重点药品的不合理使用原因及其处方点评的成效分析  

Analysis of Irrational Use of Key Drug and The Effectiveness of Prescription Review

作　　者：董雁[1] 王海燕[1] 闵春燕[1] 王泽荣[1] DONG Yan;WANG Hai-yan;MIN Chun-yan;WANG Ze-rong(The Fifth People's Hospital of Suzhou,Suzhou Jiangsu 215123,China)

机构地区：[1]苏州市第五人民医院,江苏苏州215123

出　　处：《抗感染药学》2021年第12期1767-1772,共6页Anti-infection Pharmacy

基　　金：苏州市卫生健康委:同济大学附属上海市肺科医院孙道远教授职业病专家团队(编号:SZYJTD 201904)。

摘　　要：目的:分析重点药品的不合理使用原因及其处方点评的成效,为有效促进重点药品合理使用提供参考。方法:按苏州市第五人民医院重点药品监控预警制度的点评标准,对2017年-2019年的7月-11月病区重点药品处方进行点评,按病区、药品类别、月份统计重点药品不合理率,分析不合理情况及其原因。结果:妇产科2017年和2018年的7月-11月不合理率均居首位,外科2017年7月-11月不合理率居第2位,2018年同期骤降至第5位;ICU/急诊科2017年-2019年的7月-11月不合理率由第3位降至第6位,职业病科2017年7月-11月不合理率居第4位,2018年7月-11月和2019年同期均未发现不合理用药情况;2017年7月-11月不合理率居前3位药品为心血管系统用药、抗肿瘤和免疫调节类、维生素电解质补充药,后2类药品在2019年7月-11月的不合理率均有较大幅度下降,2017年-2019年的7月-11月大部分类别(神经系统用药除外)不合理率均有不同幅度下降;2017年-2019年的7月-11月占比第1的不合理原因由病程录不合规转变为疗程过长,超适应证(先增后降)稳居第2位,不合理原因疗程过长是唯一占比增高的原因,由第5位、第3位升至第1位;2017年7月-11月医院各月重点药品不合理率呈升-降-升-降趋势,2018年7月-11月医院各月重点药品不合理率呈升-降-升趋势,2019年7月-11月医院各月重点药品不合理率整体呈下降趋势;2018年、2019年的8月-10月医院各月重点药品不合理率均低于2017年同期,2019年11月的不合理率低于2018年同期。结论:采用处方点评管控重点药品,有效降低了重点药品的不合理使用率,促进了临床合理用药;根据点评、管控结果和疾病的临床治疗需求,调整医院重点药品目录和改进管控措施,能更好地保障患者用药的有效性和经济性。Objective: To analyze the irrational use of key drug and the effectiveness of prescription review so as to provide reference for effectively promoting rational usage of key drugs. Methods: Based on the evaluation standard of the key drug monitoring and early warning system of The Fifth People’s Hospital of Suzhou, the key drug prescriptions in the ward from July to November from 2017 to 2019 were reviewed, and the irrational rate of key drugs was counted by ward, drug category and month, and the irrationality situation and reasons were analyzed. Results: The irrationality rates of obstetrics and gynecology department ranked 1 st from July to November in 2017 and 2018, the irrationality rates of surgery department ranked 2 nd from July to November in 2017 and dropped to 5 th in the same period in 2018.The irrational rate of ICU/emergency department from July to November 2017 decreased from the 3 rd to the 6 th;the irrational rate of occupational disease department from July to November 2017 ranked the 4 th, and no irrational drug usage was found in July to November 2018 and the same period in 2019. From July to November 2017, the top 3 drugs in the irrational rate were cardiovascular system drugs, anti-tumor and immunomodulatory drugs, and vitamin and electrolyte supplements. The irrationality rates of the latter two types of drugs decreased significantly from July to November in 2019. From July to November of 2017 to 2019, the irrationality rates of most categories(except neurologic drugs) decreased with different amplitude. From July to November in 2017 to 2019, the most unreasonable reason changed from unstandard course record to long course of treatment, the excess indications(increasing first and then decreasing) ranked the 2 nd place, and the only reason for the increase of unreasonable reason was the long course of treatment, which rose from the 5 th, 3 rd place to the 1 st place. From July to November in 2017, the monthly rate of unconscionability of key drugs in a hospital showed an upward-downward-upwa

关 键 词：处方点评 重点药品 合理用药 治疗需求 管控措施 

分 类 号：R969.3[医药卫生—药理学]