Analysis on the Problems of Rational Drug Use Carrying Out by Hospital Pharmacists in China ()
1. Introduction
The rational drug use is an important part of the national essential drug policy, directly related to the quality of medical care for patients and the vital interests of the general public. The “Several Opinions on Further Reforming and Improving Policies for the Production, Distribution and Use of Drugs” issued by the General Office of the State Council clearly stated that it is necessary to “give full play to the role of pharmacists in the rational use of drugs.” Pharmacists are the implementers of clinical medication management and play an indispensable and key role in the rational use of medications. This study investigates the problems encountered by pharmacists in the rational drug use from multiple perspectives of pharmacists, physicians and patients, and provides suggestions for pharmacists to play the professional value of promoting the level of rational use of drugs.
2. Materials and Methods
2.1. Source of Information
From April 1, 2021 to April 15, 2021, a combination of the online questionnaires and paper questionnaires was used to investigate the current situation of rational drug use by hospital pharmacists, physicians, and patients.
2.2. Questionnaire Design
Design a questionnaire based on relevant literature [1] [2] [3] [4] [5], and distribute questionnaires to hospital pharmacists, physicians, and patients. The main contents of the questionnaire for pharmacists are: the basic situation of the survey object, the development of rational drug use, and the problems existing in the development of rational drug use; the main content of the questionnaire for physicians and patients is: the basic information of the survey object, the level of cognition with pharmacists and the level of cooperation with pharmacists.
3. Results
3.1. Source of Materials
We conducted a survey of doctors, pharmacists and patients in hospitals in Jiangsu Province by combining online and offline questionnaires. A total of 223 questionnaires were collected, of which 130 were from hospital pharmacists, 63 were from physicians, and 130 were from patients.
3.2. The Current Situation of Hospital Pharmacists’ Rational Drug Use Work
This study investigated the implementation of rational drug use by pharmacists at all levels of hospitals. A total of 130 questionnaires were returned, of which 78 were from third-level hospital pharmacists, 9 were from second-level hospital physicians, and 43 were from first-level hospital pharmacists.
The top three pharmaceutical service projects carried out by pharmacists are prescription review and comment, patient medication guidance, and adverse drug reaction monitoring. The frequency of assisting doctors in medication tracking is the lowest. The current situation of rational drug use carried out by hospital pharmacists is shown in Table 1.
The main difficulties encountered by pharmacists in the process of rational drug use in hospitals at all levels are: lack of time to conduct prescription review and medication guidance, poor patient compliance, and inability to conduct individualized medication guidance based on the detailed conditions of patients.
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Table 1. The current situation of rational drug use carried out by hospital pharmacists.
The problems and reasons of pharmacists’ rational use of drugs are shown in Table 2.
3.3. Physicians’ Cognitive and Cooperation with Pharmacists
In this study, a total of 63 questionnaires were collected about physicians’ cognitive and cooperation with pharmacists, of which 29 were from physicians in third-level hospitals, 6 were from physicians in second-level hospitals, and 28 were from physicians in first-level hospitals.
In the survey of physicians’ cognition and cooperation with pharmacists, 57.14% of physicians believe that the primary job of pharmacists is to ensure the supply of medicines, and less than 30% of physicians believe that the first person responsible for prescription review is the pharmacist. 92.06% of physicians encountered pharmacists communicating with patients about medication problems, but only 53.97% of those who adopted the prescription modification suggestions put forward by pharmacists. Among the doctors interviewed, 92.06% of the doctors believed that the degree of trust in the professional level of the pharmacist’s medication was the most important factor affecting the degree of cooperation with the pharmacist. The details of physicians’ cognitive and cooperation with pharmacists are shown in Table 3.
3.4. The Public’s Cognition and Cooperation with Pharmacists
In this study, 130 questionnaires were returned to investigate the public’s cognition and cooperation with pharmacists.
In the survey of public awareness and cooperation with pharmacists, only 30.77% of patients knew that pharmacists have the responsibility to participate in the formulation of patient medication regimens; they choose to consult pharmacists when they have doubts about drug use. Less than 30% of the public fully trust that pharmacists can promote the level of rational drug use; more than half of the public believe that the degree of trust in the professional level of pharmacists and their cognition of the pharmacist profession are the main
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Table 2. The problems and reasons of pharmacists’ rational drug use.
reasons that affect their cooperation with pharmacists. The details of physicians’ cognitive and cooperation with pharmacists are shown in Table 4.
4. Discussion
4.1. The Role of Pharmacists in Guiding Patients to Rational Use of Drugs Has Not Been Fully Utilized
At present, because medical institutions do not pay enough attention to the rational use of drugs by pharmacists, it is difficult for pharmacists to review and comment on prescriptions and guide medication. According to the survey results, 83.85% of hospital pharmacists frequently conduct prescription review and review, which did not meet the requirement of “Prescriptions can be paid and adjusted after review” stipulated in the “Specifications for Prescription Review of Medical Institutions”. The overall regular rate of patient medication guidance
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Table 3. The physicians’ cognitive and cooperation with pharmacists.
was 78.46%, of which 91.02% were pharmacists in tertiary hospitals, 33.33% were pharmacists in second-level hospitals, and 65.11% in first-level hospitals. From the results, the development rate of prescription review and comment and patient medication guidance in first-level and second-level hospitals is relatively low, showing that the third-level hospitals are better than the first-level and second-level hospitals. The role of pharmacists in guiding patients to rational use of drugs has not yet played out.
Carrying out prescription review and comment is the core link of rational drug use, and it is also a necessary link for pharmacists to effectively manage clinical drugs and improve the quality of medical services [6]. Medical institutions should attach importance to prescription review and prescription review, and formulate unified and standard management documents to promote the standardized implementation of prescription review and prescription review. At the same time, providing individualized medication guidance is the last link of “patient-centered” pharmaceutical care, which can ensure the safety of patients’ medication and improve the level of clinical rational medication [7] [8]. Medical institutions should standardize the rules, regulations and procedures for medication accountability and guidance, which will help pharmacists to further fulfill their responsibilities, provide pharmaceutical services closer to patients, and improve patient medication compliance.
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Table 4. The public’s cognitive and cooperation with pharmacists.
4.2. The Communication Channels between Pharmacists and Doctors and Patients Need to Be Broadened
As the demand for pharmacy services increases, hospital pharmacy services are also transforming, gradually moving from behind the clinical diagnosis and treatment of patients to the front stage, and pharmacists are also gradually changing their job positioning, from dispensing pharmacists to clinical pharmacists, participating with clinicians Treatment of patients. But at present, pharmacists are less active in the process of clinical participation and lack communication and cooperation with doctors. As doctors dominate the diagnosis and treatment activities, most patients and their families have insufficient understanding of the important position and functions of pharmacists, and their understanding of pharmacists is still at the stage of traditional hospital pharmacy, which mainly focused on the supply of medicines.
Broadening the communication channels between pharmacists, physicians and patients in daily diagnosis and treatment activities can effectively improve the cooperation between physicians and patients [9]. It is recommended that medical institutions increase the real-time interactive function of the relevant rational drug use management system to facilitate pharmacists to provide necessary professional pharmacy support to enhance the understanding and trust between pharmacists and physicians; at the same time, an Internet communication platform between pharmacists and patients can be opened for the convenience of patients inquire about prescription information, drug usage and dosage, precautions and other pharmaceutical information. This will also indirectly urge pharmacists to continuously improve their professional skills and humanistic qualities, and actively carry out pharmaceutical services to effectively make up for the omission of doctor-patient communication.
4.3. The Construction of Pharmaceutical Informatization Still Needs to Be Improved
Since the full implementation of the zero-markup policy for drugs, the pharmacy department of hospitals has been transformed into a cost department. In order to ensure the interests of hospitals, many hospitals have paid less attention to pharmacies and pharmacists that currently cannot bring great economic benefits to the hospital. The investment in hardware and software facilities cannot meet the needs of pharmaceutical services. 41.54% of the pharmacists in the survey believed that the lack of hardware equipment and software facilities made them lack detailed patient information and could not conduct individualized medication guidance, which hindered the normal development of clinical rational drug use. Due to differences in facility conditions, technical capabilities, and fund investment, there are differences in the level of development of rational drug use among hospitals.
Information technology plays an important role in the management of all walks of life [10]. As an indispensable department in the medical system, the hospital pharmacy should conform to the current development trend of information technology and continuously strengthen its own information construction and management. Promoting the Pharmaceutical informatization construction of can reduce the workload of pharmacists to a certain extent and improve the quality of pharmacists’ work under the premise of ensuring reasonable drug use. It is recommended that medical institutions pay attention to the construction of Pharmaceutical informatization, and effectively integrate information technology into the links of prescription review, drug preparation, and medication guidance, so as to improve the full-course and timeliness of pharmacy services.
5. Conclusion
Pharmacists are the implementers of clinical drug management, and they play an irreplaceable role in promoting the improvement of rational drug use and reducing the waste of medical resources. The survey found that the role of pharmacists in promoting rational drug use needs to be popularized. Mobilizing the enthusiasm and creativity of pharmacists to play their due functions and duties in medical work is necessary for the rationality, standardization, safety and effectiveness of clinical medication. Medical institutions must pay sufficient attention to the professional value of pharmacists in the rational drug use, and provide necessary management system guarantees and related facility support for pharmacists to carry out pharmaceutical services.