Interviewed experts: Ji Cheng, deputy chief pharmacist of Drum Tower Hospital Affiliated to Nanjing University School of Medicine
Wang Guohua, Research Fellow, International Research Center for Pharmaceutical Management, Peking University
Reporter Zhang Xiaoyue
There is such a group of staff in the hospital, who have also received professional medical education and wear white coats, but they are gradually marginalized, not valued enough, and even called "drugging" by some patients.
The two types of pharmacists are not clearly located
Xiao Li is a pharmacist in a hospital in Shenyang, talking about the current situation of work, he often ridiculed: "When I graduated from undergraduate and went to graduate school, it was because I didn't want to do the work of taking medicine, and I didn't expect that it would be the same result after master's degree." The "taking medicine" in Xiao Li's mouth refers to the dispensing work of the pharmacy, mainly to help patients distribute drugs according to the prescription. With the general improvement of people's academic qualifications, the threshold for hospital access has risen, and the employment requirements of pharmacists have also "risen in the water", well-known universities and master's degrees or above abound. However, after entering the hospital, most of them do the work of "taking medicines", which makes the pharmacists have a low sense of self-worth and the recognition of them by society is not high.
In recent years, the "patient-centered" pharmaceutical service model has begun to receive attention, and the pharmacy work of hospitals has gradually changed from the past "simple supply" to "scientific and technological service". The "Interim Regulations on the Administration of Pharmaceutical Affairs in Medical Institutions" formulated by China's medical and health management departments clearly require that the pharmacy departments of medical institutions carry out clinical pharmacy work with rational drug use as the core and participate in the diagnosis and treatment of clinical diseases.
Wang Guohua, a researcher at the International Research Center for Pharmaceutical Management at Peking University, told the Life Times that pharmacy services play an indispensable role in ensuring the health of patients. Different from the traditional dispensing function, the combination of pharmacists and clinics to make suggestions to doctors and patients from a pharmacological point of view is conducive to the medical team to better play the overall effectiveness, and is of great significance to improving the safety, accuracy, rationality and scientificity of clinical drugs. For example, an elderly person with a variety of chronic diseases may be treated in multiple departments at the same time, and each doctor prescribes medicine according to his own specialty, and the pharmacist can use his professional knowledge to prevent and resolve the hidden dangers caused by the interaction between drugs.
But in fact, "dispensers" and "clinical pharmacists" are often not clearly positioned. According to the recruitment information of pharmacists in 2021 in a third-class hospital in Beijing, it is necessary to be a fresh graduate, have a bachelor's degree or above, have excellent results (average score of 80 points or above or equivalent level), no failing and make-up examination subjects, etc., but it is not clear what type of pharmacists to recruit. In many countries, most of the transfer work is completed by technicians, and at present, in China's major public hospitals, whether it is a clinical pharmacist or a transfer pharmacist, they are high-quality talents from the class.
Ji Cheng, deputy director of the Drum Tower Hospital affiliated to Nanjing University School of Medicine, said: "Some hospitals will transfer interested transfer pharmacists to clinical pharmacists through post adjustments and internal selection, but most people can only look forward to transferring positions for a long time, and gradually lose their original professional skills with the passage of time." "Pharmacists go directly into the clinic and participate in the formulation of reasonable drug delivery plans, which is difficult to achieve in many hospitals. Ji Cheng said: "In principle, the top three hospitals will be equipped with a certain number of clinical pharmacists, but the implementation effect in different regions is different, some clinical pharmacists are often 'nominal', or wait alone in the post, occasionally a few patients come to consult, or do the same work as the dispenser." ”
Multiple factors make pharmaceutical services tend to be superficial
Since the pilot training of clinical pharmacists was carried out in January 2006, China has been exploring a training model suitable for national conditions, which is still in its infancy, unbalanced development, the pharmaceutical services provided tend to be superficial, the pharmacists have a low sense of value, and it is difficult to play a clinical role, which is affected by many factors.
The concept of "heavy medicine over medicine" has long existed. The traditional view is that the role of the pharmacist is to dispense medicine according to the prescription, and the work object is the drug, not the patient. This concept has led to the fact that the status of pharmacists in the hospital has not been high, and their sense of professional identity has not received the attention they deserve. This traditional understanding of "emphasizing medicine over medicine" limits the development and cultivation of pharmacists. Although some hospitals are aware of the importance of clinical pharmacy, there is still little support in human, material and financial resources, and the attention to pharmacy still stays in the supply of drugs and the production of preparations, and the development of clinical pharmacy work is only "embellishment".
The knowledge structure of talents does not adapt to market demand. At this stage, the training of undergraduate students majoring in pharmacy is still an expanded extensive teaching model, which cannot meet the needs of innovative talents, social pharmacy service talents, and clinical pharmacy service talents. Ji Cheng said that although some medical schools have now divided the pharmacy profession and clinical pharmacy, the situation that pharmacists only understand medicine and do not understand medicine still exists, and some pharmacy graduates cannot even understand medical records, laboratory tests, etc., so that when they go to the clinic, they have a weak heart and timidity, and it is difficult to get the trust of doctors and patients.
The relevant regulations are not perfect. Most hospitals have an imperfect mechanism to promote the participation of clinical pharmacists in diagnosis and treatment, coupled with the fact that there are few opportunities for pharmacists to study and learn, and there is a general lack of diagnosis and treatment knowledge and clinical practice experience that clinical pharmacists should have, resulting in their embarrassing position in the hospital. In addition, the law related to pharmacists has not yet been introduced in China, and the rights and interests of pharmacists are difficult to protect, and the working environment is more difficult, and it is difficult to play a real role.
Pharmacists have a lot to offer
In addition to traditional prescription adjustments, pharmacy services also include participation in and implementation of drug treatment, monitoring of therapeutic drugs, conducting drug utilization research and evaluation, conducting pharmaceutical information services, monitoring and reporting of adverse reactions, and health education. Wang Guohua said that the work of pharmacists should return to the origin of pharmaceutical services, provide pharmaceutical support for doctors' diagnosis and treatment, and provide guarantees for safe and rational use of drugs. To truly achieve this, changes must be made to the pharmacist team, hospital management, laws and regulations, and so on.
Publicize rational drug use and raise public awareness. It is necessary to publicize to the public and to physicians, so that both doctors and patients recognize the importance of rational drug use, so that more people understand the work of clinical pharmacists, which is not only conducive to creating an atmosphere of rational drug use, establishing the correct direction of drug use, but also helping to change people's inherent cognition of pharmacists and improve social recognition.
Clarify the division of labor and play a practical role. In view of the difference between dispensing pharmacists and clinical pharmacists, there is a clear distinction between professional training and employment requirements, so that people can make the best use of their talents. Hospitals should strengthen the "medical linkage", formulate a reasonable compensation mechanism and a scientific performance appraisal system, pharmacists should actively improve their professional quality, and doctors should try to accept, so as to achieve clinical pharmacists to cooperate with clinicians to provide patients with safer and more effective treatment plans.
Improve policies and introduce the "Pharmacist Law". At present, China has specific requirements and training for pharmacists, but there is no relevant legislation. Ji Cheng said that doctors and nurses have relevant laws, but pharmacists do not, and it seems that some "names are not right, and words are not smooth." Through legislation, not only can the behavior and work of pharmacists be regulated, but also make them more recognized in society. ▲