Source Health Times reporter Wang Zhenya Kong Tianjiao
Read the executive summary:
According to Kang Zhen, professor at the School of Basic Medicine and Clinical Pharmacy of China Pharmaceutical University and deputy director of the National Center for the Development of Licensed Pharmacists, the department of pharmacy has made an important change from workshop-style preparation production to the construction of scientific clinical pharmacy disciplines.
"Previously, when we reviewed prescriptions, we often audited the single prescription of the patient to take the drug, rather than the merger of the 5 prescriptions, and in the 90s, when the concept of pharmacy services was proposed, it was necessary to review the patient's 5 combination prescriptions from the patient's overall medication and follow up to monitor and evaluate the treatment effect." Because the patient goes to five doctors to see a doctor, it is possible that 5 prescriptions together will go wrong. ”
Such a shift has allowed pharmacists to play a more important role in medical services. The value of the pharmacy department is not a simple drug guarantee, but to do a good job in pharmacy services, so that patients can use drugs more "safely, effectively and economically". In the past, the position of the pharmacy department was in the pharmacy, but now it is necessary to move towards the clinic and work with the doctor to ensure the safe use of drugs for patients.
From workshop preparations to drug discovery, from pharmacy to pharmacy... Under the general trend of normalization and institutionalization of drug collection and the deepening of medical reform, the pharmacy departments (pharmacy departments) of various hospitals have borne the brunt of the epidemic, and pharmacists under the tide of pharmaceutical reform have experienced a stage from loss, confusion, and transformation.
A number of pharmaceutical experts told the Health Times reporter that in the future, clinical pharmacy will pay more attention to rational drug use, play more drug guidance functions, and pay more attention to discipline construction. With the deepening of the pace of medical reform, the Faculty of Pharmacy will continue to transform and reform, not only to solve the "expensive medical treatment" of patients, but also to develop efforts to safely use drugs and high-quality medical care for patients.
Courtesy of respondents.
Healthcare Reform Challenges:
Pharmacy Department of Pharmacy, not like the "scenery" of the past
Zero difference rate of drugs, centralized procurement... Pharmacists in the tide of pharmaceutical reform are both challenges and opportunities. "Now the work is busier than before, the responsibility is more, and the pressure is getting bigger." Deng Guiming is a doctoral supervisor of clinical Chinese medicine in the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, she has witnessed the development of the Department of Pharmacy and has a deep understanding of the changes in the work of pharmacists.
Faculty of Pharmacy staff in the work of drug dispensing. Courtesy of respondents
In 1999, Deng Guiming entered the Department of Pharmacy of the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, starting his career as a pharmacist in pharmacy. Although she was initially engaged in the window front-line "dispensing" work, but at that time by the unit welfare room, the work environment information technology dependence is not high, coupled with a harmonious doctor-patient relationship, let Deng Guiming feel that this is a very respected job.
"Previously, the drug bonus part was included in the hospital's revenue, and the pharmacy department was one of the four technical support systems (medicine, medicine, nursing, and technology) in the hospital's medical work, which belonged to the business department, and with the implementation of zero addition to drugs in medical institutions, the traditional model of medicine for medical care was changed, and the service orientation of hospital pharmacy practitioners became sensitive in this change. Invisibly became a cost department. Deng Guiming told reporters. The storage cost of drugs in the circulation process of medical institutions requires the labor cost of additional pharmaceutical professional and technical personnel. Abolish the drug surcharge, change the situation of "using medicine to support medicine" from the source, promote the healthy development of the medical and pharmaceutical industries, and enable the people to enjoy high-quality and inexpensive basic medical services.
The existence of drug bonus is also the root of the system of "using medicine to support doctors", the key to canceling drug bonuses and breaking the problem of expensive medical treatment for the people is also the meaning of the medical reform, in 2008, the drug income of public hospitals accounted for 46% of the total income of hospitals.
Since 2009, the reform of "zero drug markup" has been gradually implemented. In that year, grass-roots medical institutions implemented zero-plus sales of essential drugs. From 2012 to 2013, more county hospitals implemented zero drug markup. In 2015, 3,077 county-level public hospitals and 446 urban public hospitals implemented a zero-difference rate for drugs. In 2017, all public medical institutions in Beijing canceled drug bonuses...
Under the national medical reform policy, the hospital canceled the 15% bonus of drugs for many years, so that the drug income was completely decoupled from the hospital, and the situation of the hospital "supplementing the medicine with medicine" no longer existed.
Zhang Yatong, deputy director of the Pharmacy Department of Beijing Hospital, said that after the medical reform, the salaries of employees of the Department of Pharmacy are mainly composed of post allowances, prescription quantities, scientific research contributions, etc. Basically, the salary level is mostly in the middle and lower reaches of the hospital department.
Deng Guiming told reporters that with the development of information technology, new drugs are increasing, and people need to obtain high-quality pharmaceutical services that match the status quo. After the reform of the medical and health system, the opportunities and challenges brought to hospital pharmacy at the same time propose that hospital pharmacy should change the traditional service model, carry out pharmacy services centered on rational drug use, and provide individualized pharmacy services based on evidence-based models. Pharmacists need to learn and update their knowledge for life, the work requirements are increasing, the workload overload is the norm, the existing income and payment are not equal, and many hospitals have difficulty recruiting.
Functional Transformation:
From "incoming medicine, dispensing" to clinical medication guidance
When it comes to the pharmacy department of the hospital, most people probably think of the pharmacy staff, who are responsible for giving medicines to patients and purchasing drugs for the hospital. These two jobs were the original titles of the Pharmacy Section.
"We are a hospital of traditional Chinese medicine, and in addition to the basic work, we also have some preparation work." In the first five years of his career, Deng Guiming rotated in various positions in the pharmacy department of the hospital. I've been a pharmacist and a pharmacist.
With the increase in patients' demand for medical treatment and the requirements for the quality of medical treatment. The pharmacy section is increasing in its functions and the scope of its work is constantly expanding.
The number of beds in the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine has been expanded from more than 600 to more than 1800, and the number of daily outpatient visits has reached about 6000-8000.
At the end of 2013, the Department of Pharmacy of the Institute of Institutional Reform established two departments at the level of the Department of Pharmacy and the Department of Preparation, and set up a department of pharmacy. Under the Department of Pharmacy, in addition to the dispensing room, the clinical pharmacy room, and the central drug library, a total of four secondary departments of the "intravenous infusion preparation center" were established.
In 2010, the former Ministry of Health issued the Notice on Printing and Distributing the Basic Standards for Pharmacy Departments of Secondary and Tertiary General Hospitals (Trial Implementation), and in 2011 issued the Notice on Printing and Distributing the Regulations on the Administration of Pharmaceutical Affairs in Medical Institutions. The document clearly stipulates that the pharmacy department is set up in the second-level general hospital and the pharmacy department is set up in the third-level general hospital. After that, the Pharmacy Department of tertiary hospitals was gradually renamed the Faculty of Pharmacy. However, some county or township hospitals still use the name of the Pharmacy Department, and their main function is to provide clinical drug supply guarantee services.
At present, the work of the Pharmacy Department mainly includes three parts: drug supply guarantee work; clinical pharmacy (rational use of drugs) work; and pharmacy personalization work. Before the medical reform, the guarantee of drug supply was the focus of work, and now, the focus of the pharmacy department is to provide rational drug use and personalized services for the clinic.
Jiang Zhiping, deputy director of the Pharmacy Department of Hunan Children's Hospital, told the Health Times reporter, "On the basis of ensuring the normal supply of drugs, the Pharmacy Department has focused on developing and vigorously promoting clinical pharmacy work since ten years ago, also known as rational drug use work, including prescription review and reorganization, prescription review, difficult case consultation, medication consultation, pharmacy rounds, pharmacy clinics, etc." At the same time, we actively carry out pharmaceutical personalization work to improve the comprehensive level of pharmacy disciplines, such as therapeutic drug monitoring, drug metabolism gene detection, centralized allocation of intravenous drugs, and research and development and production of self-made preparations in hospitals. ”
In the view of Kang Zhen, professor of the School of Basic Medicine and Clinical Pharmacy of China Pharmaceutical University and deputy director of the National Development and Research Center for Practicing Pharmacists, this is an important change in the pharmacy department from workshop-style preparation production to the construction of scientific clinical pharmacy disciplines.
Kang Zhen introduced, "Before we reviewed prescriptions, we often audited the single prescription of the patient to take the drug, rather than reviewing the merger of 5 prescriptions, and in the 90s, when the concept of pharmacy services was proposed, it was necessary to review the patient's 5 combination prescriptions from the patient's overall medication and follow up monitoring to evaluate the treatment effect." Because the patient goes to five doctors to see a doctor, it is possible that 5 prescriptions together will go wrong. ”
"Doctors pay more attention to the diagnosis of the patient's disease and the clinical treatment plan. Pharmacists pay more attention to the rationality of drug treatment options, adverse drug reactions, compatibility contraindications, efficacy evaluation, and drug safety. Deng Guiming told reporters that pharmacists are now deeply involved in the diagnosis and treatment of patients in the multidisciplinary diagnosis and treatment mode, and are important members of the patient treatment team to escort the safety of patient medication.
In July 2018, the National Health Commission issued the "Specification for The Review of Prescriptions in Medical Institutions", which clarified that pharmacists are the first responsible persons for prescription review, and prescriptions that have not been approved without audit shall not be charged and allocated, strengthen prescription reviews, and promote rational clinical drug use.
Positive Transformation:
Seek the way to reduce costs and increase efficiency
Because, after the implementation of the cancellation of the drug markup policy, the total medical income of the hospital has declined month-on-month, increasing the pressure on the operation and development of the hospital. Kang Zhen said that many hospitals have lost money in the process of canceling the drug markup. Assuming that the drug cost of a public hospital reaches 200 million, removing 15% of the bonus income, it means that the profit of 30 million yuan has been 'drifted'.
In March 2021, the National Health Commission issued the "2019 National Tertiary Public Hospital Performance Appraisal National Monitoring and Analysis Circular", showing that the 2413 tertiary public hospitals in the mainland participated in the monitoring had an average surplus rate of 3% in 2019, a median surplus rate of 1.69%, and 17.6% of the tertiary public hospitals had losses.
The reduction of pharmacists has become a "worry" for pharmacy staff for a while.
Jiang Zhiping told reporters: "At present, the pharmacy department of public hospitals provides doctors and patients with many pharmaceutical professional and technical services such as prescription review, prescription review, prescription allocation, medication consultation, drug storage and maintenance, etc. The human resources needed to complete these basic work account for more than one-half of the total number of pharmacy departments, and there are a large number of storage costs, energy costs, consumable costs and information costs. But these jobs and costs are currently free. ”
Moreover, the hospital's annual financial allocation is not even enough to pay the salaries of retired employees, let alone "feed" the huge pharmaceutical team, which is also full of highly educated talents.
The Department of Pharmacy of the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine has 189 employees (including contract system), including 1 postdoctoral, 5 with doctoral degrees, 3 doctoral students, 30 people with master's degrees, 11 people with high professional titles, 9 deputy high professional titles, 3 doctoral supervisors, and 10 master's supervisors.
According to Zhang Yatong of the Pharmacy Department of Beijing Hospital, the pharmacy department of the hospital has about 150 personnel, and about 70% of the employees serve the drug transfer work.
What to do? Transformation becomes the only way out of the pharmacy department: cost reduction and efficiency increase.
How to reduce costs? Deng Guiming told reporters that for some non-technical work, such as dispensing drugs, taking medicines, swiping cards, drug hospital transportation, etc., the hospital takes measures to do it for workers or third-party service personnel to reduce human resource costs. In addition, it will also increase the informatization construction of hospital pharmacies to improve work efficiency.
In the First People's Hospital of Zhumadian City, Henan Province, the centralized deployment of static distribution centers is adopted to reduce costs. The static distribution center will free nurses from the daily complicated infusion work, nurses no longer have to undertake the dispensing work, to each department with one less nurse to calculate, the monthly hospital labor costs can be saved hundreds of thousands of thousands.
How to increase efficiency? Many hospitals find ways to find ways from medical insurance funds and scientific research funds.
Deng Guiming, who has worked in the Department of Pharmacy for 20 years, has presided over more than 20 scientific research projects, won 2 Hunan Provincial Science and Technology Progress Awards, 3 Hunan Provincial Traditional Chinese Medicine Science and Technology Progress Awards, 1 authorized invention patent, and published more than 40 professional papers, including 6 papers included in SCI. Therefore, through the development of pharmaceutical research, she led the team of highly educated pharmacists to carry out scientific research work, thereby increasing the scientific research results of the pharmacy discipline of the hospital, and to a certain extent, improving the comprehensive business level and service capabilities of high-quality pharmacists.
Clinical Pharmacy:
How to develop higher quality in the future
"The cancellation of the price difference by the medical reform is an idea of the national medical reform. This is the inevitable in the reform, and the medical reform work needs to re-evaluate the value and contribution of its existence and change the bird. At the hospital terminal, patients are no longer dominated by drugs and consumables, do not use more drugs, do not do too many examinations, so that patients can enjoy just the right medical services, is the medical value itself. Zhang Yatong said.
In 2021, the Opinions of the General Office of the State Council on Promoting the High-quality Development of Public Hospitals mentioned that "public hospitals should optimize the income structure and increase the proportion of medical service revenue (excluding drugs, consumables, inspections, and chemical inspections) in medical revenue".
Zhang Yatong pointed out, "In the early days, many people issued drugs over the counter, and now they should go out and take the initiative to see the results of pharmaceutical services; before the normal drug was issued, what the doctor prescribed, what we sent, now and in the future we have increased the review of the doctor's prescription, whether the drug is reasonable, whether the patient has taken it after the drug is sent, how the patient's compliance and effect are, and we also need to evaluate in this regard." At the same time, we will tap the potential of the pharmacy department, recruit talents, do clinical pharmacy research, and expand the pharmaceutical service business. ”
In June 2021, the Information Office of the State Council said at a regular briefing that in 2021, 30 pilot cities across the country will carry out payment by disease diagnosis-related grouping, that is, DRGs payment, which indicates that the DRGs payment model will replace the traditional daily payment model as the main form of medical insurance payment.
Kang Zhen pointed out that DRGs are medical insurance through the unified customization of disease diagnosis related classification quota payment standards, which combine pharmacy monitoring practice, guide clinicians to accurately select and pay more attention to the rational use of drugs, standardize drug use behavior, especially strengthen the appropriateness of auxiliary drugs, usage and dosage and the appropriateness of combination drugs.
Kang Zhen suggested that in addition to drug supply and clinical trial research, hospitals should be encouraged to add pharmacy clinics, including drug treatment management clinics in various disease fields, online pharmacy consulting services, set up pharmacy staff service charging items, explore "smart service pharmacies"; establish a performance appraisal system to improve the quality of clinical services, innovate the promotion of pharmacists' titles and salary systems, and promote the sustainable development of pharmacists' careers.
Zhang Yatong pointed out that in the future, the skills of members of the pharmacy department should be comprehensive, not only have the basic work ability, but also have clinical thinking, cooperate with doctors and nurses, mutual assistance in medicine, increase scientific research capabilities, management functions, and ensure that in the entire process of medical reform, the reform process in the field of medicine has analysis, monitoring, suggestions, coordination, and management.
bibliography:
Xingtan Hospital Affiliated to Shunde Hospital, Southern Medical University. Study on the Impact of Drug Surcharge Cancellation on Drug Use Architecture in Public Hospitals[J].Chinese Journal of Pharmaceutical Sciences,2020,06(3):207-209.
Taizhou Enze Medical Center (Group) Zhejiang Taizhou Hospital. Discussion on the development of pharmacy department in hospitals under the situation of new medical reform[J].Journal of Traditional Chinese Medicine Management,2020,04(2):225-226.