医疗机构开展处方评价工作的系统评估

Systematic Judgment on Evaluation of Prescription in Health Facilities

目的了解并评估《处方管理办法》实施以来,医疗机构开展处方评价工作的现状、效果及存在的问题,为规范我国医疗机构处方评价,提高处方评价水平提供决策依据。方法采用文献计量学方法,对比分析《处方管理办法》实施前后中国医院数字图书馆收录的与处方评价工作相关的文献;统计文章数量,分析汇总期刊分布、评价指标的变化及存在的问题。结果《办法》实施前,处方评价指标主要由处方和技术指标构成,发表文献数量为572篇;实施后,新《办法》根据合理用药国际指标做了调整,并引入了患者关怀指标,发表文献数量达到了2 101篇。由于各级医疗机构药事部门对《办法》中规定指标的理解存在偏差,文献报道存在抽样方法、指标标准、指标种类(本级指标与区域指标)、指标表述等的不一;涉及患者关怀指标的文献少,占1.48%(31∶2 101);重复性文献多。结论处方合格率是《办法》颁布前我国医疗机构处方评价工作表达的唯一指标,也是一项综合指标。《办法》实施后,医疗机构处方评价的内容发生了质的变化,特别是合理用药国际指标引入并写入《办法》后,医疗机构的处方评价工作的指标多样化、结果多样化,注重单项指标,对促进合理用药工作更具可操作性。但由于各级医疗机构对《处方管理办法》的理解存在偏差,导致执行《办法》随意性大,无法整体了解我国处方管理的现状。总体来说,处方评价,规范了临床诊疗行为,提高了药物治疗水平和药物治疗管理水平。

OBJECTIVE To understand and evaluate the situation, effect and problem of prescription management in health facilities since Administrative Rules on Prescription issued in 2007 and provide the decision-making basis for standardizing the prescription evaluation. METHODS Relevant literature of prescription evaluation collected in the Chinese Hospital digital li- brary were be analyzed comparatively by bibliometric ; then take the number of articles statistics, analysis and summary periodical distribution, changes in evaluation indicators and problems. RESULTS The prescription evaluation indicators are mainly con- stituted by prescription and technical aspects before issue of ＂Administrative Ruleson Prescription＂ , the quantity of published lit- erature was 572 and after , the new rules based on rational drug use international indicators were adjusted, and the introduction of patient care indicators, the quantity of published literature reached 2 101 . Because there is a deviation in understanding, sam- piing methods reported in the literature, standard indicators, indicator species （the level indicator and regional indicators ） , in- dicators, etc. expressed mixed ; involving patient care indicators literature less, accounting for 1.48% （31：2 101 ） ; repeat- ability literature and more . CONCLUSION The total quality rate of prescriptionis ＂measures＂ was only index before the prom- ulgation of China＇s medical institutions prescription evaluation expression, but also a comprehensive index. ＂ Rules＂ implemen- ted, changed prescription evaluation of medical institutions, especially the international rational drug use index is introduced and write ＂way＂ , prescription evaluation work in medical institutions of the index diversification, result diversification, pay attention to individual indicators of rational use of drugs, work more operable and promote. But because the medical institutions at all levels exist deviation on the ＂prescription management method＂ understanding, leading to the implementation of ＂measures＂ arbitrarily large, not overall understanding of prescription management in china. In general, the prescription evaluation can standardize the clinical behavior, improve the level of drug treatment and medication management level.