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一家跨学科记忆诊所:基层医疗中药剂师的一种新型执业环境。

An interdisciplinary memory clinic: a novel practice setting for pharmacists in primary care.

作者信息

Rojas-Fernandez Carlos H, Patel Tejal, Lee Linda

机构信息

University of Waterloo School of Pharmacy, Kitchener, ON, Canada.

出版信息

Ann Pharmacother. 2014 Jun;48(6):785-95. doi: 10.1177/1060028014526857. Epub 2014 Mar 20.

Abstract

Pharmacists have developed innovative practices in various settings as singular providers or as members of multidisciplinary or interdisciplinary teams. Examples include pharmacists practicing in heart failure, hypertension, or hyperlipidemia clinics. There is a paucity of literature describing pharmacists in interdisciplinary memory clinics and specifically pharmacists practicing in interdisciplinary, primary care-based memory clinics. New practice models should be disseminated to guide others in the development of similar models given the complexity of this population. Patients with dementia are more difficult to manage because of cognitive impairment, behavioral and psychological symptoms, the common presence of multiple comorbidities, and related polypharmacy and caregiver issues. These challenges require expertise in neurodegenerative disorders and geriatrics. The purpose of this article is to describe the role of clinical pharmacists providing care to patients with cognitive complaints in a primary care-based, interdisciplinary memory clinic, with a focus on how the pharmacist practices and is integrated in this collaborative care setting. Patients are assessed using an interdisciplinary approach, with team consensus for assessment and planning of care. Pharmacists' activities include assessment of (1) appropriateness of medications based on frailty, (2) medications that can impair cognition and/or function, (3) medication adherence and management skills, and (4) vascular risk factor control. Pharmacists provide education regarding medications and diseases, ensure appropriate transitions in care, and conduct home visits. Pharmacist participation in this clinic represents a novel opportunity to advance pharmacy practice in primary care, interdisciplinary models. Work is ongoing to describe outcomes attributable to pharmacist participation in this clinic.

摘要

药剂师在各种环境中都开展了创新实践,他们既可以作为独立的提供者,也可以作为多学科或跨学科团队的成员。例如,在心力衰竭、高血压或高脂血症诊所执业的药剂师。目前缺乏关于跨学科记忆诊所药剂师的文献描述,特别是在基于初级保健的跨学科记忆诊所执业的药剂师。鉴于这类患者群体的复杂性,新的实践模式应予以推广,以指导他人开发类似模式。患有痴呆症的患者由于认知障碍、行为和心理症状、多种合并症的普遍存在以及相关的多重用药和护理人员问题,更难管理。这些挑战需要神经退行性疾病和老年医学方面的专业知识。本文的目的是描述临床药剂师在基于初级保健的跨学科记忆诊所中为有认知主诉的患者提供护理的作用,重点关注药剂师如何开展工作以及如何融入这种协作护理环境。患者采用跨学科方法进行评估,团队就护理评估和规划达成共识。药剂师的活动包括评估:(1)基于虚弱状况的用药合理性;(2)可能损害认知和/或功能的药物;(3)用药依从性和管理技能;(4)血管危险因素控制。药剂师提供有关药物和疾病的教育,确保护理的适当过渡,并进行家访。药剂师参与该诊所代表了在初级保健跨学科模式中推进药学实践的新机会。目前正在开展工作,以描述药剂师参与该诊所所带来的结果。

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