基于中药饮片处方点评不同模式的效果分析及改进措施  

Effect Analysis and Improvement Methods Based on Different Comment Modes of Prescriptionsof Chinese Herbal Prepared Decoction Pieces

作　　者：张友恒[1] 曹伟灵[1] 叶陈丽 杨文静 ZHANG Youheng;CAO Weiling;YE Chenli;YANG Wenjing(Luohu People's Hospital,Shenzhen 518001,Guangdong,China;Dalian Medical University,Dalian 116044,Liaoning,China)

机构地区：[1]深圳市罗湖区人民医院,广东深圳518001 [2]大连医科大学,辽宁大连116044

出　　处：《实用中医内科杂志》2021年第1期90-94,共5页Journal of Practical Traditional Chinese Internal Medicine

基　　金：深圳市罗湖区软科学研究计划(201974)。

摘　　要：目的分析某院中药饮片处方点评难点问题,改进处方点评模式,探索符合中药饮片处方特点的点评模式。方法对医院2019年第二季度门诊中药饮片处方随机抽取1800张,分A、B两种点评模式点评,点评结果按照《医院处方点评管理规范(试行)》不合理处方类别划分,对不合理处方数、医生驳回情况、问题类别、影响因素四个方面分析。结果在1800张处方中,男815例占45.74%,女967例占54.26%。A模式点评不合理数共有155张(8.61%),其中医师驳回数的比例为15.48%(24张)。B模式点评不合理数共有171张(9.50%),其中医师驳回数的比例为5.85%(10张)。两种点评模式点评的不合理处方数及医生驳回有效处方数存在差异;两种模式不合理处方均体现在不规范类别以及药物使用不规范中。而A、B模式点评下的差异主要体现在辨证论治和配伍原则、处方规范性、超剂量超疗程用药、妊娠禁忌、配伍禁忌、特殊中药的煎煮方法、贵重药、高价药等判定难点方面。处方药味数越多不合理处方占比越高;开方医生职称级别越高不合理处方越少。结论在不合理处方数、医生驳回情况、问题类别、影响因素方面,以中医和中药临床药师参与的处方点评模式在辨证论治、处方规范性、超剂量超疗程用药、妊娠禁忌、配伍禁忌、特殊中药的煎煮方法等难点判定上具有明显优势。Objective To explore the comment mode of prescriptions of traditional Chinese medicine(TCM)prepared decoction piecesthrough the analysis of difficult problems in the prescription review of TCM prepared decoction pieces occurredin a hospital.Methods In the second quarter of 2019,1800 prescriptions of TCM prepared decoction pieceswere randomly selected from the outpatient department of the hospital,which were divided into two evaluation modes,A and B.The evaluation results were divided according to the unreasonable prescription categories in the Management Standard of Hospital Prescription Evaluation(Trial).The number of unreasonable prescriptions,rejection of doctors,problem categories and influencing factors were analyzed.Results Of the 1800 prescriptions,815 male patients accounted for 45.74%,and 967 female patients accounted for54.26%.There were 155(8.61%)unreasonable prescriptions in A mode,and the proportion of doctors’rejections was 15.48%(24).There were 171(9.50%)unreasonable prescriptions in the B mode,of which 5.85%(10)were rejected by doctors.There were differences in the number of unreasonable prescriptions commented by the two comment modes and the number of valid prescriptions dismissed by the doctor.The unreasonable prescriptions of the two modes were reflected in the non-standard categories and the non-standard use of drugs.The differences under the A and B model were mainly reflected in the difficulties in determining the principles of syndrome differentiation and compatibility,prescription standardization,over-dose and over-treatment medication,pregnancy contraindications,compatibility contraindications,special Chinese medicine decoction methods,costly drugsand high-priced drugs.The greater the number of prescription drugs was,the higher the proportion of unreasonable prescriptions was.The higher the doctor’s professional title level was,the less unreasonable prescriptions was.Conclusion In the aspects of unreasonable prescription number,rejection of doctors,problem category and influencing fa

关 键 词：处方点评 中药临床药师 不合理处方 差异 处方规范性 中药饮片 门诊处方 影响因素 

分 类 号：R288[医药卫生—中药学]