基于ORTCC模型的重点监控药品管控措施实施效果分析  

Analysis of the Implementation Effect of Control Measures for Key Monitoring Drugs Based on the ORTCC Model

作　　者：张洁[1,2] 龚青云 张成 王婷 焦阳阳 陈彦 ZHANG Jie;GONG Qingyun;ZHANG Cheng;WANG Ting;JIAO Yangyang;CHEN Yan(School of Health Policy&Management,Nanjing Medical University,Nanjing,Jiangsu,211166;Medical Depart-ment,Rugao People’s Hospital,Rugao,Jiangsu,226500;Emergency Medicine Center,The First Affiliated Hospital of Nanjing Medical University,Nanjing Medical University,Nanjing,Jiangsu,211166;Technology Department,Women’s and Children’s Hospital of Jiangsu Province Hos-pital,Nanjing Medical University,Nanjing,Jiangsu,211166;Health Jiangsu Research Institute,Nanjing Medical University,Nanjing,Jiangsu,211166;Outpatient Depart-ment,The First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu,210029)

机构地区：[1]南京医科大学医政学院,江苏南京211166 [2]如皋市人民医院医务科,江苏如皋226500 [3]南京医科大学第一附属医院急诊医学中心 [4]南京医科大学第一附属医院妇幼分院科技处,江苏南京211166 [5]南京医科大学健康江苏研究院,江苏南京211166 [6]南京医科大学第一附属医院门诊部,江苏南京210029

出　　处：《江苏卫生事业管理》2022年第12期1654-1659,共6页Jiangsu Health System Management

基　　金：江苏省医院协会医院管理创新研究重点课题(JSYGY-2-2020-695);江苏省医院协会医院管理创新研究重点课题(JSYGY-2-2019-150);江苏省医学重点人才项目(ZDRCA2016016);江苏省妇幼保健协会科研项目(FYX201915)。

摘　　要：目的:探索有效的重点药品合理使用管控措施,为医疗机构重点监控药品的监管提供参考。方法:基于QRTCC模型,围绕目标、规则、培训、考核、文化5个要素,设置年度重点监控药品管控目标,设立处方点评专家组与处方点评工作小组,遴选医院重点监控药品目录,建立重点监控药品管理制度与重点监控药品医嘱点评制度,对重点监控药品采取动态监测、考核、熔断目录与培训等一定的干预措施。结果:采用此模式对重点监控药品合理使用进行了精细化管理,干预后医院重点监控药品收入、住院患者重点监控药品使用费用、重点监控药品使用强度、医师开具医嘱的不合理率均有所下降,改善效果明显(P<0.05),但中成药、特殊使用抗菌药物的医嘱合理率改善效果不佳,仍需后续进一步研究。结论:基于ORTCC模式的重点监控药品管控措施成效显著,重点监控药品的使用强度与费用均显著下降,医嘱合理率得到较大提升,在一定程度上提升了医院合理用药水平,保障患者用药安全并减轻了就医负担。Objective:To explore effective management and control measures for the rational use of key drugs to provide reference for the supervision of key monitored drugs by medical institutions. Methods:This survey is based on the QRTCC model,focusing on the five elements of goals,rules,training,assessment,and culture. The hospital has implemented administrative intervention measures such as establishing systems,selecting catalogs,setting annual control targets,setting up prescription review expert groups and prescription review working groups,dynamic monitoring of usage,assessment and training,and other administrative intervention measures to achieve control of key monitored drugs. Result:This model is adopted to carry out refined management of the rational use of the key monitored drugs in our hospital. After the implementation of the plan,the hospital’s key monitoring drug revenue,the cost of key monitoring drugs used by inpatients,the intensity of drug use under key monitoring,and the unreasonable rate of doctors’ orders issued have all decreased significantly(P<0.05)However,the improvement of the reasonable rate of doctor’s orders for Chinese patent medicines and special use of antibacterial drugs is not effective,and further research is still needed. Conclusion:Our hospital’s key monitoring drug control program based on the ORTCC model has achieved remarkable results. The use intensity and cost of key monitoring drugs have been significantly reduced,and the reasonable rate of doctor’s orders has been greatly improved. The implementation of the plan has raised the level of rational drug use in hospitals to a certain extent,ensured the safety of patients’ drug use and reduced the burden of medical treatment.

关 键 词：ORTCC模式 精细化管理 重点监控药品 合理用药 

分 类 号：R197.1[医药卫生—卫生事业管理]