Release date: 2017-06-20
The concept of chronic disease management has entered the retail pharmacy industry for more than five years. From the initial Diabetes Living Museum to the various chronic disease management experience centers, everyone has made chronic disease management a breakthrough in the professional transformation of retail pharmacies. Recognizing the opportunities that slow disease management will bring to retail pharmacies in the future. However, the real good work is rare. On the contrary, the phenomenon of “slow disease management†as a gimmick to make “single product breakthrough†is quite a lot.
The management of chronic diseases is actually to help patients with chronic diseases to manage their health. It is aimed at preventing and controlling the occurrence and development of chronic diseases, reducing medical expenses, and improving the quality of life. It aims to educate individuals or groups of chronic diseases to improve their self-management awareness and level. And the health risk factors related to their lifestyles, through the health information collection, health testing, health assessment, personalized monitoring management, health interventions and other means to continuously improve the process and methods. The focus of chronic disease management is on patients who have low medication adherence and unhealthy lifestyle habits.
Recognizing this, it is not difficult to see that the core of chronic disease management is actually the lifestyle change of patients with chronic diseases and the improvement of drug treatment compliance. The entrance to chronic disease management is to collect health information for them, that is, patients. The establishment of a health record.
Who will do it?
There are several difficulties in establishing a file for a chronically ill patient. One is that pharmacy clerk lacks pertinence when collecting patient information. The second is that the pharmacy clerk lacks subjective initiative, either fill in perfunctory things or refuse to find various reasons. The third is that patients are worried that their personal information will be leaked and they are not willing to establish a file for the pharmacy. The fourth difficulty is related to the marketing attributes of traditional pharmacies. After all, most pharmacies are currently only the sales of goods, and most of the time and energy invested in marketing.
The difficulties listed in the four chronic diseases management listed above are believed to be encountered by most pharmacies. So how should we solve these difficulties? In fact, the hard part is that pharmacies need someone to do it, that is, "willing to do" and "will do."
First of all, the difficulty of “willing to do†is solved, that is, how to choose the right employees and encourage them to persist in the management of chronic diseases. In fact, many retail pharmacies now select a group of employees with certain medical and pharmacy backgrounds to engage in chronic disease management, such as “Sugar Commissionerâ€, “Crisis Commissionerâ€, and “Health Management Consultantâ€. "When these positions are taken, the pharmacy gives these commissioners a distinction between the post allowances of other employees, and this also increases the labor costs of the drug store. Most pharmacies are unable to insist that chronic disease management has something to do with the labor costs that are less willing to invest in this part.
Who should choose a pharmacy to manage chronic disease? The author believes that licensed pharmacists as a hot group in retail pharmacies are very suitable for this work. Due to industry policy and regulations, licensed pharmacists have always been indispensable for retail pharmacies, and their basic salary is much higher than that of general pharmacy salespersons. However, most licensed pharmacists only play the role of GSP quality administrators in retail pharmacies, but do not really play the value of pharmaceutical services as stated in the Code of Practice for Licensed Pharmacists. Chronic disease management is actually a pharmacy service for patients with chronic diseases, which is the best entry for licensed pharmacists to play their role. Therefore, for pharmacies, instead of spending a lot of effort to select people, it is better to consider how to motivate ready-made licensed pharmacists to let them take advantage of their business expertise. Because, unlike other employees who have been selected as “commissionersâ€, licensed pharmacists have passed the more difficult qualification examinations. The medical and pharmacy knowledge they possess is more professional and comprehensive, and they will consider problems when serving chronic patients. More detailed.
Of course, in addition to doing a good job of motivation, you should also create a good chronic disease management atmosphere for licensed pharmacists, such as setting up a chronic disease management center or a pharmacist service area in a pharmacy, so that their professional service work receives sufficient attention. Another example is to provide a set of intelligent chronic disease management system tools, so that they can use information tools to quickly and easily create electronic health records for patients, and can quickly view chronic disease patients information on the PC or mobile phone, making chronic diseases The patient's return visit work has become simple.
How to do it?
The difficulty in "doing it" mainly refers to how to train and train employees to become healthy butlers around chronic patients.
Before that, I think that there must be a point of view that needs to be clear: pharmacies are not hospitals, licensed pharmacists are not doctors, don't try to replace doctors' functions, and even do work that doctors can't do. Here, “will do†must be directed at one or several chronic diseases. According to the treatment opinions on the guidelines, the medication process of chronically ill patients is tracked, and relevant indicators are monitored to evaluate the treatment effect and timely discover the risks. Unreasonable diet and lifestyle interventions are targeted to inform relevant patients to attend expert lectures or free clinics. To sum up, it is the "sixty section of chronic disease management", that is, the basic information record - the clear control target - the indicator monitoring service - to find the treatment target - the analysis of the treatment plan - the invitation to engage in educational activities.
After clarifying the process of chronic disease management, let's talk about the key items that the patient's health record needs to fill out.
Age
In the case of a single disease or without complications, the criteria for blood pressure control and glycemic control in patients with chronic conditions will vary according to age. For example, in diabetic patients, the ideal fasting blood glucose should be controlled at 6.0mmol/L, and the blood glucose should be controlled at 8.0mmol/L 2h after meal. However, for patients over 65 years old, it can be relaxed to fasting blood glucose 7.0mmol/L. Within 2 hours after the meal, the blood glucose is less than 10.0mmol/L, so as to avoid the quality of life of elderly patients due to excessively strict bloodline control.
2. Disease category
Many patients with chronic diseases suffer from a variety of chronic diseases or complications, and different chronic diseases have certain differences in the control of the same index. For example, the control standard for blood pressure in ordinary hypertensive patients is <140/90mmHg, but for hypertension. In patients with cerebral infarction, systolic blood pressure can be appropriately relaxed to <160 mmHg in order to avoid ischemic stroke, and systolic blood pressure should be reduced to below 130 mmHg in patients with hypertension and coronary heart disease. Therefore, recording the patient's chronic disease category will play an important role in the subsequent testing services and medication reminders.
3. Test results (such as blood pressure, blood sugar, heart rate, glycosylated hemoglobin, blood uric acid, LDL-c, BMI)
For patients with chronic diseases, blindly taking drugs without index detection is equivalent to driving with closed eyes, and it is extremely dangerous to go wherever. Therefore, the premise of chronic disease management is to let patients understand the control of their indicators to grasp whether the current treatment plan is effective and reduce the incidence of end point events (death).
At present, the most chronic disease management is hypertension management and diabetes management. Blood pressure and blood sugar testing are the services that most pharmacies have already done, and glycated hemoglobin (HbA1c), which is the “gold standard†for diabetes treatment and monitoring, is gradually causing The focus of retail pharmacies, but only a few pharmacies have introduced testing equipment and as a program to provide regular testing services for diabetic patients. Several other testing services are relatively unpopular. In fact, non-goutic hyperuricemia is also an independent risk factor for cardiovascular events. In addition to sorghum food and metabolic syndrome, some chronic drugs can also cause blood uric acid to rise in the body. High, such as long-term use of aspirin, hydrochlorothiazide, levodopa, etc., so pharmacies can also regularly check blood uric acid for chronically ill patients as a value-added service. Low-density lipoprotein (LDL-c) has been a very important control indicator in the treatment of various chronic diseases such as diabetes and coronary heart disease.
If the detection of glycosylated hemoglobin, blood uric acid and LDL-c depends on the introduction of new equipment, equipment and consumables need to be put into a certain cost, not all pharmacies can have such conditions, then the detection of heart rate is completely different. . The electronic sphygmomanometer displays the heart rate detection result while measuring blood pressure, so it is very convenient to record. Why do heart rate management? In fact, according to the requirements of the guidelines for the treatment of hypertension, patients with hypertension should have blood pressure and heart rate management at the same time, which is ignored by many people. A large number of evidence-based medical data show that more than 50% of hypertensive patients have sympathetic over-activation, which is a synchronous rise in heart rate and blood pressure. In the guidelines for the treatment of hypertension, it is recommended that the heart rate of the young patients with simple hypertension be controlled at 60-75 times/min. If the heart rate is >75 beats/min, the beta blocker treatment should be initiated.
Finally, talk about the body mass index BMI. In fact, as early as a few years ago, many health care products companies began to manage this group of people, that is, the hot weight loss nutrition club in the WeChat circle. Weight control is one of the important measures to prevent and treat chronic diseases. Modern medical research has determined that overweight and obesity are the key causes of abnormal blood sugar and lipid metabolism. For example, insulin resistance is associated with obesity. In contrast, traditional pharmacies rely solely on recommending weight loss and lipid-lowering products to patients with chronic diseases, and nutritionists at these nutrition clubs follow up on obesity by making weight loss plans and creating files for obese people. The daily diet, exercise, and weight recording, through the effective implementation of the weight loss program, coupled with the product, so that obese people eventually lose weight. Therefore, when retail pharmacies are managing health care for chronically ill patients, they should be able to establish files, return via SMS, and make phone calls to transfer attention from a single product success recommendation to a focus on product use. Through the good communication between pharmacists and chronic disease management specialists, help chronically ill patients choose nutritional diets and appropriate exercise methods, so that chronically ill patients can overcome the discomfort in correcting bad diet and lifestyle, help patients build confidence in rehabilitation, overcome pessimism, depression, Negative emotions enable them to actively participate in treatment options.
4. Medication
Medication is the most important thing in the management of chronic diseases. No matter what kind of healthy diet or lifestyle, the management of chronic diseases leaving medical treatment is “fudgeâ€. In order to better track drug use in patients with chronic diseases, if the pharmacy uses the member management system that implements the data docking with the invoicing (cash register) system, the product details of the patient's drug purchase can be automatically uploaded to the employee cashier. In its health file. This not only enhances the efficiency of chronic disease management, but also enhances the work compliance of licensed pharmacists, and also creates conditions for subsequent implementation of the system intelligent reminder of medication expiration.
Based on the "Internet + chronic disease management" information platform, through the analysis of health data (test data) and medication data (consumption records) of chronically ill patients, the health risks and demand potential of patients can be found, for example, after PCI In patients with chronic diseases, follow-up medications and timely detection of compliance problems in the use of dual-antibody therapy (aspirin + clopidogrel / ticagrelor), such as the patient's own withdrawal, then the pharmacist can do this from the system The patients are screened, and then the medication return visit or the invitation to teach is targeted to correct the patient's wrong medication habits. On the one hand, it reduces the risk of acute myocardial infarction caused by stent thrombosis after stopping the drug, and can increase the frequency of repeated drug purchases in the pharmacy. Another example is the long-term blood glucose monitoring service for diabetic patients (fasting and 2h after meal). By comparing the patient's blood glucose data and the use data of diabetes drugs in the system, the patient's drug regimen can be found according to the blood glucose map and the drug action curve analysis. Where adjustments can be made.
Therefore, the entry point for pharmacy implementation of chronic disease management is to document patients, while the core is professional chronic disease management personnel (practical pharmacists), intelligent information management systems and a good in-store service environment.
Source: The first pharmacy Caizhi (micro signal yaodiancaizhi)
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