建立不合理用药干预机制的探索

Search for unreasonable drug use intervention mechanism

目的探索建立不合理用药长效干预机制,促进临床合理用药。方法参照WHO推荐合理用药国际指标和《处方管理办法》,对该院2009年7～12月(干预前)和2010年7～12月(干预后)门诊患者的处方指标和患者关怀指标进行调查并进行统计分析,同时采用药物利用研究方法对使用量前10位的抗菌药物进行使用合理性分析。结果干预后平均用药2.58种、应用抗菌药物比例为25.94%、应用注射剂比例20.89%、每张处方平均药费98·36元、抗菌药物占总药费比例22.80%、注射剂占总药费比例17.80%均低于干预前,使用非专利名的百分率为95·30%和基本药物占处方用药的比例为88.50%高于干预前。干预后平均就诊时间11.3min、平均调配时间35.2s、药品实际调配比例为98.7%、药物标示完整率为100.0%、患者用药知晓率为98.6%、总体服务满意率为98.6%均高于干预前。干预后处方适应证相符率为92.72%(433/467),干预前为85.66%(448/523)。干预前阿莫西林DUI值为1.57均高于其他抗菌药物,居第1位,干预后DUI值下降,为0.98,但排序仍居第1位。结论采用合理用药国际指标和药物利用研究方法,可对干预机制进行评价,具有可操作性和有效性。

Objective To search for unreasonable drug use intervention mechanism,so as to promote rational drug use in the clinic.Methods Referring to the WHO recommends rational drug use international index and Prescription Management Method,the outpatient prescription indexes and patient care indicators of patients outpatient from July to December in 2009（before intervention） and from July to December in 2010（after intervention） were statistically analyzed.At the same time,the rationality of the top 10 antimicrobial who were used most were analyzed by drug use research methods.Results After intervention,the average number of drugs was 2.58 species;the application of antibiotics took a proportion of 25.94%;the application of injection took a ratio of 20.89%;the average cost of the prescription was 98.36 yuan;the proportion of antimicrobial drugs accounted for 22.80% of the total drugs cost,while that of the injection was 17.80%;All the number above was lower than those before intervention.After intervention,the use of generic names accounted for 95.30%,and the essential drugs accounted for 88.50%,which were respectively higher than those before intervention.After intervention,the accordance rate between prescription and indication was 92.72%（433/467） higher than 85.66%（448/523） before intervention.Before intervention,DUI of aspirin was 1.57 higher than other antibiotics,who was on the first place,and after intervention,its DUI reduced to 0.98,but still on the first place.Conclusion WHO recommends rational drug use international index and Prescription Management Method can be used to estimate the intervention mechanism,which is of operability and effectiveness.