处方指标公开对抗生素使用的影响分析  

Analysis on the impacts of public disclosure of physician＇s antibiotics prescription indicators

作　　者：杨廉平[1] 叶菁[1] 姚强[1] 刘晨曦[1] 唐玉清[1] 刘晗 毛道元 张新平[1] 

机构地区：[1]华中科技大学同济医学院医药卫生管理学院,武汉430030 [2]湖北省潜江市卫生局

出　　处：《中华医院管理杂志》2015年第1期42-45,共4页Chinese Journal of Hospital Administration

基　　金：国家自然科学基金（71373092）

摘　　要：目的探讨医生处方指标的透明排名和公开对抗生素使用产生的影响。方法采用随机分组的前瞻设计，湖北省潜江市20家卫生院被分到干预组（10家）和对照组（10家）。干预组接受处方指标透明和排名的信息干预措施。收集医疗机构的基本资料和干预前5个月、后3个月门诊电子处方资料，运用DID模型进行效果评价。结果医生处方指标排名和公开没有降低抗生素处方率，但对于降低二联及以上抗生素处方率起到效果（概率下降7％，P〈0．001）。男性患者接受抗生素概率低于女性（OR=0．6，P〈0．001）。18岁以下的患者接受抗生素治疗的可能性要高于其他年龄段（P〈0．001）。新农合患者接受的抗生素治疗和同时接受2种及以上抗生素治疗的概率比其他费别患者要高出了1．91倍（P〈0．001）和1．34倍（P〈0．001）。结论基于前期评价，医生处方指标排名和公开的用药管理措施对减少二联及以上抗生素使用有一定效果，仍需进一步完善和研究。Objective To evaluate the impacts of public ranking and disclosure of physicians＇ prescribing indicators on the antibiotics usage. Methods Applying randomized cohort study, twenty primary health institutions were assigned into an intervention group and a control group. Intervention group received the public disclosure information of physicians＇ indicators. Hospital characteristics and data of prescription records were collected from June 2013 to February 2014. Difference-in-difference analysis was used to evaluate the intervention effect, Results Intervention did not reduce the probability of prescribing antibiotics, but did decrease the probability of prescribing two or more antibiotics for the patients （ -7%, P〈0. 001）. The doctors prescribed more antibiotics for females than males （OR=0. 6, P〈0. 001）. Patients under 18 years old received much more antibiotics than the others （P〈0. 001）. The prescribed probability of two or more antibiotics for the patients was much higher for the NCMS insurance patients （OR=2. 91 and OR=2. 34）. Conclusion Based on the early-stage evaluation, it is found that public disclosure of doctors＇ prescribing indicators can reduce the probability of two and more antibiotics, but more detailed research is needed.

关 键 词：处方指标 抗生素使用 DID分析 多水平模型 

分 类 号：R95[医药卫生—药学]