临床药师干预辅助用药使用合理性的效果
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摘要
目的:分析临床药师合理用药干预前后辅助用药使用的金额及医嘱合理性变化,评价干预效果。方法:利用医院HIS及PASS合理用药系统,对合理用药干预前后出院患者的药品平均费用、辅助用药平均费用、药占比、平均住院日,不同药理类别药物人均使用金额及用药频度(DDDs)、点评中不合理使用频次的变化进行统计分析。结果:干预后患者的药品平均费用、辅助用药平均费用、药占比、平均住院日等指标均有明显下降;辅助用药类型中酶及辅酶、神经保护剂、心肌保护剂类药物的人均使用费用降幅高达50. 0%。干预后各类型不合理医嘱比例均较干预前大幅下降。结论:临床药师对辅助用药临床应用的干预,可以提高药物使用的合理率,降低住院患者药品费用。
Objective: To evaluate the intervention effect of clinical pharmacists on supplementary medicines by analyzing the changes of the amount and the rationality of doctor's advice before and after the intervention. Methods: By using PASS rational drug use system,the average cost of drugs,the average cost of supplementary drugs,the proportion of drugs,the average length of stay,the amount of drugs used per capita with different pharmacological categories,DDDs and the frequency changes of unreasonable use of drugs during the intervention were statistically analyzed before and after the rational drug use intervention. Results: After the intervention,the average cost of the drugs,the average cost of supplementary drugs,the proportion of drugs,and the average length of stay were significantly decreased. The per capita cost of the supplementary drug category such as enzymes,coenzymes,neuroprotective agents and myocardial protective agents decreased by as much as 50. 0%. After the intervention,the proportion of unreasonable doctor's advice was significantly lower than that before the intervention. Conclusion: The intervention of clinical pharmacists with the clinical application of adjuvant drugs can improve the rational rate of drug use and reduce the drug cost of inpatients.
Objective: To evaluate the intervention effect of clinical pharmacists on supplementary medicines by analyzing the changes of the amount and the rationality of doctor's advice before and after the intervention. Methods: By using PASS rational drug use system,the average cost of drugs,the average cost of supplementary drugs,the proportion of drugs,the average length of stay,the amount of drugs used per capita with different pharmacological categories,DDDs and the frequency changes of unreasonable use of drugs during the intervention were statistically analyzed before and after the rational drug use intervention. Results: After the intervention,the average cost of the drugs,the average cost of supplementary drugs,the proportion of drugs,and the average length of stay were significantly decreased. The per capita cost of the supplementary drug category such as enzymes,coenzymes,neuroprotective agents and myocardial protective agents decreased by as much as 50. 0%. After the intervention,the proportion of unreasonable doctor's advice was significantly lower than that before the intervention. Conclusion: The intervention of clinical pharmacists with the clinical application of adjuvant drugs can improve the rational rate of drug use and reduce the drug cost of inpatients.
引文
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2湖北省卫生和计划生育办公室.鄂卫生计生办发[2018]4号《湖北省医疗机构辅助用药管理办法(试行)》[Z]2018-8-7
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12张松,王丽,蔡德芳,等.我院辅助用药临床应用监控管理策略与成效[J].云南医药,2017,38(2):178-181
13刘杨从,张韶辉,郭珩,等.新医改形势下药师参与住院药费控制成效分析[J].中国医院药学杂志,2018,38(2):189-191
14袁芳,彭冉,梁虹艺,等.外科手术患者围术期磷酸肌酸钠应用评价[J].广东药学院学报,2016,32(5):625-628
15王静,郭宇姝,游亮,等.某院住院药房辅助用药使用情况分析[J].解放军药学学报,2017,33(5):467-468,471
16王慧媛,杨莉,赵志刚.2012~2016年我国六城市神经保护剂用药现状调查[J].中国医药导报,2018,15(3):46-51
17 Horjus DL,Oudman I,Montfrans GAV,et al.Creatine and creatine analogues in hypertension and cardiovascular disease[J].Cochrane Database Syst Rev,2011,2011(11):CD005184
18吴建英.左卡尼丁治疗心绞痛的临床分析[J].中外医疗,2015,34(11):102-103
19严新美.左卡尼丁治疗心绞痛临床疗效观察[J].现代诊断与治疗,2014,25(10):2224
20孔伟,陈震,严霞.左卡尼丁治疗急性病毒性心肌炎疗效观察[J].实用临床医药杂志,2007,11(5):133,135
21张雪山,师省省,刘福松.临床药师参与辅助用药医嘱审核及临床干预效果分析[J].临床医药文献电子杂志,2016,3(53):10469-10470,10472
22卢长伟,胡倩倩,吴昊.医生不合理用药的行为经济学假说[J].检验医学与临床,2016,13(12):1736-1737
23周琰,石卫峰.临床药师对某院2016-2017年住院患者用药医嘱点评与分析[J].中南药学,2018,16(8):1041-1045
2湖北省卫生和计划生育办公室.鄂卫生计生办发[2018]4号《湖北省医疗机构辅助用药管理办法(试行)》[Z]2018-8-7
3国家卫计委,国家中医药管理局.进一步改善医疗服务行动计划[Z].2015-1-28
4国家卫生计生委.国家卫生计生委关于落实完善公立医院药品集中采购工作指导意见的通知[Z].2015-6-19
5昆明市卫生和计划生育委员会.转发云南省卫生计生委关于进一步加强医疗机构注射用辅助治疗药品使用管理的通知[Z].2015-9-28
6安徽省卫生和计划生育委员会.安徽省县级公立医院临床路径管理推进工作实施方案[Z].2016-1-4
7四川省卫生和计划生育委员会.四川省卫生和计划生育委员会关于建立医疗机构重点监控药品管理制度的通知[Z].2016-03-01
8内蒙古自治区卫生和计划生育委员会.内蒙古自治区卫生计生委关于进一步规范医疗机构辅助用药管理的通知[Z].2016-07-14
9中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257
10国家卫生计生委合理用药专家委员会.消化道恶性肿瘤合理用药指南[J].中国合理用药探索,2017,14(9):5-54
11赵玉沛,杨尹默,楼文晖,等.外科病人围手术期液体治疗专家共识(2015)[J].中国实用外科杂志,2015,35(9):960-966
12张松,王丽,蔡德芳,等.我院辅助用药临床应用监控管理策略与成效[J].云南医药,2017,38(2):178-181
13刘杨从,张韶辉,郭珩,等.新医改形势下药师参与住院药费控制成效分析[J].中国医院药学杂志,2018,38(2):189-191
14袁芳,彭冉,梁虹艺,等.外科手术患者围术期磷酸肌酸钠应用评价[J].广东药学院学报,2016,32(5):625-628
15王静,郭宇姝,游亮,等.某院住院药房辅助用药使用情况分析[J].解放军药学学报,2017,33(5):467-468,471
16王慧媛,杨莉,赵志刚.2012~2016年我国六城市神经保护剂用药现状调查[J].中国医药导报,2018,15(3):46-51
17 Horjus DL,Oudman I,Montfrans GAV,et al.Creatine and creatine analogues in hypertension and cardiovascular disease[J].Cochrane Database Syst Rev,2011,2011(11):CD005184
18吴建英.左卡尼丁治疗心绞痛的临床分析[J].中外医疗,2015,34(11):102-103
19严新美.左卡尼丁治疗心绞痛临床疗效观察[J].现代诊断与治疗,2014,25(10):2224
20孔伟,陈震,严霞.左卡尼丁治疗急性病毒性心肌炎疗效观察[J].实用临床医药杂志,2007,11(5):133,135
21张雪山,师省省,刘福松.临床药师参与辅助用药医嘱审核及临床干预效果分析[J].临床医药文献电子杂志,2016,3(53):10469-10470,10472
22卢长伟,胡倩倩,吴昊.医生不合理用药的行为经济学假说[J].检验医学与临床,2016,13(12):1736-1737
23周琰,石卫峰.临床药师对某院2016-2017年住院患者用药医嘱点评与分析[J].中南药学,2018,16(8):1041-1045