持续学习提升癌痛治疗相关药学服务质量*

Continuous learning improves the quality of pharmaceutical care in cancer pain treatment *

摘要:

目的：探讨北京地区医疗机构继续医学教育 (continuing medical education, CME) 对癌痛治疗相关药学服务质量的影响。方法：北京市疼痛治疗质量控制和改进中心于2016年至2019年举行为期4年的癌痛治疗知识年度CME培训，并依据癌痛规范化示范病房现场评审标准，分别从药师参与、药品配备、药品管理、门诊处方点评和住院处方点评5个项目，对CME培训前（2015年）后（2017年和2019年）进行了3次药学服务质量评估，以探讨CME的影响。结果：共48家医院连续参与年度CME培训，2019年癌痛治疗相关药学服务质量总分（18.69±1.38）明显高于2015年（17.24±3.62）和2017年（17.68±1.47）（P<0.05）。2019年评分“优秀”医院有38家（79.17%），无评分“不合格”医院。在2015和2017年度评估时，三甲医院药学服务质量评分较二级医院高（P<0.05），但2019年时不同医院等级之间评分显示已无统计学差异。各检查项目中，不同年度中“药师参与”项目评分最低，但改善成效最显著（P<0.05）。结论：临床药师在癌痛治疗相关药学服务中的作用仍有待加强，连续CME培训可有助于提升药师参与癌痛诊疗服务，改善参与医院的癌痛治疗相关药学服务质量。

Abstract:

Objective: To explore the effect of continuing medical education (CME) on the quality of pharmaceutical care related to cancer pain treatment in medical institutions in Beijing. Methods: The Beijing Pain Management Center for Quality Control and Improvement held annual continuing medical education and training on cancer pain treatment for 4 years from 2016 to 2019 according to the criterion of ‘Good Pain Management Ward’. The quality level of pharmaceutical care before (2015) and after (2017 and 2019) were retrospectively evaluated to explore the impact of CME retrospectively from 5 projects， including namely ‘Pharmacist participation’, ‘drug supply’, ‘drug management’, ‘outpatient prescription comment’ and ‘outpatient prescription comment’. to explore the impact of CME. Results: A total of 48 hospitals participated in the annual CME for 4 consecutive years. The total score of pharmaceutical care quality for cancer pain treatment in 2019 (18.69±1.38) was significantly higher than that in 2015 (17.24±3.62) and 2017 (17.68±1.47) (P<0.05). In 2019, there were 38 ‘excellent’ hospitals (79.17%) and zero ‘unqualified’ hospitals. In 2015 and 2017, the total score of pharmaceutical care treatment in tertiary A hospitals was higher than that in secondary hospitals (P<0.05), but there was no statistical difference among different grades of hospitals in 2019. Among different projects, the score of ‘pharmacist participation’ was the lowest, but the improvement effect was the most significant. Conclusion: The role of clinical pharmacists in cancer pain treatment remains to be strengthened. Continuous CME training help significantly improve pharmacists' participation on the quality of pharmaceutical care related to cancer pain treatment in participating hospitals.