上海市社区药学服务开展现状及药师 融入家庭医生团队情况研究
背景 目前，居民多重用药现象普遍，由于缺少药物重整和全程的用药管理，不安全用药风险较大。 由具有区域优势的社区卫生服务中心提供社区药学服务，符合其功能定位，但是社区卫生服务中心药学服务供给与民 众需求仍存在较大差距。目的 了解上海市社区药学服务现况、药师融入家庭医生团队情况，以及社区药学服务面临 的问题，以期为推动社区药学服务发展提供建议。方法 采用定性研究和定量研究相结合的方法。2020 年 12 月采用 分层抽样的方法对中心城区 6 家、近城区 8 家、远城区 15 家，共 29 家社区卫生服务中心 307 名具有执业药师资格的 在岗从事药学工作的人员开展问卷调查，调查内容包括药学人员基本情况、社区药学服务开展情况、社区药师参与家 庭医生团队情况等。同期采用便利抽样的方法，邀请了中心城区、近城区、远城区药剂科科长 11 人、家庭医生代表 6 人、 社区中心主任及卫生健康委员会管理人员 12 人，共 29 名关键知情人，围绕药学服务需求、药学资源配置、药学服务 过程 3 方面进行半结构化焦点访谈。结果 定量研究结果显示，社区药师参与培训以 1~2 次占比最高〔139 名（45.3%）〕， 培训形式以继续教育为主〔252 名（82.1%）〕。社区药师开展药学服务项目最多的 3 项分别为处方调剂〔284 名（92.5%）〕、 处方审核〔253 名（82.4%）〕、药学窗口或门诊咨询指导〔196 名（63.8%）〕。占据药师服务时长最长 3 项分别为 处方调剂〔280 名（91.2%）〕、处方审核〔244 名（79.5%）〕、处方点评〔145 名（47.2%）〕。有 78 名（25.4%） 药师加入了家庭医生团队。定性研究结果显示：在社区居民药学服务需求上，社区老年居民药学服务需求大，但老年人合理用药意识淡薄；在社区药学资源配置上，药师数量短缺，专业素质有待提升，社区药学药品目录不齐，信息化 作用有待加强；在社区药学服务过程中，社区药师认可度不高，服务内容单一，针对性的合理用药培训相对较少，药 师未能在家庭医生团队中发挥作用。结论 目前，社区药学服务资源配置和供给能力无法满足居民需求，药学服务服 务过程还需完善、优化。仅有部分药师加入家庭医生团队，在团队中发挥作用有限，还需加大激励机制，明确服务内容， 完善服务模式。
BackgroundAt presentpolypharmacy is common among residents with high risk of unsafe medication due to the lack of drug reorganization and whole-course drug management. Community pharmacy services provided by community health service centersCHSC with regional advantages is in line with its functional orientationbut there is still a large gap?between the supply of pharmacy services in CHSCs and the demand of the public. ObjectiveTo understand the current situation of community pharmacy services and the integration of pharmacists into family doctor team in Shanghaias well as the problems faced by community pharmacy servicesso as to provide suggestions for promoting the development of community pharmacy services. MethodsA combination of qualitative and quantitative research was adopted. In December 2020a stratified sampling method was used to conduct a questionnaire survey on 307 pharmacy staff on duty with licensed pharmacist qualification from 29 CHSCsincluding 6 in the central urban area8 in the near urban areaand 15 in the far urban area. The questionnaire included the basic information of pharmaceutical staffthe development of community pharmacy servicesand the participation of community pharmacists in the family doctor team. In the same perioda convenience sampling method was used to invite 29 key insidersincluding 11 pharmacy section chiefs6 family doctor representatives12 community center directors and health commission managers from central urban areanear urban area and far urban areato conduct a semi-structured focus interview on pharmacy service needspharmacy resource allocation and pharmacy service process. ResultsThe quantitative research results showed that the highest proportion of community pharmacists participating in training is 1-2 times13945.3% and the main form of training is continuing educationaccounting for 25282.1%. The three most frequently conducted pharmacy service projects by community pharmacists are prescription dispensing28492.5%prescription review253 82.4%and pharmaceutical window or outpatient consultation guidance19663.8%. The three longest service hours occupied by pharmacists are prescription dispensing28091.2%prescription review24479.5%and prescription comment14547.2%. A total of 7825.4% pharmacists joined the family doctor team. The qualitative study showed that the elderly residents in the community had a great demand for pharmacy servicebut their awareness of rational drug use was weak. In the allocation of community pharmacy resourcesthe pharmacists are lacjingthe professional quality needs to be improvedthe community pharmacy drug list remains uncompletedand the role of informatization needs to be strengthened. In the process of community pharmacy servicethe recognition degree of community pharmacists is not highwith single service content and relatively little targeted training on rational drug use and pharmacists fail to play a role in the family doctor team. ConclusionAt presentthe resource allocation and supply capacity of community pharmacy service cannot meet the needs of residentsand the pharmacy service process needs to be improved and optimized. The role played by the only part of pharmacists joining the family doctor team is limited. Thereforeit is necessary to increase the incentive mechanismclarify the service content and improve the service model.
刘锐 1 ，曹宇 2 ，褚爱群 1 ，吴欢云 3*
药学
药学服务社区卫生服务中心家庭医生团队定量研究定性研究
刘锐 1 ，曹宇 2 ，褚爱群 1 ，吴欢云 3*.上海市社区药学服务开展现状及药师 融入家庭医生团队情况研究[EB/OL].(2023-07-26)[2025-08-02].https://chinaxiv.org/abs/202307.00683.点此复制
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