北京市社区医疗卫生机构实施集中处方点评效果分析

Effectiveness of Implementing Centralized Prescription Comment in Community Health Facilities of Beijing

目的:探讨实施集中处方点评对社区医疗卫生机构处方质量的影响。方法:将北京市18家社区医疗卫生机构点评处方分成干预前、干预后半年、干预后1年3组,运用前后对照的试验方法,依照《医院处方点评管理规范(试行)》的点评标准,进行点评,数据用SPSS 13.0软件进行统计分析。结果:平均用药品种数从干预前的2.9个降至干预后半年的2.4个,干预1年后仍维持为2.4个;抗菌药物使用率从干预前的25.5%降至干预后半年的16.0%,但在干预后1年又上升为18.9%;基本药物使用率从干预前的66.8%增加到干预后半年的70.9%,干预1年后上升为75.4%;注射剂使用率从干预前的8.6%降至干预后半年的7.2%,干预1年后仍维持为7.2%;通用名使用率从干预前的87.3%增加到干预后半年的90.6,干预1年后持续增加到96.7%;不规范处方百分率从干预前的9.2%降至干预后半年的5.4%,干预1年后持续下降为2.9%;不适宜处方百分率从干预前的6.8%,降至干预后半年的2.2%,但干预1年后又上升为3.6%。结论:在社区医疗卫生机构实施集中处方点评,并采取相应的干预措施对处方各项核心指标的持续改进是有效的和可行的。实施集中处方点评是医疗机构贯彻《医院处方点评管理规范(试行)》的创新尝试,对于促进整个区域内的医疗机构处方点评的协调发展,推动区域内合理用药水平的整体提高有着重要意义。

OBJECTIVE：To explore the effects of implementing centralized prescription comment in community health facilities on prescription quality.METHODS： The prescriptions in 18 community health facilities of Beijing,which were carried out at three stages： before intervention,half year after intervention,and 1 year after intervention,were commented according to Management Practices of Hospital Prescription Comment（trial）（Hereinafter referred to as Practices） by the way of comparison.Data was analyzed by using SPSS 13.0 software.RESULTS： The number of drug varieties dropped from 2.9 before intervention to 2.4 half year after intervention,and remained at 2.4 one year after intervention（P0.01）.The percentage of encounters with prescribed antibiotics dropped from 25.5% before intervention to 16% half year after intervention,but rose to 18.9% one year after intervention.The percentage of drugs prescribed from essential drug list increased from 66.8% before intervention to 70.9% half year after intervention,and increased to 75.4% one year after intervention.The rate of injection prescriptions dropped from 8.6% before intervention to 7.2% half year after intervention,and remained at 7.2% one year after intervention.The rate of prescriptions in generic drug name increased from 87.3% before intervention to 90.6% half year after intervention,and increased to 96.7% one year after intervention.The percentage of non-standard prescriptions dropped from 9.2% before intervention to 5.4% half year after intervention,and dropped to 2.9% one year after intervention.The percentage of inappropriate prescriptions dropped from 6.8% before intervention to 2.2% half year after intervention,but rose to 3.6% one year after intervention.CONCLUSION： The adopted corresponding intervention during implementing centralized prescription comment in community health facilities is effective and practicable for the continuous improvement of various core indices of prescription.Implementing centralized prescription comment in certain region and establishing a set of unified standard system of prescription comment is a new attempt to carry out Practices,which is of great significance for promoting coordinative development of the prescription comment of the regional medical institutions and improving the whole level of rational drug use.