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Filename: config/ci_database.php
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Filename: config/ci_database.php
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Filename: config/ci_database.php
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Filename: config/ci_database.php
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仁和藥房網(wǎng)用藥咨詢平臺是為保障仁和藥房網(wǎng)會員用藥安全有效,及時針對性地提出用藥建議,回答會員關(guān)于用藥方面的咨詢以及詳細(xì)地介紹藥品的信息和政策等專門設(shè)置的服務(wù)體系。
該平臺主要為會員提供藥品專業(yè)知識、安全合理用藥、安全購藥警示、藥械查詢、公眾健康保健咨詢、網(wǎng)上答疑、用藥咨詢、藥品價效比、投訴舉報、建議意見等服務(wù)。
仁和藥房網(wǎng)開展用藥咨詢服務(wù)是為了指導(dǎo)患者個體化用藥,以幫助患者提高藥物治療安全性、有效性、依從性和經(jīng)濟(jì)性,減少毒副反應(yīng)的發(fā)生,提高用藥水平,最終達(dá)到改善和提高人們健康水平的目的,同時,也對降低藥源性疾病、減少醫(yī)療糾紛、提高疾病治愈率等都有重要意義。
一、用藥咨詢服務(wù)的重要性
1、患者的需要:在門診藥房藥師的調(diào)劑任務(wù)異常繁重,配藥窗口難以深入解釋、交待與藥物治療相關(guān)的問題,最多只能局限在簡單的你問我答上。另外,我國藥品說明書仍不盡規(guī)范,部分廠家對其中的不良反應(yīng)有意圖回避或含糊其詞,部分患者看不懂說明書,甚至連藥品名稱都不知道,更無從談起對藥品的了解。因此,仁和藥房網(wǎng)藥師針對患者個體差異化給予用藥的詳細(xì)指導(dǎo),解決患者用藥難的問題,保障了患者用藥的準(zhǔn)確性和安全性。
2、補(bǔ)充臨床醫(yī)務(wù)工作者的不足:隨著醫(yī)學(xué)技術(shù)的快速發(fā)展,多種新藥的開發(fā)和上市,同一種藥物的商品名和規(guī)格繁多,醫(yī)生對大量涌現(xiàn)的各類藥品信息不能及時全面地了解,致使用藥復(fù)雜性越來越高,新的配伍禁忌不斷增加的情況。而仁和藥房網(wǎng)藥師時刻掌握第一線藥品的相關(guān)信息和知識,可以有力補(bǔ)充臨床醫(yī)務(wù)工作者不足的情況,為會員提供更科學(xué)、安全和價效比最低的用藥方案。
3、安全用藥體系的重要組成部分:安全用藥必將會從管理藥品為主轉(zhuǎn)移到監(jiān)督、執(zhí)行和保障用藥安全有效、經(jīng)濟(jì)合理、提高患者生命質(zhì)量上來,用藥咨詢工作的開展已經(jīng)成為安全用藥體系的重要組成部分。
二、用藥咨詢服務(wù)的主要內(nèi)容和范圍
1、解釋不良反應(yīng)及注意事項
是否按照正確方法和有效劑量使用藥品、對于各種藥品可能發(fā)生的潛在不良反應(yīng)的掌控,是保證患者是否安全有效治療疾病的關(guān)鍵。仁和藥房網(wǎng)執(zhí)業(yè)藥師一方面會告知患者用藥后會產(chǎn)生的正常生理反應(yīng),如:服氨苯喋啶后尿液呈淡藍(lán)色,服枸櫞酸后口中有氨味并使舌、糞染成黑色,都是正?,F(xiàn)象。另一方面,執(zhí)業(yè)藥師也會告知患者密切觀察服藥后反映,在用藥后如果出現(xiàn)藥物的不良反應(yīng)應(yīng)及時采取的應(yīng)急處理方案——停藥、減量等。如:服用硫脲類藥物時,若出現(xiàn)咽痛或發(fā)熱時應(yīng)立即停藥,可避免粒細(xì)胞缺乏癥的發(fā)生。
2、建議藥物的服用時間及用法、用量
執(zhí)業(yè)藥師會在患者用藥時,準(zhǔn)確告知便于患者理解的藥物知識和服藥小常識,使其掌握正確服藥的方法,獲取有益于疾病恢復(fù)的知識。如:①根據(jù)人體血壓的晝夜節(jié)律性,大多數(shù)人的血壓在凌晨2~3時最低,上午8~10時及下午4~6時最高,從晚上6時起血壓呈緩慢下降趨勢。因此,降壓藥卡托普利主張清晨覺醒后一次服用2片效果好,如果還沒達(dá)到預(yù)期效果,可在下午2時左右加服1片,這樣可以更好地控制血壓,同時,也防止夜間服藥使血壓過低的現(xiàn)象。②治療骨質(zhì)疏松的藥物阿侖膦酸鈉片,要求患者必須每天第一次進(jìn)食前至少半小時,用大量的白開水送服,增加藥物的吸收,而且在服藥后要避免躺臥,減少食道不良反應(yīng)的發(fā)生。藥師的適時提醒,將有利于患者正確、合理地用藥及最大限度地降低不良反應(yīng)的發(fā)生。③對于一些特殊劑型特殊用法的藥物,如控釋劑、緩釋劑、腸溶劑等嚴(yán)禁嚼服或擊碎分次食用。
3、提醒多種藥物聯(lián)合使用的注意事項
藥師會從藥物的藥理學(xué)、藥動學(xué)、藥效學(xué)特點(diǎn)全面考慮,將藥物所帶來的不良反應(yīng)發(fā)生率降至最低,如鎮(zhèn)靜催眠藥與抗精神病藥合用時,中樞抑制作用會相互增強(qiáng)。大環(huán)內(nèi)酯類紅霉素與H1拮抗劑合用時,紅霉素可抑制H1拮抗劑的代謝,從而使其血藥濃度增高,導(dǎo)致室性心律失常的危險性增加。
4、老年人與兒童的用藥
老年人因各臟器的組織結(jié)構(gòu)和生理功能都有不同程度的退行性改變,因而影響了藥物在體內(nèi)的吸收、分布、代謝和排泄過程,肝腎功能、免疫功能均較成年人降低1/3~1/2,致使血液內(nèi)藥物濃度較一般成年人高,藥物半衰期也較一般人明顯延長。嬰幼兒由于機(jī)體一些器官發(fā)育尚未成熟,肝腎清除功能差,在此期間,生長發(fā)育隨日齡增加而迅速變化,對藥物敏感,因此,對于此類人群應(yīng)該綜合各項機(jī)體指標(biāo),制定個體化的用藥方案,謹(jǐn)慎用藥,避免造成嚴(yán)重的不良反應(yīng)。
5、妊娠或哺乳期婦女用藥
優(yōu)孕、優(yōu)生、優(yōu)育不僅是家庭的問題,更是整個社會的問題,妊娠期用藥不當(dāng),可導(dǎo)致胎兒畸形和流產(chǎn)。上世紀(jì)50年代,一種阻止孕早期婦女嘔吐的藥品沙利度胺(反應(yīng)停)導(dǎo)致近萬例“海豹畸形嬰兒”出生。所以嚴(yán)格來講,在婦女的整個妊娠期間,使用中西藥都應(yīng)慎重,尤其在妊娠頭三個月,為胎兒生長發(fā)育最為活躍的時期,用藥應(yīng)慎之又慎。另外,部分藥物在乳汁中排泄較多,易通過乳汁進(jìn)入新生兒體內(nèi)帶來不良的影響。所以,哺乳期婦女首先應(yīng)權(quán)衡用藥的必要性和對乳兒可能造成的危害性以決定取舍。盡量選用進(jìn)入乳汁最少,對嬰幼兒影響最小的藥物。注意用藥和哺乳的時間間隔避免在藥物濃度高峰時授乳,或采取哺乳后用藥,最少間隔4小時以上。
6、藥物與食物的禁忌
生活中必不可少的蔬菜、肉、水果、牛奶、雞蛋等食品,還有飲料、煙、酒、糖等都會對藥物的療效產(chǎn)生影響,增加藥物不良反應(yīng)發(fā)生的機(jī)率。如牛奶中的鈣可使四環(huán)素的吸收率減少80%以上;鐵鹽可使四環(huán)素和紅霉素吸收率減少40%~60%,因此,在服用紅霉素時不宜吃含鈣、鎂、鐵豐富的食物。服用地高辛的患者在服藥后食用含甘草苷的飲料和糖果,可引起低血鉀反應(yīng)。服用頭孢菌素和甲硝唑后飲酒可引起雙硫侖樣不良反應(yīng)。補(bǔ)充鐵劑的藥物與茶同服會生成難溶性化合物影響鐵的吸收等等,這些都需要執(zhí)業(yè)藥師更專業(yè)、更全面地掌握各種相關(guān)的藥學(xué)、營養(yǎng)學(xué)知識,并告知患者。
7、個體差異的用藥
對具有病例、生理異常的患者應(yīng)采取個體差異用藥。由于該類患者的某些生理特點(diǎn)會與常人不同,所以藥動學(xué)特點(diǎn)也有所改變,對普通人的藥動學(xué)研究不能適用,如肝、腎功能不全的患者可能會對一些藥物的代謝、排泄能力減弱,按照常用劑量易造成蓄積中毒,由此在選用藥物時,應(yīng)避免使用有肝、腎毒性的藥物,否則會加重肝、腎損害。
8、其他
除以上內(nèi)容外,仁和藥房網(wǎng)的用藥咨詢服務(wù)還可解決包括商品名和通用名的核對,藥品價格,藥品是否進(jìn)入醫(yī)療保險報銷目錄,藥品的鑒定、辨識、貯存、有效期等常遇到的問題。
9、公眾健康保健咨詢
當(dāng)前中國居民亞健康狀況急需改正,其保健意識、保健行為都需加強(qiáng),從“治病”到“治未病”的理念的轉(zhuǎn)變,需要有更多專業(yè)的人員去為民眾提供健康指導(dǎo)和正確的健康消費(fèi)。執(zhí)業(yè)藥師可以將治病與防病有效地結(jié)合,為會員提供全方位的服務(wù)。
三、會員咨詢服務(wù)中注意的問題
1、進(jìn)入仁和藥房網(wǎng)在線咨詢服務(wù)系統(tǒng)進(jìn)行咨詢或者電話咨詢的客戶,均可以享受該項服務(wù)。
2、藥師的咨詢意見僅作參考使用,具體的診療方法必須經(jīng)過診斷醫(yī)生的認(rèn)可?!?/p>
3、會員或者客戶咨詢時,應(yīng)該戒驕戒躁,共同協(xié)商解決問題,彼此尊重、信任,有助于工作的順利開展。
4、藥師不是醫(yī)生,因此,對于疾病的問題請通過門診進(jìn)行咨詢。用藥咨詢服務(wù)主要還是解釋藥品相關(guān)的問題。
5、藥師在服務(wù)時,會做好咨詢服務(wù)的記錄和收集工作,其中包括咨詢?nèi)掌?、患者基本情況、所患疾病及用藥情況、咨詢的問題及解答的內(nèi)容等,詳細(xì)的記錄有利于及時總結(jié)、評價、發(fā)現(xiàn)問題,并能收集特殊病例、特殊不良反應(yīng)等相關(guān)問題,為客戶提供更好的服務(wù)。因此,希望客戶您能全力配合。