DRG模式下临床药师在神经内科开展按病种分组用药医嘱点评的探讨  

Exploration of Clinical Pharmacists’Review of Medical Orders Based on Disease Classification in Neurology Under DRG Model

作　　者：张磊[1] 李浩[2] ZHANG Lei;LI Hao(Dept.of Pharmacy,the First People’s Hospital of Yibin,Sichuan Yibin 644000,China;Dept.of Neurology,the First People’s Hospital of Yibin,Sichuan Yibin 644000,China)

机构地区：[1]宜宾市第一人民医院药学部,四川宜宾644000 [2]宜宾市第一人民医院神经内科,四川宜宾644000

出　　处：《中国医院用药评价与分析》2023年第11期1391-1395,共5页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：2020年宜宾市卫生健康委员会科研项目(No.2020-KYY-08)。

摘　　要：目的:探讨DRG模式下临床药师在神经内科住院医嘱点评中开展按病种分组分类点评的创新模式及其效果。方法:选取该院神经内科3种常见疾病(分别为脑梗死、脑出血、脑动脉供血不足)的住院患者,2022年1—6月每月定期安排临床药师对其进行住院医嘱合理性点评,发现用药问题及时与临床医师沟通,对不合理用药医嘱中用法与用量不适宜、适应证不适宜等相关指标进行统计和分析,动态监控上述3种疾病患者的住院药品次均费用、平均住院日的变化情况。结果:2022年1—6月,临床药师每月点评的不合理医嘱数呈逐月下降趋势,其中脑梗死患者医嘱不合理率由1月的7.00%(113/1 615)降至6月的1.79%(32/1 783);脑出血组医嘱不合理率由1月的6.00%(147/2 450)降至6月的1.58%(40/2 533);脑动脉供血不足组医嘱不合理率由1月的6.26%(187/2 986)降至6月的1.81%(55/3 035)。2022年1—6月,3种疾病患者的住院药品次均费用均有所下降,其中脑梗死患者降低了9.31%[1月:(17 420.44±61.25)元;6月:(15 798.67±63.83)元];脑出血患者降低了26.50%[1月:(14 827.74±78.53)元;6月:(10 899.03±76.63)元];脑动脉供血不足患者降低了30.30%[1月:(12 212.24±89.52)元;6月:(8 511.34±88.82)元]。结论:通过临床药师在神经内科开展按病种分组的点评模式,用药医嘱不合理率得到明显降低。该模式有助于促进住院患者药品次均费用的降低,协助临床控制药品费用指数。OBJECTIVE:To explore the innovative model and effect of inpatient medical order review based on disease classification in neurology under DRG model.METHODS:Inpatients with 3 common diseases(cerebral infarction,cerebral hemorrhage,cerebral artery insufficiency)in neurology were selected.From Jan.to Jun.2022,clinical pharmacists were regularly arranged to make rational review on inpatient medical orders,and timely communication with clinicians were performed when medication problems were found.Relevant indicators such as inappropriate usage and dosage,improper indications in irrational medical orders were statistically analyzed,and changes of the average cost of inpatient drugs and average length of stay with the above three kinds of diseases were dynamically monitored.RESULTS:From Jan.to Jun.2022,the number of irrational medical orders reviewed by clinical pharmacists decreased month by month,and the irrational rate of medication orders of cerebral infarction decreased from 7.00%(113/1615)in Jan.to 1.79%(32/1783)in Jun.The irrational rate of medication orders in cerebral hemorrhage group decreased from 6.00%(147/2450)in Jan.to 1.58%(40/2533)in Jun.The irrational rate of medication orders in cerebral artery insufficiency group decreased from 6.26%(187/2986)in Jan.to 1.81%(55/3035)in Jun.From Jan.to Jun.2022,the average cost of inpatient drugs for patients with cerebral infarction decreased by 9.31%[(17420.44±61.25)yuan in Jan.and(15798.67±63.83)yuan in Jun.];for patients with cerebral hemorrhage decreased by 26.50%[(14827.74±78.53)yuan in Jan.and(10899.03±76.63)yuan in Jun.];for patients with cerebral artery insufficiency decreased by 30.30%[(12212.24±89.52)yuan in Jan.and(8511.34±88.82)yuan in Jun.].CONCLUSIONS:The irrational rate of medication orders is significantly reduced through the inpatient medical order review based on disease classification in neurology under DRG model.This model is helpful to reduce the average drug cost of inpatients and assist the clinical control of the drug cost index.

关 键 词：疾病诊断相关分组 病种分组 用药医嘱点评 临床药师 

分 类 号：R95[医药卫生—药学]