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“新生代”门诊各地涌现 三类人群成重点服务对象

2019-07-25 05:48:44     来源:中新网     责任编辑:刘欣

  这个门诊有点“冷” 却能帮你解决用药大问题

  实习记者 于紫月 通讯员 左 彦

  高血压、糖尿病、高脂血症、哮喘、胃炎……人一迈入中老年,很多慢性病、急性病“找上门”的风险便会越来越高,即便是一些年轻人或者孩童,也有被多种疾病缠身的例子。多病共存的患者一趟趟往医院跑,在人满为患的各个科室之间徘徊逡巡,从药房抱回来一堆药,从此“把药当饭吃”。俗话说,“是药三分毒”,不同药物之间相生相克,若服用不当,很有可能带来负面效果。

  近日,国务院印发的《国务院关于实施健康中国行动的意见》等健康中国行动系列文件也显示,目前我国城乡居民在合理用药等方面的健康知识和技能还比较缺乏。目前的现状是,在一些大医院的“热门”科室里,一位患者通常只有几分钟的问诊时间,医师治疗“专病”之余,哪还剩下宝贵的时间问询其他病症和用药?其实,很多人不知道,在很多医院,已经有一个独立的科室部门——药学门诊或用药咨询中心,能为患者提供合理的用药指导。  

  “新生代”门诊各地涌现

  “过年吃了不少大鱼大肉,作息一不规律,吃药时间也没那么准时了,可以帮我看看有需要注意的事项吗?”一位在上海某医院就诊药学门诊的患者表示,以前看病吃药都找医生,现在看病找医生,吃药找药师。

  2015年6月,第一个由药学人员筹建的门诊——精准用药门诊,在首都医科大学附属北京朝阳医院开诊。从此,医院的药师们正式从幕后走到台前,与医护人员并肩作战,如同量体裁衣一样,为患者订制个性化的精准用药方案。

  时隔近3年,2018年2月,原国家卫生计生委召开新闻发布会表示,北京市市属22家医院全部设立用药咨询中心,为患者提供用药咨询和指导服务,开展政策宣传和解读,积极服务患者。

  除了北京、上海,全国各地在近三四年间纷纷涌现这类新的药学门诊。2017年年底,山西省首家药学门诊开诊;2018年3月,甘肃省首家临床药物咨询门诊开诊,涵盖呼吸等10个专业;2019年初,重庆首家可预约、挂号就诊的专科药学门诊也正式开诊……

  目前,全国各地的用药咨询中心或药学门诊收费尚没有统一的标准,有些医院免费提供咨询服务,有些医院适当收取挂号费。

  别看用药咨询中心或门诊跟其他科室比起来是个名副其实的“新生儿”,其实患者和社会对该部门构建的渴求由来已久。记者注意到,在国家《二级综合医院评审标准(2012年版)实施细则》中就明确提出,评价“良好”及以上的医院必须有专业人员向患者提供安全用药咨询。

  三类人群成重点服务对象

  药学咨询中心或门诊能够提供怎样的服务?

  “多病共存对传统的专科学科来说是一种冲击,存在反复住院、医疗指导片面或存在矛盾、综合疗效差等情况。药学咨询中心或门诊的设立既能回答药怎么吃、什么时候吃的基本问题,也能从更专业的角度出发,尽可能实现联合用药精准化。”北京华信医院(清华大学第一附属医院)药学部副主任药师万里燕在接受科技日报记者采访时表示。

  “我们会将患者同时服用的、由不同专科医师开具的药品做一个全面的有效性和安全性评估,结合患者实际情况,提出药物治疗方案的优

  化调整,目的在于最大限度降低副作用,确保科学合理用药。通常有三类人群是我们重点服务的对象。”首都医科大学附属北京世纪坛医院药剂科副主任药师金锐告诉记者。

  第一类人群为服用药物品种类数比较多的患者,如同时患有冠心病、糖尿病、高血压等,超过5种药品以上就建议到这种专业的药学门诊进行咨询,服药种类不仅包括西药,也包括中药。第二类人群为一些患有慢病、已经服药较长时间的患者,他们会对自己的用药方案有疑惑:是不是需要一直吃?能不能自己调整一下?为什么觉得症状改善不明显?这些情况都需要药师对药物治疗方案进行评估。还有一些特殊人群,如孕妇、老年人、小孩、肝功能不全者、更年期综合征患者、心理疾病患者,这些人在制订药物治疗方案、注意事项上皆与普通人群不同。

  同为药师值守,药房、用药咨询中心、药学门诊这三者有何异同?金锐告诉记者,药房药师主要负责审方发药、核对药品,北京世纪坛医院早在2015年便设立了用药咨询中心,一些用药复杂的取药患者和不挂号看病只咨询用药的患者会被药房药师推荐到用药咨询中心,免费接受专业人员用药指导,也避免耽误药房发药窗口的正常工作。2019年5月,北京世纪坛医院开设药学门诊之后,患者便可像普通门诊一样挂号就诊,不收挂号费。相比咨询中心,药学门诊有一套更详细的文书和问询流程,药学服务时间也更为充分,对于出诊药师的要求更高。

  “由于前来就诊的患者往往是多病共存、中西药并用,目前,我院药学门诊要求从事临床药学工作、高年资且具有中级及以上职称的3位药师联合出诊。也就是说,3位不同学科的临床药师共同为一位患者进行药物治疗方案的评估与优化。”金锐表示。

  “冷门”科室也有“回头客”

  在采访中,两位医师坦言,不论是用药咨询中心还是药学门诊,咨询和就诊人数远不如其他门诊多,“科室很冷门”。

  由于药师数量有限,且药师还有查房等其他工作,目前北京世纪坛医院的药学门诊,一周开放2个半天,挂号数量不设上限。华信医院的用药咨询中心周一到周五上午开放半天,咨询人数同样不设上限。

  “我院药学门诊每个半天大约有5—8名患者,少的时候也就2—3名患者就诊。”金锐表示。“我中心每半天约服务5—10例,前来咨询的人数并不多。”万里燕说,大多数人并不了解用药咨询中心或门诊的存在。

  “不仅我院,北京市其他医院甚至全国范围内,患者对药学咨询的认知度和重视程度都不高。”金锐说,相比起来,国外的情况可能会好一点。欧美等发达国家的医疗体制与我国不同,通常医院不设门诊,只承接住院患者,药店则承担了门诊的业务,因此很早之前药师就兼具了审方发药、优化药物治疗方案的工作,因此患者认知度较高。国内的药师则是近些年才从幕后走到幕前,直接面对患者,还需要一定时间推广和宣传。

  虽然认知度有待提升,但两位医师均表示,咨询中心和药学门诊也有“回头客”。

  “给我印象很深刻的一位患者,药学门诊开诊后,2个月的时间内前来就诊3次。第一次前来咨询高血压头晕的用药,我们建议其将不可靠保健品减掉甚至停掉之后,患者血压稳定;第二次来询问血糖管控相关问题,药师从营养学角度出发,教患者热量控制与食物交换份的概念,也帮助患者学会了管理饮食控制血糖。尝到‘甜头’的患者第三次又来问询其他病症的相关用药事项。”金锐表示,没有人会跟自己的身体过不去,酒香不怕巷子深,真正体会到专业医师“私人订制”的好处之后,很多患者便“欲罢不能”。

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