一级医院开展抗菌药物临床应用专项整治活动的必要性分析

Analysis of the Necessity of Special Rectification Activities for Clinical Application of Antibacterials in Grade-one Hospitals

目的:评价常州地区27家一级医院在实施基本药物制度前、后临床抗菌药物的使用情况。方法:收集常州地区27家一级医院2010-2011年门诊处方2700张、住院病历1522份,分别统计门诊及住院患者人均费用及总费用、门诊及住院患者抗菌药物使用率、抗菌药物使用强度(AUD)等指标,并对住院患者病历中抗菌药物的使用进行合理性评价。结果:实施基本药物制度后,一级医院药品收入下降17.37%,抗菌药物费用上升2.89%;门诊处方平均金额下降17.33%,但抗菌药物使用率上升11.88%;住院患者人均药品费用下降22.03%,抗菌药物使用率及AUD分别下降2.58%、6.63%;828份非手术病历中有611份使用抗菌药物,472份不合理,而694份手术病历100%使用抗菌药物,仅1份合理。结论:一级医院实施基本药物制度后,有效减轻了患者的医疗负担,但抗菌药物使用不合理情况仍较严重。随着"医改"制度的完善及二级以上医院抗菌药物专项整治活动的进一步深化,全面开展对一级医院抗菌药物临床应用的专项整治显得十分必要。

OBJECTIVE： To evaluate the clinical application of antibacterials in 27 grade-one hospitals of Changzhou area be- fore and after implementation of essential drug system. METHODS ： 2 700 outpatient prescriptions and 1 522 medical records were randomly sampled from 27 grade-one hospitals of Changzhou area during 2010--2011. The average cost and total cost of outpatient and inpatients, the utilization rate of antibacterials and the AUD of antibacterials use were analyzed statistically, and the rationality of antibacterials use in medical records of inpatients were also evaluated. RESULTS： After the implementation of essential drug sys- tem, the drug income had decreased by 17.37%, but the expense of antibacterials had increased by 2.89% ; the average amount of outpatient prescription had decreased by 17.33%, however the utilization rate of antibacterials drug had decreased by 11.88 % ; drug cost per capita of inpatient had decreased by 22.03%, and the utilization rate and AUD of antibacterials had decreased by 2.58% and 6.63%, respectively. Antibacterials had been used in 611 pieces among 828 non-operation records and 472 were irrational. Yet, only one case was reasonable in 694 operation records which antibacterials drugs were used 100%. CONCLUSION： The patients＇ medical burden is effectively relieved after the essential drug system has been carried out, but the irrational use of antibacterials is still serious. With the improvement of Medical Reform and the further special rectification activities of antibacterials in second-level hospitals or above, it is necessary to regulate the clinical application of antibacterials in grade-one hospitals.