关键词: 药物相关问题, 药学服务, 社区药房, 家庭医生签约服务, 老年患者

Abstract:

Drug-related problems (DRPs) pose a significant risk to medication safety among older adults with chronic conditions in community settings. Although global evidence underscores the value of integrating pharmacists into primary care, community pharmacists in China remain underutilized in promoting rational drug use and lack a structured, operational model aligned with the family doctor contract service (FDCS) framework. In this prospective pilot study, conducted across 31 community health centers in Beijing, we developed and evaluated a pharmacy care model centered on DRP identification for older patients with chronic diseases within FDCS teams. Trained community pharmacists, with support from clinical pharmacists at tertiary hospitals, systematically screened FDCS-enrolled patients aged ≥ 60 years who had at least one chronic condition for potential DRPs. Identified DRPs were classified according to the Pharmaceutical Care Network Europe (PCNE) DRP Classification V9.1, and targeted, proactive pharmacy services were provided to address these issues. During the study period, 36 pharmacists served 866 patients and identified 731 DRPs in 540 patients, corresponding to a DRP incidence of 62.4% (540/866). Among patients with DRPs, the mean number of problems per patient was 1.35 (731/540). The most frequently observed issue was “effect of drug not optimal” (56.8%), followed by “untreated symptoms/indication” (17.6%) and “adverse drug event occurring” (13.3%). This model enabled community pharmacists to proactively detect and manage DRPs within FDCS teams, despite limited pharmacist resources. It offered a scalable, evidence-based framework for systematically enhancing medication safety in China’s primary care system and provided practical insights for similar resource-constrained settings globally.

Key words: Drug-related problems, Pharmaceutical care, Community pharmacy, Family doctor contract service, Older patients