跨区域点评制度对二级综合医院合理用药的促进作用

Promotion effects of trans-regional review system on rational drug use in second-grade general hospital

目的探讨跨区域点评制度的建立对二级综合医院合理用药的作用,促进医院合理用药水平的提升。方法通过酒泉市卫生健康委的行政支持,联合酒泉市医疗联合体内5家二级综合医院成立酒泉市合理用药点评培训中心,并建立跨区域点评制度,在5家二级综合医院之间相互交叉开展处方、医嘱点评工作。收集本课题方案实施前(2020年4-6月)、方案实施后(2020年7-9月)5家二级综合医院的处方共1500张、住院医嘱900份,考察方案实施前后各医院合理用药指标及处方、医嘱点评结果的变化。结果方案实施后,除1家医院外,其余入组医院药占比均不同程度地下降,最高下降幅度达22.56%。与方案实施前比较,入组医院方案实施后门急诊处方用药合理率平均提高了5.72%,医院医嘱用药点评合理率平均提高了10.10%(P<0.05);门诊患者抗菌药物使用率平均下降了14.45%,住院患者抗菌药物使用率平均下降了7.98%,抗菌药物使用强度平均下降了25.19%。结论通过建立跨区域点评制度,可以促进各医疗机构加强对处方点评工作的重视,以有效提高医疗机构药师的处方点评水平,对推动区域内医疗机构处方合理用药水平的提高有促进作用;但目前仍存在制度覆盖面不完全、工作经验不足、信息化程度滞后、药师水平参差不齐、行政职能部门考核监管力度不够等问题。

OBJECTIVE To explore the role of the establishment of the trans-regional review system on rational drug use in second-grade general hospital,and to promote the rational drug use.METHODS With the administrative support of Jiuquan Health Commission,5 second-grade general hospitals in Jiuquan Medical Association jointly established Jiuquan Rational Drug Use Review Training Center.A trans-regional review system was established to carry out cross-review of prescriptions and medical orders among 5 second-grade general hospitals.Totally 1500 prescriptions and 900 medical records were collected from 5 second-grade general hospitals before(April to June,2020)and after(July to September,2020)the implementation of the project.The changes of rational drug use indicators,the results of prescriptions and medical order review were investigated before and after the implementation of the project.RESULTS After the implementation of the project,except for one hospital,the proportion of drugs in other hospitals decreased to varying degrees with the highest decline rate of 22.56%.Compared with before the implementation of the project,reasonable rate of outpatient and emergency prescription review increased by 5.72%averagely and the reasonable rate of medical order review increased by 10.10%(P<0.05).The average utilization rate of antibiotics in outpatients decreased by 14.45%,the average utilization rate of antibiotics in inpatients decreased by 7.98%,and the average use intensity of antibiotics decreased by 25.19%.CONCLUSIONS Through the establishment of trans-regional review system,medical institutions can be forced to pay more attention to prescription review,effectively improve the prescription review of pharmacists in medical institutions,and promote the rational use of drugs in medical institutions in the region.However,there are still some problems,such as incomplete system coverage,insufficient work experience,lagging of informatization,uneven pharmacist level,and insufficient assessment and supervision of administrative functional departments.