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仁和药房网用药咨询平台是为保障仁和药房网会员用药安全有效,及时针对性地提出用药建议,回答会员关于用药方面的咨询以及详细地介绍药品的信息和政策等专门设置的服务体系。
该平台主要为会员提供药品专业知识、安全合理用药、安全购药警示、药械查询、公众健康保健咨询、网上答疑、用药咨询、药品价效比、投诉举报、建议意见等服务。
仁和药房网开展用药咨询服务是为了指导患者个体化用药,以帮助患者提高药物治疗安全性、有效性、依从性和经济性,减少毒副反应的发生,提高用药水平,最终达到改善和提高人们健康水平的目的,同时,也对降低药源性疾病、减少医疗纠纷、提高疾病治愈率等都有重要意义。
一、用药咨询服务的重要性
1、患者的需要:在门诊药房药师的调剂任务异常繁重,配药窗口难以深入解释、交待与药物治疗相关的问题,最多只能局限在简单的你问我答上。另外,我国药品说明书仍不尽规范,部分厂家对其中的不良反应有意图回避或含糊其词,部分患者看不懂说明书,甚至连药品名称都不知道,更无从谈起对药品的了解。因此,仁和药房网药师针对患者个体差异化给予用药的详细指导,解决患者用药难的问题,保障了患者用药的准确性和安全性。
2、补充临床医务工作者的不足:随着医学技术的快速发展,多种新药的开发和上市,同一种药物的商品名和规格繁多,医生对大量涌现的各类药品信息不能及时全面地了解,致使用药复杂性越来越高,新的配伍禁忌不断增加的情况。而仁和药房网药师时刻掌握第一线药品的相关信息和知识,可以有力补充临床医务工作者不足的情况,为会员提供更科学、安全和价效比最低的用药方案。
3、安全用药体系的重要组成部分:安全用药必将会从管理药品为主转移到监督、执行和保障用药安全有效、经济合理、提高患者生命质量上来,用药咨询工作的开展已经成为安全用药体系的重要组成部分。
二、用药咨询服务的主要内容和范围
1、解释不良反应及注意事项
是否按照正确方法和有效剂量使用药品、对于各种药品可能发生的潜在不良反应的掌控,是保证患者是否安全有效治疗疾病的关键。仁和药房网执业药师一方面会告知患者用药后会产生的正常生理反应,如:服氨苯喋啶后尿液呈淡蓝色,服枸橼酸后口中有氨味并使舌、粪染成黑色,都是正常现象。另一方面,执业药师也会告知患者密切观察服药后反映,在用药后如果出现药物的不良反应应及时采取的应急处理方案——停药、减量等。如:服用硫脲类药物时,若出现咽痛或发热时应立即停药,可避免粒细胞缺乏症的发生。
2、建议药物的服用时间及用法、用量
执业药师会在患者用药时,准确告知便于患者理解的药物知识和服药小常识,使其掌握正确服药的方法,获取有益于疾病恢复的知识。如:①根据人体血压的昼夜节律性,大多数人的血压在凌晨2~3时最低,上午8~10时及下午4~6时最高,从晚上6时起血压呈缓慢下降趋势。因此,降压药卡托普利主张清晨觉醒后一次服用2片效果好,如果还没达到预期效果,可在下午2时左右加服1片,这样可以更好地控制血压,同时,也防止夜间服药使血压过低的现象。②治疗骨质疏松的药物阿仑膦酸钠片,要求患者必须每天第一次进食前至少半小时,用大量的白开水送服,增加药物的吸收,而且在服药后要避免躺卧,减少食道不良反应的发生。药师的适时提醒,将有利于患者正确、合理地用药及最大限度地降低不良反应的发生。③对于一些特殊剂型特殊用法的药物,如控释剂、缓释剂、肠溶剂等严禁嚼服或击碎分次食用。
3、提醒多种药物联合使用的注意事项
药师会从药物的药理学、药动学、药效学特点全面考虑,将药物所带来的不良反应发生率降至最低,如镇静催眠药与抗精神病药合用时,中枢抑制作用会相互增强。大环内酯类红霉素与H1拮抗剂合用时,红霉素可抑制H1拮抗剂的代谢,从而使其血药浓度增高,导致室性心律失常的危险性增加。
4、老年人与儿童的用药
老年人因各脏器的组织结构和生理功能都有不同程度的退行性改变,因而影响了药物在体内的吸收、分布、代谢和排泄过程,肝肾功能、免疫功能均较成年人降低1/3~1/2,致使血液内药物浓度较一般成年人高,药物半衰期也较一般人明显延长。婴幼儿由于机体一些器官发育尚未成熟,肝肾清除功能差,在此期间,生长发育随日龄增加而迅速变化,对药物敏感,因此,对于此类人群应该综合各项机体指标,制定个体化的用药方案,谨慎用药,避免造成严重的不良反应。
5、妊娠或哺乳期妇女用药
优孕、优生、优育不仅是家庭的问题,更是整个社会的问题,妊娠期用药不当,可导致胎儿畸形和流产。上世纪50年代,一种阻止孕早期妇女呕吐的药品沙利度胺(反应停)导致近万例“海豹畸形婴儿”出生。所以严格来讲,在妇女的整个妊娠期间,使用中西药都应慎重,尤其在妊娠头三个月,为胎儿生长发育最为活跃的时期,用药应慎之又慎。另外,部分药物在乳汁中排泄较多,易通过乳汁进入新生儿体内带来不良的影响。所以,哺乳期妇女首先应权衡用药的必要性和对乳儿可能造成的危害性以决定取舍。尽量选用进入乳汁最少,对婴幼儿影响最小的药物。注意用药和哺乳的时间间隔避免在药物浓度高峰时授乳,或采取哺乳后用药,最少间隔4小时以上。
6、药物与食物的禁忌
生活中必不可少的蔬菜、肉、水果、牛奶、鸡蛋等食品,还有饮料、烟、酒、糖等都会对药物的疗效产生影响,增加药物不良反应发生的机率。如牛奶中的钙可使四环素的吸收率减少80%以上;铁盐可使四环素和红霉素吸收率减少40%~60%,因此,在服用红霉素时不宜吃含钙、镁、铁丰富的食物。服用地高辛的患者在服药后食用含甘草苷的饮料和糖果,可引起低血钾反应。服用头孢菌素和甲硝唑后饮酒可引起双硫仑样不良反应。补充铁剂的药物与茶同服会生成难溶性化合物影响铁的吸收等等,这些都需要执业药师更专业、更全面地掌握各种相关的药学、营养学知识,并告知患者。
7、个体差异的用药
对具有病例、生理异常的患者应采取个体差异用药。由于该类患者的某些生理特点会与常人不同,所以药动学特点也有所改变,对普通人的药动学研究不能适用,如肝、肾功能不全的患者可能会对一些药物的代谢、排泄能力减弱,按照常用剂量易造成蓄积中毒,由此在选用药物时,应避免使用有肝、肾毒性的药物,否则会加重肝、肾损害。
8、其他
除以上内容外,仁和药房网的用药咨询服务还可解决包括商品名和通用名的核对,药品价格,药品是否进入医疗保险报销目录,药品的鉴定、辨识、贮存、有效期等常遇到的问题。
9、公众健康保健咨询
当前中国居民亚健康状况急需改正,其保健意识、保健行为都需加强,从“治病”到“治未病”的理念的转变,需要有更多专业的人员去为民众提供健康指导和正确的健康消费。执业药师可以将治病与防病有效地结合,为会员提供全方位的服务。
三、会员咨询服务中注意的问题
1、进入仁和药房网在线咨询服务系统进行咨询或者电话咨询的客户,均可以享受该项服务。
2、药师的咨询意见仅作参考使用,具体的诊疗方法必须经过诊断医生的认可。
3、会员或者客户咨询时,应该戒骄戒躁,共同协商解决问题,彼此尊重、信任,有助于工作的顺利开展。
4、药师不是医生,因此,对于疾病的问题请通过门诊进行咨询。用药咨询服务主要还是解释药品相关的问题。
5、药师在服务时,会做好咨询服务的记录和收集工作,其中包括咨询日期、患者基本情况、所患疾病及用药情况、咨询的问题及解答的内容等,详细的记录有利于及时总结、评价、发现问题,并能收集特殊病例、特殊不良反应等相关问题,为客户提供更好的服务。因此,希望客户您能全力配合。