按病种分类进行用药医嘱点评模式初探
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摘要
目的:考察按病种分类进行用药医嘱点评新模式的应用效果。方法:从我院各科室中共选择16个常见病种,每个病种分别随机抽取2016年1月1日-12月31日医院信息系统中的各10份、总计160例患者的电子病历,对各患者住院期间的10 720条用药医嘱从合理性方面进行回顾性点评,对不合理用药医嘱中用法用量不适宜、辅助用药占比、适应证不适宜等相关指标进行统计和分析,建立按病种分类进行用药医嘱点评的新模式;收集点评新模式实施及进行相关干预后(2017年4-5月)相同病种的9 862条用药医嘱,点评其不合理率,评价新模式的应用效果。结果:在2016年的样本中,共点评出751条不合理用药医嘱,以用法用量不适宜情况最多(414条,55.12%),其中尤以在脑出血病种中最多(69条,16.67%),此病种下以单次给药用量过大最多(31条,44.92%);辅助用药占病种药品总费用比排序前3位的病种依次为肾肿瘤手术(39.43%)、急性脑梗死(非手术)(37.03%)和椎间盘突出手术(35.26%);适应证不适宜用药有70条(9.32%)。应用按病种分类的点评模式及进行相关干预后,医嘱不合理率由点评前的7.00%(751/10 720)下降至点评后的2.95%(291/9 862),降幅为57.86%。结论:应用按病种分类的点评模式管理用药医嘱不合理率取得了一定的成效,该模式有助于促进临床合理用药。
OBJECTIVE: To investigate the effects of new mode of medical orders evaluation according to diseaseclassification. METHODS:Totally 16 kinds of common diseases were selected from each department of our hospital. Each 10 electronic medical records of each disease were randomly selected from 160 patients in the hospital information system from Jan. 1 to Dec. 31,2016. The rationality of 10 720 medical orders were evaluated retrospectively during hospitalization. Statistical analysiswas made on the relevant indicators such as unsuitable usage and dosage,the proportion of auxiliary drugs and unsuitableindications in medical orders of irrational drug use,and a new mode of prescription comment was established according to theclassification of diseases. 9 862 medical orders of same disease types were collected after the implementation(from Apr.-May,2017)of new mode and intervene to evaluate the irrational rate of them so as to evaluate the effects of new mode. RESULTS:Inthe samples in 2016,a total of 751 medical orders of irrational drug use were evaluated,the most of them were unsuitable usageand dosage(414 items,55.12%),especially in the intracerebral hemorrhage diseases(69 items,16.67%);under this kind ofdisease,most of irrational drug use was excessive dosage of single dosing(31 items,44.92%). The top three disease types in thelist of the ratio of adjuvant drug cost in total drug cost were surgery for renal tumors(39.43%),acute cerebral infarction(non-surgery)(37.03%)and intervertebral disc herniation surgery(35.26%). 70 medical orders of irrational drug use were unsuitableindications(9.32%). After the application of evaluation mode according to classification of disease types and intervene,theirrational rate of medical orders decreased from 7.00%(751/10 720) before evaluation to 2.95%(291/9 862)after evaluation,decreasing by 57.86%. CONCLUSIONS:The application of evaluation mode according to classification of disease types can achieve good results in controlling the irrational rate of medical orders and contribute to rational drug use in clinic.
OBJECTIVE: To investigate the effects of new mode of medical orders evaluation according to diseaseclassification. METHODS:Totally 16 kinds of common diseases were selected from each department of our hospital. Each 10 electronic medical records of each disease were randomly selected from 160 patients in the hospital information system from Jan. 1 to Dec. 31,2016. The rationality of 10 720 medical orders were evaluated retrospectively during hospitalization. Statistical analysiswas made on the relevant indicators such as unsuitable usage and dosage,the proportion of auxiliary drugs and unsuitableindications in medical orders of irrational drug use,and a new mode of prescription comment was established according to theclassification of diseases. 9 862 medical orders of same disease types were collected after the implementation(from Apr.-May,2017)of new mode and intervene to evaluate the irrational rate of them so as to evaluate the effects of new mode. RESULTS:Inthe samples in 2016,a total of 751 medical orders of irrational drug use were evaluated,the most of them were unsuitable usageand dosage(414 items,55.12%),especially in the intracerebral hemorrhage diseases(69 items,16.67%);under this kind ofdisease,most of irrational drug use was excessive dosage of single dosing(31 items,44.92%). The top three disease types in thelist of the ratio of adjuvant drug cost in total drug cost were surgery for renal tumors(39.43%),acute cerebral infarction(non-surgery)(37.03%)and intervertebral disc herniation surgery(35.26%). 70 medical orders of irrational drug use were unsuitableindications(9.32%). After the application of evaluation mode according to classification of disease types and intervene,theirrational rate of medical orders decreased from 7.00%(751/10 720) before evaluation to 2.95%(291/9 862)after evaluation,decreasing by 57.86%. CONCLUSIONS:The application of evaluation mode according to classification of disease types can achieve good results in controlling the irrational rate of medical orders and contribute to rational drug use in clinic.
引文
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[2]卫生部.医院处方点评管理规范(试行)[S]. 2010-03-03.
[3]国家卫生和计划生育委员会.抗菌药物临床应用指导原则[S]. 2015-07-24.
[4]陈新谦,金有豫,汤光.新编药物学[M]. 17版.北京:人民卫生出版社,2011:34-817.
[5]中华医学会.临床诊疗指南:消化系统疾病分册[M].北京:人民卫生出版社,2005:3-7.
[6]中华医学会神经病学分会.中国脑出血诊治指南[J].中华神经科杂志,2015,48(6):435-444.
[7]于世英,胡国清.肿瘤临床诊疗指南[M]. 3版.北京:科学出版社,2018:157-308.
[8]杜明梅,张勇,施振国,等.信息化方法管理抗菌药物合理使用4年效果分析[J].中华医院感染学杂志,2016,26(18):4255-4258.
[9]徐伟,郝梅,杜珍珍.总额控制下按病种分值付费的实践与思考[J].中国药房,2016,27(6):721-723.
[10]茹爱忠,刘静,蔡瑞君,等.建立辅助用药预警监控干预体系对合理用药及新医改控费的作用[J].中国药事,2018,32(1):97-103.
[11]钱小蔷,徐永中.新医改形势下合理控制医院药占比的效果分析[J].江苏卫生事业管理,2017,28(6):13-15.