Study On The Current Situation And Development Strategy Of Clinical Pharmaceutical Care In Xinjiang

Objective: Under the background of comprehensively implementing the reform of the medical system,in the process of promoting the transformation of hospital service mode,the problems existing in the development of hospital clinical pharmacy in Xinjiang were investigated,the causes of the problems were analyzed,the methods and approaches to solve the problems were discussed,and the development experience of the United States,the United Kingdom and the leading areas in the construction of clinical pharmacy system in China was referred to.Suggestions and countermeasures suitable for the development of clinical pharmacy in Xinjiang were put forward in order to promote the implementation of the collaborative medical system reform of hospital pharmaceutical care mode transformation in Xinjiang.Methods: In this study,literature research,consulting interview,questionnaire and a variety of statistical methods were adopted,including descriptive statistical analysis,t test,variance analysis,Chi-square test,rank sum test,univariate regression analysis,multiple Logistic regression analysis,simple linear regression and multiple linear regression modeling analysis,exploratory factor analysis and confirmatory factor analysis.Results:(1)The construction rate of secondary and tertiary hospitals in Xinjiang was lower than the national level in data information department,centralized intravenous drug dispensing room and "management system for clinical pharmacy and pharmaceutical research work",and the difference was statistically significant(P<0.05);The satisfaction of principals of pharmacy departments in secondary and tertiary hospitals in Xinjiang was lower than that of the whole country,and the difference was statistically significant(P<0.05).The percentage of pharmaceutical professionals in Xinjiang was lower than that in the whole country,and the difference was statistically significant(P<0.05).The educational level of pharmacists in Xinjiang secondary hospitals was lower than that in national secondary hospitals and Xinjiang tertiary hospitals,the difference was statistically significant(P<0.05).The educational level of clinical pharmacists needed to be introduced in Xinjiang secondary hospitals was mainly bachelor’s degree,while those in tertiary hospitals were mainly master’s degree,the difference was statistically significant(P<0.05).The professional title and educational level of clinical pharmacists in Xinjiang tertiary hospitals were higher than those in national tertiary hospitals,and the difference was statistically significant(P<0.05).The intensity of clinical pharmacy work in Xinjiang secondary hospitals was lower than that in Xinjiang tertiary hospitals,and the difference was statistically significant(P<0.05).The cognitive level of pharmacy department heads and nonclinical pharmacists in Xinjiang secondary hospitals was lower than the national level,and the difference was statistically significant(P<0.05).The attitude score of pharmacy department heads in tertiary hospitals of Xinjiang was higher than that of the whole country,and the difference was statistically significant(P<0.05).The skill demand of clinical pharmacists in Xinjiang secondary and tertiary hospitals was higher than that in national secondary and tertiary hospitals,but the recognition degree was lower than that in national secondary and tertiary hospitals,and the difference was statistically significant(P<0.05).(2)81.67%of the nonclinical pharmacists had the intention of transformation;The transformation intention of nonclinical pharmacists with different ages,marital status,working years and technical titles had statistical differences(P<0.05).The composition ratio of the two groups with or without the intention of transformation had statistical differences in four aspects: whether they thought the establishment of human resources in the pharmacy department was reasonable,thought the educational level of clinical pharmacists should be introduced,thought the salary level of clinical pharmacists was higher,and whether they had pharmaceutical care experience(P<0.05).There were significant differences in the total scores of pharmaceutical care attitude scale between the willing group and the unwilling group(P<0.05).Multivariate logistic regression analysis showed that experience in providing pharmaceutical care(OR=4.601,95%CI1.13-18.69,P < 0.05)and attitude towards pharmaceutical care(OR=3.302,95%CI1.19-9.19,P < 0.05)/(OR=2.670,95%CI1.098-6.488,P < 0.05)had statistical significance on the transformation intention of nonclinical pharmacists.(3)Pharmaceutical care disorders were different in hospitals of different grades in Xinjiang.The total score of obstacles in secondary hospitals was 61.93±15.45,which was significantly higher than that in tertiary hospitals(54±12.89),with statistical significance(P<0.05).Multiple linear regression model was established,and six factors were selected as influencing factors of pharmaceutical care disorder,including hospital level,monthly income,working hours of pharmaceutical care,reasonable allocation of human resources in the department of pharmacy,whether the professional knowledge of clinical pharmacists met the job demand and the number of pharmaceutical care work types,with statistical significance(P<0.05).(4)87.93%of residents said they had heard of clinical pharmacists,89.3%of residents hoped to obtain pharmaceutical care provided by clinical pharmacists,and 80.51%of residents believed that it was very important for hospitals to provide pharmaceutical care;Residents with different ages,ethnic groups,marital status,children or not,different educational level,annual income,job type,medical insurance type and chronic disease status had different cognition of clinical pharmacist occupation,and the difference was statistically significant(P<0.05).72.92%of residents hoped to be able to consult and instruct drug use in outpatient department,61.88%hoped to be able to guide drug use in hospital,50.12%hoped clinical pharmacists could actively guide drug use.Among residents’ demands for drug information,74.93%wanted to know the effect of drug treatment,61.61%wanted to know the side effects of drugs,and 61.34%wanted to know how to judge the effectiveness of drugs.(5)The overall satisfaction score of clinical pharmacy undergraduates was 4.11±0.60;The entries below 4 are: "Scientific setting of course types and reasonable arrangement of class hours"(3.93±0.85),"reasonable setting ratio of compulsory courses and elective courses"(3.97±0.80),"Teaching content integrates the latest scientific research achievements"(3.98±0.76),"teaching pays attention to providing practical opportunities for students"(3.97±0.85),"satisfaction degree of practical course design arrangement"(3.99±0.82);Multiple linear regression analysis showed that whether clinical pharmacy major was consistent with interest was the influencing factor of overall teaching satisfaction,and the difference was statistically significant(P<0.05).(6)The most desired additional courses for the undergraduates of clinical pharmacy were the comprehensive knowledge and skills of licensed pharmacists(74.3%),and the most desired teaching method was the problemoriented teaching method(32.17%);Physiology(55.42%),pathology(54.72%)and pathophysiology(54.37%)were the most important in basic medical courses,diagnostics(55.77%),internal medicine(55.59%)and surgery(52.8%)were the most important in medical courses.Organic chemistry(50.52%),natural medicine chemistry(50.35%),analytical chemistry(50.17%)were the most important courses in basic pharmacy,and pharmacology of Traditional Chinese Medicine(63.29%),clinical pharmacology(62.76%),prescription/medication order review and evaluation(59.97%)were the most important courses in clinical pharmacy.Pharmaceutical scientific research ideas and methods(51.75%),pharmaceutical care and communication skills(50.7%),pharmacy quality management standards(50.35%)were the most important in public basic courses.52.45%of the students hoped that clinical pharmacy professional practice and theoretical courses would be carried out alternately/simultaneously(alongside clinical pharmacy professional course practice);51.75%of undergraduates thought that clinical pharmacy internship should be set for 1 year;53.85%of the undergraduates believed that the clinical pharmacy internship rotation departments should be mainly clinical departments;As for the internship assessment plan,69.76%of students believed that it should include the assessment of pharmaceutical practice skills,drug related theoretical knowledge and the basic situation during the internship.Conclusion:(1)The secondary and tertiary hospitals in Xinjiang need to be improved in the construction of clinical pharmacy hardware facilities,system construction,team construction and other aspects,especially the secondary hospitals were relatively weak in all aspects,not reaching the national average level,and the intensity of clinical pharmacy related work was not as strong as the tertiary hospitals;Relevant subjects in Xinjiang secondary and tertiary hospitals had a low cognition of clinical pharmaceutical care,but their attitude was optimistic.The professional skills of clinical pharmacists in Xinjiang need to be further improved.(2)Nearly one-fifth of nonclinical pharmacists were reluctant to be transformed into clinical pharmacists,and senior married pharmacists had relatively low motivation for transformation,and their attitude towards pharmaceutical care and experience in pharmaceutical care affected their transformation intention.(3)The score of pharmaceutical care disorder in secondary hospitals in Xinjiang reached an above medium level,which was higher than that in tertiary hospitals;There were great obstacles in pharmaceutical care in primary hospitals.The higher the monthly income,the higher the professional and technical level,the more reasonable the allocation of human resources and the longer the time spent in pharmaceutical care,the lower the score of pharmaceutical care disorder.(4)Residents’ understanding of the profession of clinical pharmacists was not deep enough.Most residents said they only heard about clinical pharmacists and hoped to obtain pharmaceutical services provided by clinical pharmacists,believing that it was very important for hospitals to provide pharmaceutical services.Residents with different demographic characteristics had different cognition of clinical pharmacist occupation.Residents focused on the service content provided by clinical pharmacists and the demand for drug information.(5)The overall satisfaction of clinical pharmacy students was higher;The degree of satisfaction to the types of courses,class hours and teaching content was relatively low;The students who majored in clinical pharmacy had the same interest and knew more about clinical pharmacy when applying for the university had higher satisfaction on teaching.Schools do not pay enough attention to practice and base construction.(6)Students did not have a deep understanding of career content and career planning,were not clear about courses that focus on career needs,did not pay enough attention to some courses,were less interested in traditional teaching methods,and had higher demand for practice.(7)In view of the existing problems,countermeasures and suggestions are put forward from the level of health administration departments,medical institutions and universities: it is suggested that the health administration departments should issue corresponding policies,strengthen the pharmaceutical management mechanism,strengthen the construction of pharmaceutical care system in county-level hospitals,carry out special supervision of pharmaceutical care in medical institutions,and improve the remuneration of clinical pharmacists;It is suggested that medical institutions should strengthen the construction of infrastructure,improve relevant rules and regulations,increase the publicity of clinical pharmacists and training focusing on pharmaceutical care,expand the content and intensity of pharmaceutical care,and pay attention to the training of clinical pharmaceutical research personnel.It is suggested that colleges and universities strengthen the recruitment and publicity of clinical pharmacy major,take results-oriented,reform the course content,create specialized courses,strengthen the supervision and management of practice bases,improve the quality of students’ practice and probation,innovate teaching methods and evaluation methods,strengthen the integration of information technology and education and teaching,pay attention to the frontier teaching content and train students’ scientific research thinking.