有冇諗過分家醫療成本要提幾多
乜香港冇錢咩
[討論]點睇藥劑師
切柒奇俠
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乜香港冇錢咩
再者有錢起千幾億膠鐵，你同我講乜錢搞分家？
膠鐵你會搭，冇問題，但唔係人人都會搭；但係睇醫療服務，你一年點都會掂一次啦呱。
膠鐵你會搭，冇問題，但唔係人人都會搭；但係睇醫療服務，你一年點都會掂一次啦呱。
講緊醫藥分家時，你睇下張台上面幾多個係醫生幾多個藥劑師就知。根本就醫生圍埋自己討論，一抵觸到佢地既利益時，根本無可能通過。
香港依家藥劑師過多了，你地都有今日
。返衛生署既就懶到仆街，返藥房個的...唔晒做野既，返醫院個的就咁既人工做機械人既野。
香港依家藥劑師過多了，你地都有今日
。返衛生署既就懶到仆街，返藥房個的...唔晒做野既，返醫院個的就咁既人工做機械人既野。講緊醫藥分家時，你睇下張台上面幾多個係醫生幾多個藥劑師就知。根本就醫生圍埋自己討論，一抵觸到佢地既利益時，根本無可能通過。
香港依家藥劑師過多了，你地都有今日
所以討論冇拎ｒｅｆ傾，真係唔多想理佢。
世衛話最好的比例係1:2000，但係我成日諗香港塊地唔會隨時間變大（過左2047另計），當唔夠位塞個藥劑師果陣，點解個比例唔用面積比人口？而且多左其他HPC又會唔會影響呢個Ratio？
Ｄ人成日話而家通街大學生，唔係錯曬 in term of密度。
講緊醫藥分家時，你睇下張台上面幾多個係醫生幾多個藥劑師就知。根本就醫生圍埋自己討論，一抵觸到佢地既利益時，根本無可能通過。
香港依家藥劑師過多了，你地都有今日
其實喺香港嘅藥劑師真係無嘢做齋逗人工
但又高人工過人講緊醫藥分家時，你睇下張台上面幾多個係醫生幾多個藥劑師就知。根本就醫生圍埋自己討論，一抵觸到佢地既利益時，根本無可能通過。
香港依家藥劑師過多了，你地都有今日
其實喺香港嘅藥劑師真係無嘢做齋逗人工
underutilized 丫嘛。
兩粒鐘tutorials 全部都係講本小冊子
Medication Therapy Management (MTM)
抽左少少時間講住MTM先。
１—乜野係MTM
1. 藥療檢查
2. 藥物諮詢
3. 疾病管理
4. 藥物基因應用 (即係藥物反應因基因而異)
5. 抗凝血管理
6. 其他
7. 藥物安全調查
8. 公眾健康
9. 免疫服務
就咁睇落去，係咪好似有一半的職能同藥冇咩關係 ，唔係話藥劑師做唔到，而係做唔做得好，會唔會同其他HPCs share左真係唔知（搶唔搶得贏）。但係而家會先講講1.藥療檢查先，因為類似的服務係其他國家都有，只係唔同名。
個網站話到
"...a systematic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a prioritized list of medication-related problems, and creating a plan to resolve them. ..."
簡單講句，interventions by 藥劑師減少藥物出錯。
https://www.pharmacist.com/medication-therapy-management-services
抽左少少時間講住MTM先。
１—乜野係MTM
1. 藥療檢查
2. 藥物諮詢
3. 疾病管理
4. 藥物基因應用 (即係藥物反應因基因而異)
5. 抗凝血管理
6. 其他
7. 藥物安全調查
8. 公眾健康
9. 免疫服務
就咁睇落去，係咪好似有一半的職能同藥冇咩關係
，唔係話藥劑師做唔到，而係做唔做得好，會唔會同其他HPCs share左真係唔知（搶唔搶得贏）。但係而家會先講講1.藥療檢查先，因為類似的服務係其他國家都有，只係唔同名。個網站話到
"...a systematic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a prioritized list of medication-related problems, and creating a plan to resolve them. ..."
簡單講句，interventions by 藥劑師減少藥物出錯。
https://www.pharmacist.com/medication-therapy-management-services
［２］文獻，到底MTM 有冇用？
1. Medication Therapy Management Interventions in Outpatient Settings
A Systematic Review and Meta-analysis
Data Extraction and Risk of Bias Assessment
...The evidence base consisted of 21 RCTs, 4 NRCTs, and 19 cohort studies. Most studies compared an MTM intervention with usual care (no MTM intervention).
...Medication therapy management interventions significantly improved medication appropriateness (MAI)... 4.9 vs 0.9 points, P < .001
...For some medications, MTM improved adherence as the percentage of prescribed doses taken or percentage of patients achieving a threshold adherence level and reduced medication dosing ...
但係
"...a low strength-of-evidence grade for these outcomes. Evidence was insufficient to draw any conclusions about effectiveness for the number of drug therapy problems identified and resolved."
"Evidence was insufficient to draw any conclusions about effectiveness for other intermediate outcomes, including the effect on anticoagulation, blood pressure, hemoglobin A1c, and low-density lipoprotein cholesterol."
呢D biomarkers 同好多Non-communicable disease (非傳染疾病，e.g. 糖血，動脈粥樣硬化)有關。
statistically insignificant
1. Medication Therapy Management Interventions in Outpatient Settings
A Systematic Review and Meta-analysis
Data Extraction and Risk of Bias Assessment
...The evidence base consisted of 21 RCTs, 4 NRCTs, and 19 cohort studies. Most studies compared an MTM intervention with usual care (no MTM intervention).
...Medication therapy management interventions significantly improved medication appropriateness (MAI)... 4.9 vs 0.9 points, P < .001
...For some medications, MTM improved adherence as the percentage of prescribed doses taken or percentage of patients achieving a threshold adherence level and reduced medication dosing ...
但係
"...a low strength-of-evidence grade for these outcomes. Evidence was insufficient to draw any conclusions about effectiveness for the number of drug therapy problems identified and resolved."
"Evidence was insufficient to draw any conclusions about effectiveness for other intermediate outcomes, including the effect on anticoagulation, blood pressure, hemoglobin A1c, and low-density lipoprotein cholesterol."
呢D biomarkers 同好多Non-communicable disease (非傳染疾病，e.g. 糖血，動脈粥樣硬化)有關。
statistically insignificant
1. Medication Therapy Management Interventions in Outpatient Settings
承上
Morbidity, Mortality, and Other Patient-Centered Outcomes
".... Specifically, MTM interventions did not improve measures of health-related quality of life..."
個table 太大，咁睇大家會明。
...For general health-related quality of life outcomes, meta-analyses of 7 of 8 domains and the 2 component scores (physical health andmental health) showed no significant benefit from MTM interventions.
...vitality domain of the SF-36 showed benefit in meta-analysis estimates that did not adjust for multiple comparisons... (SF-36好似得美帝先有 )
...Evidence was insufficient to draw conclusions about the effect of MTM on adverse drug events , gastrointestinal bleeding, mortality, and cognitive and affective function.
...No studies evaluated the effect of MTM on activities of daily living, work or school absenteeism, or patient and caregiver participation in medical care and decision making...
承上
Morbidity, Mortality, and Other Patient-Centered Outcomes
".... Specifically, MTM interventions did not improve measures of health-related quality of life..."
個table 太大，咁睇大家會明。
...For general health-related quality of life outcomes, meta-analyses of 7 of 8 domains and the 2 component scores (physical health andmental health) showed no significant benefit from MTM interventions.
...vitality domain of the SF-36 showed benefit in meta-analysis estimates that did not adjust for multiple comparisons... (SF-36好似得美帝先有
)...Evidence was insufficient to draw conclusions about the effect of MTM on adverse drug events
, gastrointestinal bleeding, mortality, and cognitive and affective function. ...No studies evaluated the effect of MTM on activities of daily living, work or school absenteeism, or patient and caregiver participation in medical care and decision making...
1. Medication Therapy Management Interventions in Outpatient Settings
承上
...Medication therapy management improved health plan expenditures on medications, but studies had wide CI.
...The MTM interventions also reduced the risk of hospitalization adjusted OR for diabetes and the adjusted hazard rate for heart failure....
... also reduced the costs of diabetes-specific hospitalization... (1 study)
...These results are imprecise or come from cohort studies with inherent limitations, leading to a judgment of low strength of evidence. ... 
Three RCTs did not reduce the number of hospitalizations,25-30 although a single cohort study found a lower mean number of inpatient visits for patients accepting MTM...strength of evidence insufficient... lack of consistency across studies.
Evidencewas insufficienton the effectof MTM interventions on the use of generic medications....
...only 1 study for each of 5 intervention features:
(1) access of pharmacists to patient records
(2) intensity of care coordination and follow-up after comprehensive medication review
(3) community pharmacy vs call center
(4) level of intensity of intervention
(5) type of payer (private vs Medicaid)
Evidence was insufficient for most outcomes for the first 2 intervention features, with 2 exceptions.
1.) MTM delivered by community pharmacists when compared with call center pharmacists increased the proportion of generics dispensed
(low strength of evidence). (我都想香港有份 )
2.) enhanced MTM with pharmacists’ access to patient records reduced the mean number of adverse drug events; this finding suggested benefit when compared with basic MTM (low strength of evidence).
承上
...Medication therapy management improved health plan expenditures on medications, but studies had wide CI.
...The MTM interventions also reduced the risk of hospitalization adjusted OR for diabetes and the adjusted hazard rate for heart failure....
... also reduced the costs of diabetes-specific hospitalization... (1 study)
...These results are imprecise or come from cohort studies with inherent limitations, leading to a judgment of low strength of evidence. ...
Three RCTs did not reduce the number of hospitalizations,25-30 although a single cohort study found a lower mean number of inpatient visits for patients accepting MTM...strength of evidence insufficient... lack of consistency across studies.
Evidencewas insufficienton the effectof MTM interventions on the use of generic medications....
...only 1 study for each of 5 intervention features:
(1) access of pharmacists to patient records
(2) intensity of care coordination and follow-up after comprehensive medication review
(3) community pharmacy vs call center
(4) level of intensity of intervention
(5) type of payer (private vs Medicaid)
Evidence was insufficient for most outcomes for the first 2 intervention features, with 2 exceptions.
1.) MTM delivered by community pharmacists when compared with call center pharmacists increased the proportion of generics dispensed
(low strength of evidence). (我都想香港有份
)2.) enhanced MTM with pharmacists’ access to patient records reduced the mean number of adverse drug events; this finding suggested benefit when compared with basic MTM (low strength of evidence).
1. Medication Therapy Management Interventions in Outpatient Settings
承上
Overall, we rated the MTM evidence base as insufficient
不過
...Inconsistent effects of the intervention, as well as poor measures, could explain inconsistent results....
但係好老實，你會唔會ＤＵＭ錢落去冇效果ＧＥ intervention丫？拎去馬會都有機會賺返筆啦
... Our review did not address MTM interventions conducted in inpatient settings or single-episode types of interventions (eg, medication reconciliation,
which some view as a specific type of MTM service)....
承上
Overall, we rated the MTM evidence base as insufficient
不過
...Inconsistent effects of the intervention, as well as poor measures, could explain inconsistent results....
但係好老實，你會唔會ＤＵＭ錢落去冇效果ＧＥ intervention丫？拎去馬會都有機會賺返筆啦
... Our review did not address MTM interventions conducted in inpatient settings or single-episode types of interventions (eg, medication reconciliation,
which some view as a specific type of MTM service)....
點解呢篇野咁重要？
OBJECTIVE To assess the effect of MTM interventions among outpatients with chronic illnesses.
呢幾個例子大家睇
以下原句取於"Status of prevalence study on multimorbidity of chronic disease in China: Systematic review"
[1] Making the Case for Ongoing Care.
"...It was reported that 28% of Americans have multimorbidity of chronic diseases, accounting for two-thirds of healthcare spending...."
[2] Preventing chronic diseases in China.
"...Chronic diseases now account for an estimated 80% of deaths and 70% of disability-adjusted life-years lost in China...."
以下原句取於"Chronic disease prevalence and influencing factors among rural residents in Jiangxi, China"
[3] WHOGlobal Status Report on Non-communicable Diseases, 2010GenevaWorld Health Organization
"...Of the 57 million global deaths in 2008, 36 million (63.2%) were due to NCDs, principally cardiovascular diseases, diabetes, cancers and chronic respiratory diseases...."
[4] Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data
Almost half of the disease burden in low- and middle-income countries is already due to NCDs, with over 75% of deaths in China due to chronic disease.
[5] Study on present situation and countermeasure of community chronic diseases prevention in Fuzhou
Analysis of the risk factors of chronic diseases among monitored population in Binyang county of Guangxi
"...The prevalence of chronic disease has increased rapidly, and has become an important public health issue...."
以下原句取於"The Effect of Obesity and Chronic Conditions on Medicare Spending, 1987–2011"
[6] The rise in spending among Medicare beneficiaries: the role of chronic disease prevalence and changes in treatment intensity.
"...Medicare spending is the increase in the prevalence of chronic diseases among the senior population..."
...
仲有好多paper講緊chronic disease 同NCDs 係未來會快速增長。理論上黎講，HPC互相合作好重要，但係睇返上面份systematic reviews,
。
OBJECTIVE To assess the effect of MTM interventions among outpatients with chronic illnesses.
呢幾個例子大家睇
以下原句取於"Status of prevalence study on multimorbidity of chronic disease in China: Systematic review"
[1] Making the Case for Ongoing Care.
"...It was reported that 28% of Americans have multimorbidity of chronic diseases, accounting for two-thirds of healthcare spending...."
[2] Preventing chronic diseases in China.
"...Chronic diseases now account for an estimated 80% of deaths and 70% of disability-adjusted life-years lost in China...."
以下原句取於"Chronic disease prevalence and influencing factors among rural residents in Jiangxi, China"
[3] WHOGlobal Status Report on Non-communicable Diseases, 2010GenevaWorld Health Organization
"...Of the 57 million global deaths in 2008, 36 million (63.2%) were due to NCDs, principally cardiovascular diseases, diabetes, cancers and chronic respiratory diseases...."
[4] Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data
Almost half of the disease burden in low- and middle-income countries is already due to NCDs, with over 75% of deaths in China due to chronic disease.
[5] Study on present situation and countermeasure of community chronic diseases prevention in Fuzhou
Analysis of the risk factors of chronic diseases among monitored population in Binyang county of Guangxi
"...The prevalence of chronic disease has increased rapidly, and has become an important public health issue...."
以下原句取於"The Effect of Obesity and Chronic Conditions on Medicare Spending, 1987–2011"
[6] The rise in spending among Medicare beneficiaries: the role of chronic disease prevalence and changes in treatment intensity.
"...Medicare spending is the increase in the prevalence of chronic diseases among the senior population..."
...
仲有好多paper講緊chronic disease 同NCDs 係未來會快速增長。理論上黎講，HPC互相合作好重要，但係睇返上面份systematic reviews,
。繼續忙返自己Ｄ野，遲下再討論類似MTM ge野。
瞓前推一推
打得咁辛苦冇人睇
打得咁辛苦冇人睇
瞓前推一推
打得咁辛苦冇人睇
我有睇
其實越討論
大家就越灰
我以前有諗過成立一個組織
係係社區入面做一d藥既工作
例如講座咁
大家就越灰
我以前有諗過成立一個組織
係係社區入面做一d藥既工作
例如講座咁
瞓前推一推
打得咁辛苦冇人睇
我有睇
傻啦，大把野做。不過陣間真係真。瞓。
所以我而家冇將全副精神時間投係GPA度，曬９氣。
而且再ｅｘｐａｎｄ呢個ＰＯＳＴ我諗書都可以出
。其實越討論
大家就越灰
我以前有諗過成立一個組織
係係社區入面做一d藥既工作
例如講座咁
呢個不如遲下講，因為我個front page好似有提到大眾對藥劑師的印象。
講多幾個類MTM先…不過我諗都要一段時間
上完tutorial心得
1.) 連tutor都唔肯定答案
2.) 部份答案可以google搵得
3.) further confirmed, 根本有D野學完現實都用唔返
1.) 連tutor都唔肯定答案
2.) 部份答案可以google搵得
3.) further confirmed, 根本有D野學完現實都用唔返
有冇諗過分家醫療成本要提幾多
乜香港冇錢咩
政府請多個人都話無錢唔肯加開支
病人對nurse 比例落後鬼佬幾倍
你唔好當HA 係發達國家級數
戰場醫院得返錢請醫生護士
私家另計
有冇諗過分家醫療成本要提幾多
乜香港冇錢咩
政府請多個人都話無錢唔肯加開支
病人對nurse 比例落後鬼佬幾倍
你唔好當HA 係發達國家級數
戰場醫院得返錢請醫生護士
私家另計
比較下鄰近地區D錢dum左幾多GDP，同dum左幾多係public health sector.
香港同中國都好接近，但係都係包尾咁滯。
Public expenditure is spending made by the government of a country on collective needs and wants such as pension, provision, infrastructure, etc.
(1-%public=%private)
dum係公共醫療ge錢就越黎越少（尾二）。
http://www.fhb.gov.hk/statistics/en/statistics/health_expenditure.htm
1000 population/ Licensed nurse黎講，外國係多Ｄ。
而唔淨係香港少護士，應該話上面有講的地方都有類似問題，除左南韓。
巴打你英國定澳洲派？
巴打你英國定澳洲派？
有咩唔同？
想知邊到嘅教育可以令一個undergrad未畢業就咁關心香港藥劑嘅未來