浙江省某县县域医共体抗菌药物管理案例研究  

A Case Study of Antimicrobial Stewardship in County-based Healthcare Network in a County,Zhejiang Province

作　　者：邓子如 董晓莲 王伟[1] 马聪 付朝伟[1] Helen Lambert 王娜[1] 严非[1] DENG Ziru;DONG Xiaolian;WANG Wei;MA Cong;FU Chaowei;Helen Lambert;WANG Na;YAN Fei(School of Public Health,Fudan University,National Key Laboratory of Health Technology Assessment of Ministry of Health,Fudan University,Shanghai,200032,China不详)

机构地区：[1]复旦大学公共卫生学院,国家卫健委卫生技术评估重点实验室,上海200032 [2]德清县疾病预防与控制中心,浙江湖州313200 [3]英国布里斯托大学人口健康科学系,布里斯托BS82PS

出　　处：《中国社会医学杂志》2024年第4期391-396,共6页Chinese Journal of Social Medicine

基　　金：国家自然科学基金国际地区合作交流项目(81861138050)。

摘　　要：目的探究浙江省某县县域医共体内部抗菌药物管理政策和措施实施中的经验和问题。方法研究团队于2019年10月及2020年7月赴浙江省某县开展现场调查,通过目的性抽样收集医共体内两家医疗机构的抗菌药物相关数据进行描述性分析,并对四家医疗机构中的15名关键知情人进行访谈,了解医共体内抗菌药物管理制度与抗菌药物使用状况。结果案例县县域医共体内机构已成立架构清晰的抗菌药物管理系统;设有前置审方、事后点评、绩效奖惩等管理措施;近年来抗菌药物使用相关指标总体呈下降趋势,县医院门诊、住院抗菌药物使用率均达到国家标准,但县医院住院患者抗菌药物使用强度、乡镇卫生院门诊抗菌药物使用率仍高于国家标准。结论案例县依托县域医共体制度优势,促进医疗机构抗菌药物自上而下管理,管理组织架构清晰,措施较为全面,注重过程管理,动态调整考核指标;但仍需加大对临床药师等专业技术人员的培养,完善抗菌药物管理信息系统。Objective To explore the experience and problems of the antimicrobial stewardship(AMS)policies and implementation measures of the county-based healthcare network in a county,Zhejiang province.Methods Field investigation was conducted in October 2019 and July 2020 in a county,Zhejiang province.Through purposive sampling,qualitative interviews with 15 key informants from four healthcare institutions were conducted and antimicrobial-related data from two institutions were collected and analyzed to explore the antimicrobial use and its management system in the county-based healthcare network.Results A clear AMS structure and management measures such as pre-prescription review,post-prescription review with performance reward and punishment mechanism have been established in case county's county-based healthcare network.The antimicrobial use indicators have generally shown a downward trend.Antimicrobials usage in outpatients and inpatients of county hospitals had reached the national standard,while the antimicrobials use density in inpatients of the county hospital and antimicrobials usage in outpatients of township health centers were still higher than the national standard.Conclusion Relying on the advantages of the county-based healthcare network,case county promotes top-down AMS at the grass-roots level.The organizational AMS structure is clear,the implementation measures are comprehensive,the process management has been emphasized,and the antimicrobials assessment indicators were dynamically adjusted.It is necessary to increase the training of professional and technical personnel such as clinical pharmacists and improve the AMS information system.

关 键 词：抗菌药物管理 县域医共体 案例研究 

分 类 号：R197.31[医药卫生—卫生事业管理] R954[医药卫生—公共卫生与预防医学]