| Objective:This study is based on the background of high-quality development of public hospitals,and a field survey on the current state of development of clinical pharmaceutical services in Guizhou provincial secondary or higher hospitals,Understand their cognition of clinical pharmacy services from the perspective of pharmaceutical staff,clinicians and nursing staff,Understand the medical staff’s demand for clinical pharmacy services,To explore the influencing factors affecting the attitude towards the prospect of their professional development and the influencing factors affecting the collaboration with medical and nursing workers from the perspective of pharmaceutical workers,In view of the existing problems,this paper puts forward countermeasures and suggestions to improve the capacity of clinical pharmacy services in Guizhou Province,so as to promote the high-quality development of pharmaceutical services in hospitals above the second level in Guizhou Province.MethodsUsing a cluster random sampling method,five Prefecture Cities / counties in Guizhou Province(Guiyang,Zunyi,Tongren,Bijie,Ansun)were selected from January 2022 to March 2022.A total of 15 hospitals(5 tertiary and 10secondary)were selected from 2-4 hospitals in each region for investigation.The responsible person of the surveyed department was contacted and the questionnaires were distributed in each department to collect questionnaires from clinicians,nursing,and pharmacy staff.The main points include: the work development situation and self perception of pharmaceutical staff,the factors affecting optimism about the career prospects of clinical pharmacists,the medical and pharmaceutical staff’s perception of clinical pharmaceutical services(the concept of clinical pharmaceutical services,the requirements of regulations,the development trend,and the work content),the medical and nursing staff’s need for clinical pharmaceutical services,and the medical and nursing staff’s implementation of effect evaluation on clinical pharmaceutical services.The collected survey data were collected with Epidata 3.1 software entry,and the database was established and statistical analysis was performed with SPSS20.0 statistical software.The statistical description of the qualitative data was expressed in a composition ratio,and the statistical description of the quantitative data was expressed in a (?)±s representation.By rank sum test,one-way ANOVA,χ~2 The test performed the analysis of the results;Binary as well as ordinal logistic regression and multiple linear regression analyses were used to analyze the key influencing factors and their correlations.Results:1、circumstances under which clinical pharmacy services are carried outIn general,the pharmaceutical staff in this survey is mainly female(65.2%),the staff is mostly young pharmacists(84%),the proportion of junior high school pharmacists is large(81.3%),the education is mostly concentrated in undergraduate(76.2%),the majority of specialized pharmacy(68%),the proportion of pharmacy staff in survey hospitals is relatively large(63.5%),the proportion of staff in clinical pharmacists is small(21%),and the clinical pharmacists all carry out prescription review The clinical ward,consultation,inpatient order audit,individualized medication guidance,drug counseling,adverse reaction monitoring and other work,the ability and development of clinical pharmacy services in the tertiary hospital are overall better than those in the secondary hospital.2、pharmacy staff self perceptionIn pharmacy staff self perception,pharmacist involvement in training was insufficient,31.5% did not participate in any training,26.5% had attended or were attending a pilot base for clinical pharmacist training,25.4% had received pharmacy service related further education or training,and 22.1% had undergone short rounds or training in a department.87.8% believed it was necessary to carry out pharmacy outpatient clinic,75.7% believed it needed home pharmacy services,not many hospitals carried out clinical pharmacy services charges,some hospitals mainly paid pharmacy outpatient clinic,participating consultations,therapeutic drug monitoring and other items,more than 60% of hospital pharmacy personnel think that hospital management personnel support the development of clinical pharmacy services,nearly 40%think that hospital management personnel support the development of clinical pharmacy services but do not pay enough attention to them,and pharmacists think that patients do not understand clinical pharmacy services and their awareness is low,accounting for 86.1%.In the work process,it is considered that the main problems encountered by pharmaceutical staff are insufficient knowledge about themselves and the latest medication use(76.8%),inadequate provision of pharmaceutical information and pharmacy consultations(50.8%),poor communication skills with patients(50.3%),and insufficient cooperation with health care workers(46.4%).It is believed that the main factors constraining the development of clinical pharmacy services are the following: insufficient social awareness and recognition of clinical pharmacy services,patient distrust of clinical pharmacists(76.2%),clinical pharmacists’ accountability regulations and poor management system of clinical pharmacy services(56.4%)and lack of professionals(52.8%).In terms of communication and communication with patients and families,99(54.7%)believed that it was good to communicate with patients and families,76(42.0%)believed that it was general,In terms of communication with medical staff,130people(71.9%)believed that their communication with medical staff was good,47 people(26%)believed that it was average,and those who participate in the review of inpatient medical orders and drug supply believe that they have a high level of cooperation with medical staff.3、influencing factors of optimism about the career prospects of clinical pharmaceutical services for pharmaceutical personnelThe overall optimism of pharmaceutical staff regarding the career prospects of clinical pharmaceutical services univariate analysis of the optimism of pharmaceutical staff regarding the career prospects of clinical pharmaceutical services found that: the results showed that age(χ~2=9.539,P=0.007),technical title(χ~2=9.502,P=0.05).Is there a clinical pharmacy department(χ~2=13.137,P=0.001),job assessment(χ~2= 4.067,P=0.044).Whether to carry out pharmaceutical outpatient service(χ~2= 5.769,P=0.016).Is it helpful to participate in the training(χ~2= 4.928,P=0.035).Is it recommended to adopt it(χ~2= 12.056,P=0.02),Is the treatment consistent with the value of labor(χ~2= 9.356,P=0.003)had a statistically significant impact on occupational optimism in clinical pharmacy services.The binary logistic regression analysis of the single factor meaningful analysis found that age(OR=3.174,95%CI=1.166～8.64,P=0.024),whether training was helpful(OR=3.226,95%CI=1.033～10.077,P=0.044),whether treatment and labor value were the same(OR=3.961,95%CI=1.4～11.21,P=0.01),and whether a special clinical pharmacy department was established(OR=3.744,95%CI=1.26～11.13,P=0.018)were statistically significant.4、healthcare workers,pharmacy staff awareness of clinical pharmacy servicesHealthcare workers,pharmacy staff do not have a high perception of clinical pharmacy services and healthcare workers have a low perception of pharmacy staff.medical staff’s cognition of clinical pharmacy work,in addition to the routine ADR monitoring and prescription comments,also stays in the drug dispensing and pharmacy related management The medical staff of the departments with clinical pharmacists involved in the investigation room have a high awareness of clinical pharmacy services,Among the pharmaceutical staff,those who work in the warehouse have a low understanding of clinical pharmacy service regulations and related requirements,as well as the development trend of clinical pharmacy at home and abroad.the knowledge of the regulations and requirements related to clinical pharmacy services among pharmacy staff at tertiary hospitals is high,and the knowledge of the development trend of clinical pharmacy at home and abroad by pharmacy professionals and clinical medicine is high.5、Healthcare workers’ demand profile for clinical pharmacy servicesIn our survey,more than 93% of the nursing staff needs clinical pharmacists and nurses to guide patients on the correct and reasonable use of medicines,and the training of clinical pharmacists on the preparation and stability of medicines is required,need clinical pharmacists and caregivers to work together to address adverse drug reactions and provide corrective suggestions for medication.so that clinical pharmacists and carers are required to make a good deal of adverse drug reactions as well as some of the suggested corrective opinions on medication.Physicians are most likely to require clinical pharmacists to be well equipped with monitoring of adverse drug reactions,medication errors and harmful events(93.3%),to hold continuing education lectures on the pharmaceutical aspects of clinical practice(90.8%),and to make economic evaluations and recommendations on drugs for clinical use(85.8%).6 、 Evaluation of the effectiveness of implementation of clinical pharmaceutical services by healthcare workers.Healthcare workers rated clinical pharmacists better overall,nursing staff rated medication recommendation adoption toward clinical pharmacists(4.78 ±0.49),clinical pharmacists’ job helpfulness(4.51±0.73),and clinical pharmacists’ job competence(4.22±0.84)the highest,The lowest evaluation of cooperation with nurses(3.9±0.81);Physicians’ ratings of clinical pharmacists’ helpfulness at work(4.66±0.53),adoption of medication recommendations to clinical pharmacists(4.62±0.52)were the highest,and overall evaluations of cooperation with clinical pharmacists were the lowest(4.0±0.73).The main influencing factors affecting the collaboration with nursing are attitude toward the service as well as communication communication situation,timeliness of the service,and training satisfaction are the main influencing factors affecting the collaboration with physicians.Health care workers as well as pharmaceutical staff believe that developing clinical pharmacy services can reduce the occurrence of adverse drug reactions,which can improve the level of medical institution management,improve the efficacy of drug treatment,and improve medication adherence.Conclusions:Clinical pharmacy services in hospitals above the second level in Guizhou Province have been carried out to a certain extent,and there is still a gap in the development of clinical pharmacy services at different levels.In the survey,there are few staff specialized in clinical pharmacy,lack of information operation management,the role of clinical pharmacists in controlling fees under the reform of DIP payment method needs to be played,the related learning and training is insufficient,the salary structure needs to be improved,pharmaceutical personnel lack of professional drug knowledge,and the degree of communication with patients is low It is suggested to expand the breadth and depth of clinical pharmacy services,reasonably allocate medical institutions to engage in clinical pharmacy staff,build smart hospitals,strengthen information management,strengthen professional skills training in pharmaceutical services,establish an appropriate salary evaluation system for pharmaceutical services,and enhance cooperation and exchange between pharmaceutical staff and medical staff,Promote the high-quality development of pharmaceutical services. |
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