学与社会和人文研究相结合,研究药物、患者和药师在医疗保健部门和整个社会中的作用[10]
2015 卡塔尔 综述 “药学实践研究”是指与药学实践或患者监护有关的任何研究活动,包括但不限于临床和循证研究、卫生服务研究和有效性评价研究[11]
2015 新西兰 书籍 药学实践研究是卫生服务研究中的1个子方向,其重点是探索人们如何以及为什么获得药学服务、药学服务的成本以及这些服务对患者的影响,并将这些成本和结果与其他提供者提供的相同或类似服务进行比较[12]
2016 新西兰 期刊文章 许多药学实践研究者将他们的工作定义为药物使用评价(DUR)、临床药学、社会药学、药物政策、卫生服务研究或卫生经济学的一部分[13]
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国际药学实践研究进展及对我国药学服务高质量发展的启示
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边江瑜婧 1 , 顾红燕 2 , 陆浩 3 , 潘俊杰 1 , 胡展红 1 , 俞蕴莉 1 , 徐萍 4 , 张毕奎 4, * , 潘杰 1, *
中国药学杂志 | 论著 2024,59(5): 457-462
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中国药学杂志 | 论著 2024, 59(5): 457-462
国际药学实践研究进展及对我国药学服务高质量发展的启示
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边江瑜婧1, 顾红燕2, 陆浩3, 潘俊杰1, 胡展红1, 俞蕴莉1, 徐萍4, 张毕奎4, *, 潘杰1, *
作者信息
  • 1 苏州大学附属第二医院药学部, 江苏 苏州 215000
  • 2 首都医科大学附属北京世纪坛医院药学部, 北京 100038
  • 3 壹正医院管理发展(北京)中心, 北京 100020
  • 4 中南大学湘雅二医院药学部, 长沙 410011

    • 边江瑜婧,女,硕士研究生 研究方向:临床药学

通讯作者:

*张毕奎,男,博士,主任药师 研究方向:临床药学 Tel:(0731)85295888;
潘杰,男,硕士,主任药师 研究方向:临床药学 Tel:(0512)67783422
Advances in International Pharmaceutical Practice Research and Implications for the High-Quality Development of Pharmaceutical Care in China
Jiangyujing BIAN1, Hongyan GU2, Hao LU3, Junjie PAN1, Zhanhong HU1, Yunli YU1, Ping XU4, Bikui ZHANG4, *, Jie PAN1, *
Affiliations
  • 1 Department of Pharmacy, The Second Affiliated Hospital of Soochow University, Suzhou 215000, China
  • 2 Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
  • 3 Intemed Hospital Management Development (Beijing) Center, Beijing 100020, China
  • 4 Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha 410011, China
出版时间: 2024-03-08
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摘要
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目的 为我国药学实践研究和药学服务高质量发展提供决策建议。方法 查阅文献、相关网站及会议报道,综述国际药学实践研究的进展,总结对我国的启示。结果 药学实践研究属于卫生服务研究的一个子方向,在国际上已有50多年的发展历程,重点是用科学的方法对药学实践的价值进行分析与评估,对于提升药学工作质量、探索新的药学服务模式、促进药学服务高质量发展至关重要。我国在该领域的发展正处于起步阶段,应结合国际发展经验,探索适合我国的方法论,将实践与科研有机结合。结论 药学实践研究是药学实践进一步发展的必要依据,我国应紧跟国际步伐,逐步建立规范化的药学实践研究体系,促进药学服务高质量发展。

药学实践研究  /  药学服务  /  药学价值  /  临床药学  /  医院药学

OBJECTIVE To provide suggestions for the further development of pharmacy practice research and high-quality development of pharmaceutical care in China. METHODS With comprehensive literature review, relevant websites and conference reports, this paper reviewed the progress of research on pharmacy practice in the world, and summarized the enlightenment to China. RESULTS Pharmacy practice research belongs to a sub-direction of health service research, which has been developing globally for more than 50 years, and focuses on analyzing and evaluating the value of pharmacy practice with scientific methods, which is of great importance to improve the quality of pharmaceutical work, explore new pharmaceutical care models. China is in the initial stage, we should combine the international development experience, explore the methodology suitable for China, organically combine practice and scientific research. CONCLUSION Pharmacy practice research is the necessary basis for the further development of pharmacy practice. China should keep up with the international pace, gradually establish a standardized pharmacy practice research system, and promote the high-quality development of pharmaceutical care.

pharmacy practice research  /  pharmaceutical care  /  pharmaceutical value  /  clinical pharmacy  /  hospital pharmacy
边江瑜婧, 顾红燕, 陆浩, 潘俊杰, 胡展红, 俞蕴莉, 徐萍, 张毕奎, 潘杰. 国际药学实践研究进展及对我国药学服务高质量发展的启示. 中国药学杂志, 2024 , 59 (5) : 457 -462 .
Jiangyujing BIAN, Hongyan GU, Hao LU, Junjie PAN, Zhanhong HU, Yunli YU, Ping XU, Bikui ZHANG, Jie PAN. Advances in International Pharmaceutical Practice Research and Implications for the High-Quality Development of Pharmaceutical Care in China[J]. Chinese Pharmaceutical Journal, 2024 , 59 (5) : 457 -462 .
正文
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近年来,随着人民群众合理用药需求的不断增加,以及医药卫生体制改革的逐步深化,国家卫生健康委员会出台了多项关于药学服务高质量发展的政策,高度关注药学实践的相关工作。药学实践是药师进行各类专业实践活动的统称,其目标是提供药物及相应服务,从而帮助个体和社会最大程度上从用药中受益。药师是提供药学服务的重要医务人员,是实现安全有效经济用药目标不可替代的专业队伍,在促进药学事业发展的过程中,必然会更加关注药学实践的必要性、有效性和成本等方面的信息。然而,这些结果并不能凭个别经验或过时的法规来界定,需要的是以证据为基础的药学实践[1],这种基于循证的实践过程对于提供最佳的药学服务至关重要,药学实践研究可以在这方面发挥关键作用[2],它既可以确认已有实践活动的价值或可行性,也可以为一些新政策或创新实践提供评估结果,是药学实践进一步发展的必要依据[3]。
在国际上,随着20世纪末期药学实践的不断发展,药学实践研究也逐渐成为一个公认的研究领域,有着近50年的发展历程,各国药学相关组织也对其提出了相应的定义[3-4]并稳步发展。相比之下,国内药学服务工作对临床、社会的获益少有系统的研究,在论文发表及国际合作方面的成果屈指可数[5]。在全力发展卫生健康事业,建设“健康中国”的战略形势下,紧跟国际前沿、拓展研究思路、提升药学实践研究能力,对当代药师来说责无旁贷。本文综述了国际药学实践研究的进展,并结合我国的实际,为国内药学实践研究的进一步发展提供决策建议。
1 药学实践研究的定义
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在药学实践研究的发展历程中,各国相继提出概念(表1),英国、加拿大及新西兰均将药学实践研究描述为卫生服务研究的一个领域,表明该研究在方法和理论上借鉴了经济学、社会学、人类学、心理学、统计学和计算机等其他学科。2019年,国际药学联合会(FIP)[4]提出了药学实践研究的国际通用[6-7]定义:“药学实践研究着眼于药学对医疗体系,药品使用和患者监护的影响。在过去的50年里,它的范围已经扩展到药学实践研究对于临床、行为、经济和人文等方面的影响,以及药学实践的革新和创新服务的发展与实施。”该定义将主题分为医疗体系、药品使用、患者监护三大类,全面地涵盖了药学工作的范围,且描述到近年来药学实践研究的发展,不仅停留在对临床影响的评估,还从药学实践带来的经济和社会效益等各个方面都开展科学、全面的研究,充分探讨药师的价值,以促进药学实践的发展、改革与创新。同时,药学实践的研究范围也不局限于医疗机构,而是包括社区药房等提供药学服务的各个区域。因此,为表明本文探讨的概念范畴,笔者也结合Hasan等[7]对药学实践及其研究的总结,描述了药学实践的研究范围(图1)。
2 国际药学实践研究的发展历程
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20世纪末是药学实践研究发展的萌芽期,为了证明药学服务的价值,促进药学工作的多样化和高质量发展,药学实践研究的理念逐渐受到重视,在提升药学实践水平、开展创新药学服务等方面发挥着重要作用,多国学者对其定义及研究理论进行探讨。1986年,英国Nuffield基金会[14]在多位药师和医生的讨论下,充分认可了药学服务的价值,并首次倡导开展药物社会学研究。1991年,佛罗里达大学的Charles D. Hepler教授[15]提出了药学服务项目评估的概念,并对改进研究设计提出了有益的建议,在1993年至1996年,他还主持了由FIP在东京、欧洲等地举办的药学服务项目,极大地推动了药学实践研究的发展。1994年,Nick Mays在曼彻斯特大学的药学实践研究资源中心平台上发表论文,提出应该利用社会学理论来解释药学实践研究,使这一概念有了更深入的认知[7]。1999年,牛津大学出版了《国际药学实践杂志》(International Journal of Pharmacy Practice,IJPP),发表药学和医疗保健交叉领域的创新研究,同时呼吁开展药学实践研究。2001年,Bissell等[16]着重探讨了社会学在药学实践研究领域的重要性,通过社会学理论对药师服务、患者用药、医药合作等方面的组织和制度结构进行分析,直接促进了药学实践研究的规范化、多样化和可持续性。
进入21世纪,英国、美国、加拿大、澳大利亚等国家有越来越多的学者提出了规范且高效的研究方法,药学实践研究逐渐进入了高速发展的时期。2002年前后,英国伦敦大学的药学教授Felicity Smith于《国际药学实践杂志》期刊上发表系列文章[17-19],并出版了专著《药学实践的研究方法》[20],收录了药学实践研究人员在评价药学服务时所采用的方法,概述了应如何开展实践研究项目。2015年,Zaheer Babar在他出版的《药学实践研究方法》[12]中详细讨论了其理论、方法、模型和技术,并指出药学实践研究的发展已趋于成熟。2019年,Austin和Sutton[21]出版了《药学实践研究方案—让方法及应用变得简单》专著,此书解释了药学实践研究的基本概念,它基于案例及循证研究方法,描述了一系列定性或定量的研究方案,为药学实践研究发展提供了重要参考。
随着概念的逐渐清晰,方法论上的不断发展, FIP在2018年至2023年期间举行了四次以药学实践研究为主题的国际会议。在2023年7月于西班牙举办的国际药学实践研究夏季会议[22]中,主要以 “药学实践和卫生服务研究中的证据综合”“健康经济学的基本原则”“药物流行病学和药物依从性”和“研究药师处方和轻微疾病的趋势”四个话题展开研讨,可见研究内容也在不断细化和深入。2020年,Sinaa AL-Ageel等[5]通过对19本药学实践期刊近十年的文章进行检索,纳入了来自116个不同国家的一万多篇文章,研究表明有1 670篇凝结了多国合作的药学实践研究成果,且这些文章被引率更高。可见国际研究合作是资源、技能和专业知识的共享,这对于药学实践研究的发展至关重要,同时推动着药学实践的高质量发展,对全球卫生服务做出了不可或缺的贡献。
3 药学实践研究的最新发展策略
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随着药学实践研究的不断发展,其内容与方法也逐渐成熟。2020年,澳大利亚、加拿大、欧洲等国的学者联合发表了“Pharmacy Practice Research-A call to Action ”一文[23],根据英国医学研究理事会(MRC)发布的评估复杂干预措施的框架和相应方法[24-26],提出了适用于药学实践研究的五个重点方向,呼吁药学实践研究人员的目光不应该局限于评估阶段,他们可以在这些实践的规划和执行中参与许多阶段,包括医疗需求评估、项目发展、评估、实施和可持续性研究,见图2。第一,在开展任何健康干预或病人照护服务之前,药学实践研究人员必须确定和量化社会健康需求,这些需求可以从药学服务或更广泛的医疗保健中受益,这样的评估会为设计满足病人和人口需求的干预措施提供明确的目标。第二,在干预发展的阶段,需要确定相关证据,评估其他国家的类似服务,并探索在特定背景下的实际可行性,由于国家之间的政策和背景不同,要避免对干预设计的生搬硬套。第三,评估阶段如上文所述,在药学实践研究中至关重要,可以为干预效益提供证据,并说服潜在的服务获益者、决策者和其他利益攸关方支持其未来的实施,通常使用Kozma等[27]的ECHO(Economic, Clinical, Humanistic Outcomes)模型来实现。第四,有效的执行是所有工作的关键,实施科学的出现就是为了将基于证据的创新纳入实践,例如行列式框架、经典理论和实施理论,及一系列结果指标(例如,可接受性、采用、适当性、成本、可行性)的评估,用于确定实施的成功。第五,可持续性似乎是由常规化和制度化两个方面所定义的,它是一个动态过程,对服务绩效进行评价和持续监测是确保服务有效运作和产生预期结果的关键。
药学实践研究的方法包括定量和定性分析,通常以定量方法为主,对定性结果进行补充,提供频率、普遍性和规模的估计,量化研究结果[12]。例如,在有关用药问题的研究中首先进行定性研究,引出患者的用药体验,进一步生成定量研究的结构或项目,如患者用药统计调查。在Zaheer-Ud-Din Babar 著作的《药学实践研究方法》[12]及《药学实践和临床药学百科全书》[28]中,均对方法论做出了详细的介绍,将其分为非实验研究和实验研究两部分,主要包括观察法、数据分析法、调研问卷法、随机对照法试验等,通过结合社会学、经济学和流行病学的研究思路,规范了药学实践研究的方法,从而得出更加严谨可靠的结果。
在药学实践研究的评估阶段,大多学者会首先考虑流行病学的研究方法,目前仍以随机对照试验作为评估卫生服务效果的金标准[29]。例如,Holland等[30]发表于英国医学期刊(BMJ)的研究,采用整群随机对照的方法,评估了药师作为养老院独立处方开具人员的有效性及安全性,研究显示该项干预降低了药物的经济负担指数,促进合理用药,同时改善了老人的健康结局。Swen等[31]在7个欧洲国家的18家医院、9个社区卫生中心和28个社区药房进行了一项开放标签、多中心、整群随机对照的交叉试验,将参与者根据基因分型,成立药物基因遗传学小组进行药学干预,研究表明使用药学基因型引导治疗显著降低了临床相关药物不良反应的发生率。
4 启示与实践
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4.1 对我国药学服务高质量发展的启示
2018年,国家卫生健康委员会发布了《关于加快药学服务高质量发展的意见》,明确提出要进一步提高对药学服务重要性的认识、推进分级诊疗建设、加快药学服务转型、加强药师队伍建设、积极推进“互联网+药学服务”健康发展。我们通过国际药学实践的发展经验可知,药学实践研究可以针对政策中重点方向进行分析,以科学的方法提供循证依据,从而响应国家号召,推动药学服务的高质量发展,以下从两方面进行论述。
第一,在提高对药学服务重要性的认识、充分调动药师队伍积极性、加快药学服务转型的方面,药学实践研究是证明服务效果和药师价值的关键。大多数药学实践研究的文章都论证了这一点,例如发表在美国医学会杂志(JAMA)期刊上的文章显示,Martin等[32]采用随机临床对照试验的方法,对药师干预老年人不合理药物处方的实践进行研究,表明与常规照护相比,药剂师主导的教育干预会改善更多不合理处方。Ding等[33]围绕药学实践研究相关主题分析了国家自然科学基金管理科学部项目获批情况,2015—2020年的中标主题热点包括“抗菌药物管理”“药品不良反应”“基本药物”和“药品供应”和“用药依从性” 等方面,此类药学实践研究项目获批不仅可以提升药师日常工作与科研的结合度,也能促进药师队伍的建设以及高质量科研成果的产出。
第二,在具体推进分级诊疗建设及“互联网+药学服务”健康发展的方面,依据图2所示的药学实践研究的战略领域,药学实践研究可以全流程对未满足的医疗健康需求进行研究,包括通过试验、分析等方法,评估创新药学干预的影响,探索更优的服务模式,如优化药品供应机制、远程会诊、慢病管理等,促进构建上下贯通的药学服务体系。例如JAMA中另一篇药学实践研究文章显示,美国一家医学中心采用随机对照试验的方式,评估使用患者网络服务、家庭血压监测和药师辅助管理的新型管理模式是否能改善血压控制[34],结果显示互联网+药师服务的干预组显著提高了血压达标率,表明通过安全的患者网络通信提供药师管理可改善高血压患者的血压控制。
4.2 如何开展药学实践研究
近年来,国内对药学实践的研究也逐渐增加,例如:Zhang等[35]对530例系统性红斑狼疮的患者随机分组,基于知信行干预理论,在干预组患者中依据分级药学服务标准给予不同级别的药学服务,研究表明该干预有利于药师快速筛选出需要重点干预的患者并采取针对性的干预措施。然而,我国相关的研究文献较少,与国际上有一定差距,在推进药学服务质量的同时,发展药学实践研究也同样重要。下文参考国际经验,对如何发展药学实践研究提出了三点建议。
首先,开展药学实践研究的首要工作就是明确其定义、范围及实际意义,因此,在后续研究中,我们呼吁国内权威专家创建标准化术语,使用一致的关键词和同义词库,利于药学期刊的研究传播,以建立更加完整的知识体系,有利于其进一步发展。
其次,药学实践研究常被认为是一门“软科学”[23],在药学教育中的占比较小,与其他专业性较强的药学课程不同,它整合了药学及以外多种学科的概念和方法,如心理学、社会学、药物经济学或公共卫生学,促进了跨学科的合作,可以有效提高药学工作者的实践科研能力。因此,在药学教育中增加对药学实践研究的推广和发展,可以支持教学、实践和研究的紧密结合,促进药学实践工作的高效发展。
最后,在构建药学实践研究体系的基础上,也应针对各个药学实践的领域进行全面深入的探索,例如药师服务、个体化及精准用药技术、患者用药和医生处方行为的分析、药品供应、药物经济学及综合评价等方面。国内针对医院药学服务的研究[35-36]相对较多,但国际上对于药学实践的研究[30-32]范围更广,规模更大,且不同国家之间合作更多,推动着药学实践更高效地发展。这也是本文的局限性,未系统地总结和比较国内外药学实践研究的差距,提供具体的开展方向和措施。
5 小结
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在国际上,药学实践研究已有近50年的发展,它确认了药师的角色和服务的价值,对于提升药学工作质量、探索新的药学服务模式至关重要。我国的药学实践研究目前还处于起步阶段,有必要借鉴国际经验,推动药学实践研究发展,将实践与科研有机结合,形成创新、实用、服务型药学体系。随着国际上药学实践研究相关知识的更新和我国对药学人才要求的提高,本文呼吁更多权威的专家拟定适用于我国的定义,增强这一概念在业内的接受程度。同时,为了更好地落实国内药学实践研究的推广与实施,我们还需要全面深入地了解当下我国在药学实践各领域的研究现状,明确哪些领域的研究紧跟国际步伐,哪些领域仍有较大差距,有的放矢地推动药学实践研究方向的发展。最后,我们需要不断探索适合我国的方法论,逐步建立规范化的药学实践研究体系,进一步推动我国药学服务的高质量发展。
基金
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  • 苏州大学附属第二医院学科建设托举工程项目资助(XKTJ-XK202010)
文献
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  • 接收时间：2023-09-04
  • 首发时间：2026-04-08
  • 出版时间：2024-03-08
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  • 收稿日期：2023-09-04
基金
苏州大学附属第二医院学科建设托举工程项目资助(XKTJ-XK202010)
作者信息
    1 苏州大学附属第二医院药学部, 江苏 苏州 215000
    2 首都医科大学附属北京世纪坛医院药学部, 北京 100038
    3 壹正医院管理发展(北京)中心, 北京 100020
    4 中南大学湘雅二医院药学部, 长沙 410011

通讯作者:

*张毕奎,男,博士,主任药师 研究方向:临床药学 Tel:(0731)85295888;
潘杰,男,硕士,主任药师 研究方向:临床药学 Tel:(0512)67783422
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https://castjournals.cast.org.cn/joweb/zgyxzz/CN/1248600568667726520
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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