目的 通过调查医疗机构药师参与慢病管理的现状,客观分析影响因素,为建立合理的慢病管理队伍和药师未来发展方向提供指导。方法 针对全国范围内各级医疗机构药师,设计调查问卷,问卷主体分为3部分内容,分别为基本信息、慢病管理药学服务的开展情况,以及影响药师参与慢病管理的因素。结果 共发放400份调查问卷,回收391份,问卷回收率97.8%。参与调查的医院药师来自全国28个省份,男性113名、女性278名,年龄以31～45岁为主(51.7%,n=202);其中234名来自三级医院(占59.6%),以大学本科(49.4%,n=199)和硕士研究生(34.0%,n=133)为主。参与调查的药师中有204人(52.2%)曾经或正在参与慢病管理。286名药师(73.1%)所在医疗机构设有慢病管理专区。药师参与慢病管理以全职(16.6%,n=65)和兼职(49.6%,n=194)为主。药师参与慢病管理的方式多样,面对面(上门随访)(n=307, 78.5%),电话随访(n=247, 63.2%),短信或微信随访(n=186, 47.6%)。现阶段药师可以完全做到处方审核与调剂(51.2%,n=200)、不良反应监测与指导(37.1%,n=145)、用药咨询与指导(31.2%,n=122),用药依从性教育(23.0%,n=90)。目前影响药师参与慢病管的影响因素包括缺乏提供慢病管理药学服务的资源(77.5%,n=303),患者对药师缺乏信任(67.3%,n=263),缺乏规范化的慢病管理药学服务规范(61.9%,n=242),药师服务费用问题(56.0%,n=219)。结论 药师团队目前已逐步开展或加入慢病管理的队伍,参与此项工作的态度积极,参与的广度有待进一步提高。客观的政策条件也限制了药师的发挥空间(例如:药师收费问题)。政府和医院需要对药师队伍加强专业培训,完善政策支持,让药师未来更好的参与慢病管理。

OBJECTIVE To investigate the current situation of hospital pharmacists participating in chronic disease management, and to objectively analyze the influencing factors, so as to provide guidance for the establishment of reasonable chronic disease management team and development direction of pharmacists.METHODS A questionnaire was designed for hospital pharmacists at all levels nationwide. The questionnaire was divided into three parts, including basic information, development of pharmaceutical care for chronic disease management, and factors affecting pharmacists' participation in chronic disease management. RESULTS A total of 400 questionnaires were sent out and 391 were collected with a recovery rate of 97.8%. There were 113 males and 278 females from 28 provinces in China, and the majority of the pharmacists were between 31-45 years old(51.7%, n=202). Among them, 234(59.6%) were from tier 3 hospitals, and most of them have bachelor's degree(49.4%, n=199) and master's degrees(34.0%, n=133). Two hundred and four pharmacists(52.2%) were involved in chronic disease management. Two hundrwed and eighty-six pharmacists(73.1%) worked in hospital with chronic disease management unit. The majority of pharmacists involved in chronic disease management were full-time(16.6%, n=65) and part-time(49.6%, n=194).Pharmacists participated in chronic disease management in a variety of ways, including face-to-face(dropping in follow-up)(n=307, 78.5%), telephone follow-up(n=247, 63.2%), text message or WeChat follow-up(n=186, 48.6%). Pharmacists can complete prescription review and dispensing(51.2%, n=200), adverse reaction monitoring and guidance(37.1%, n=145), medication consultation and guidance(31.2%, n=122), and medication compliance education(23.0%, n=90). The influencing factors of pharmacists' participation in chronic disease management included lack of pharmaceutical care resources for chronic disease management(77.5%, n=303), patients' lack of trust in pharmacists (67.3%, n=263), lack of standardized pharmaceutical care procedures for chronic disease management(61.9%, n=242), and pharmacists' service cost(56.0%, n=219). CONCLUSION The pharmacists' team has gradually started or joined the chronic disease management team, and they have a positive attitude to participate in such work. The breadth of participation needs to be further improved.Objective policy conditions also limit the play space of pharmacists(pharmacists charge). The government and hospitals need to strengthen professional training for pharmacists and improve policy support, so that pharmacists can better participate in chronic disease management in the future.