对临床药学焦点问题的认识

对临床药学焦点问题的认识,邵宏史录文北京大学药学院药事管理与临床药学系,主要内容,对临床药学内涵的理解临床药师为谁而工作？临床药师主要干什么？临床药师都在哪里工作？临床药师的水平如何分出高下？行业协会与药师的认证评估我国临床药学的可持续发展,何为临床药学？,ACCP和ESCP的定义：ClinicalPharmacyisacommonlyusedterminpharmacypracticeandinpharmacyliterature形式药学实践(PharmacyPractice)Itdescribestheactivitiesandservicesoftheclinicalpharmacisttodevelopandpromotetherationalandappropriateuseofmedicinalproductsanddevices核心合理用药药学监护(PharmaceuticalCare)necessaryphilosophyandmissionofpharmacypractice,abasicpatientneed临床药学对人，药学对物RevolutionorRenaissance?临床药学是医疗发展的结果,何为临床药师？,美国药学人员的分类Pharmacist(Pharmacyspecialist,ClinicalPharmacist)Pharmacytechnician临床药师PartorFull？FTEPharmacists(FullTimeEquivalent，40hrs/w)临床药师的数量和学位药师的社会地位,临床药师的工作对象与工作性质,工作对象医师or患者?工作性质监管or服务?工作手段工作性质鉴别、解决、预防潜在的或实际发生的DRPs工作目的工作内容改善患者生命质量(qualityoflife),临床药师的工作内容,药师职业角色的发展药学实践(Pharmacypractice)药学实践的几种模式美国药师岗位培训Residency美国药师继续教育规范,临床药师的工作范围,ACCP和ESCPItincludesalltheservicesperformedbypharmacistspractisinginhospitals,communitypharmacies,nursinghomes,home-basedcareservices,clinicsandanyothersettingwheremedicinesareprescribedandused药学实践的主要方向我国现阶段的情况主要在三甲医院,临床药师的工作层次,初级（Fundamental）在对病人提供安全的药学监护中起关键作用18项具体指标中级（Desirable）提供更专业化和专科化的药物治疗学服务13项具体指标高级（Optimal）提供整合的、专业化的和精细的专科服务，旨在通过最高层次的教学、研究和药物治疗实践活动优化药物治疗效果12项具体指标,RudisMIandBrandlKM.CritCareMed2000;28(11):3747南加州大学；新墨西哥州大学,每个等级都包含了4个方面的活动：clinical,educational,administrative,scholarly,行业协会与药师的认证评估,APhAAmericanPharmacistAssociation(1852)NARDNationalAssociationofRetailDruggists(1898)NABPNationalAssociationofBoardsofPharmacy(1904)ACPEAccreditationCouncilforPharmacyEducation(1932)AACPAmericanAssociationofCollegesofPharmacy(1937)ASHPAmericanSocietyofHealth-SystemPharmacists(1942)ASCPAmericanSocietyofConsultantPharmacists(1969)ACCPAmericanCollegeofClinicalPharmacy(1979)AAPSAmericanAssociationofPharmaceuticalScientists(1986)NISPCTheNationalInstituteforStandardsinPharmacistCredentialing(1998)ESCPEuropeanSocietyofClinicalPharmacy,TheBoardofPharmaceuticalSpecialties(B.P.S.)1976NuclearPharmacy(1978)BCNPNutritionSupportPharmacy(1988)BCNSPPharmacotherapy(1988)BCPSPsychiatricPharmacy(1992)BCPPOncologyPharmacy(1996)BCOP,TheCommissionforCertificationinGeriatricPharmacy(C.G.P.)1997,CertifiedDiseaseManager(C.D.M.)ofdiabetes,asthma,dyslipidemia,andanticoagulationtherapy.,2006年美国临床药师工作状况,MacLarenR,RudisMI,etal.AnnPharmacother2006;40:612-8科罗拉多州大学；南加州大学382个医疗机构,我国临床药学的可持续发展,处于初级起始阶段普通药师与临床药师并存，需设立适当门槛，普通药师需经过专门培训合格后方可成为临床药师临床药师社会化由医院临床药师逐渐向社区临床药师发展,我国临床药学的可持续发展,人才培养是可持续发展的根本数量与质量由少而精逐渐往多而专发展大专院校人才储备要多层次多方向培养不同院校应根据自己的特点进行某些层次某些方向的培养明确普及教育与精英教育、理学(学位)教育与专业(职业)教育的不同教学目标和教学方式岗位人才培训将转型培训与继续教育分开转型培训以初级岗位培训项目为主继续教育以中级和高级培训项目为主由全能型培养往方向型培养转换,我国临床药学的可持续发展,相关制度的跟进是可持续发展的保障临床药师岗位制度“编制、配比、分级”从“三无”到“三有”临床药师的“头衔”可以在现有药师职称的基础上附加，无需另设职称认证与评估制度,Helpindividualhospitalinpatientsandnonhospitalizedpatientsachievethebestuseofmedications.Applyevidence-basedmethodstotheimprovementofmedicationtherapy.Improvingthesafetyofmedicationuse.Applytechnologyeffectivelytoimprovethesafetyofmedicationuse.Engageinpublichealthinitiativesonbehalfoftheircommunities.,Thanks!,MONEYMagazine2006CareerSurvey,Pharmacists9/50Stress:BFlexibility:CCreativity:BDifficulty:CTenYearGrowth:24.5%AveragePay:$91,988,临床药师的数量与学位,PhysiciansAttendingFellowResidentInternMedicalstudentPhysicianassistant56:1981-7,TotalPharmacyCare(TPC),美国药师岗位培训Residency,Job(practice)ResidencyPh.D.,Pharm.D.,PharmacistTeacher&ResearcherPharmacytechnician（药技师，无执业药师资格）,PGY1(普通培训)PGY2(专科培训),LicensedPharmacist,Boardcertification,BCPSBCOPBCPPBCNSPBCNP,测试与评估,ResidencyProtestforPharmacokinetics,转科,Resident主要工作内容,药学服务(PharmacyService)查房前更新药历PatientProfile&SOAP随治疗团队常规查房RoundWorksheet上报不良反应报告、用药差错报告实时网络填写相关病例单PharmacistWorksheet提供药物信息和教育向指导药师(Advisor)汇报病例用药医嘱与药学服务PharmacotherapyWorkup24小时On-Call制度和中心药房服务教学活动(EducationalActivities)课堂学习与科研活动(ScholarlyActivities),PatientProfile,SOAP,RoundWorksheet,PharmacistWorksheet,PharmacotherapyWorkup(1),PharmacotherapyWorkup(2),PharmacotherapyWorkup(3),Resident部分课程,MedicalLibraryandResourcesMedicationHistoriesAnemiaProtocol,IntensiveInsulin,SedationPediatricOverviewPharmacokineticServicesIVCompounding/SterileTechniquesNutritionSupportServicesPharmacistCareDiabetesClassPharmacistCareCardiovascularClassAnticoagulationclinicPharmacyAdministrationSTLC(ScholarshipofTeaching&LearningCertificateProgram)PharmacyGrandRounds（每周1次）,STLC(ScholarshipofTeaching&LearningCertificateProgram),Ph