山东省某县新农合急性阑尾炎病人抗菌药物利用过程质量分析

Process quality of antibacterial drugs utilization among NRCMS acute appendicitis patients in one county of Shandong Province

目的：对新农合急性阑尾炎病人的抗菌药物利用过程质量进行客观评价,为新农合县乡两级定点医疗机构药物利用的规范性提供依据。方法：利用2007—2011年山东省某县新农合信息系统数据,共纳入县乡两级定点医疗机构1 721例急性阑尾炎病人。采用客观评价法,将实际利用的抗菌药物种类与质量规范推荐的药物进行比对,计算相应符合率来代表药物利用过程质量。定量数据主要采用描述性统计分析方法,通过Excel 2007、Microsoft SQL 2005和SPSS17.0进行。结果：2007—2011年推荐抗菌药物的总体符合率为22.4%（SD=22.3%）。乡镇卫生院推荐抗菌药物的总体符合率在14.6%-19.6%之间,差异无统计学意义。五年间,头孢类药物利用在乡镇卫生院趋于稳定,利用率最高的为第三代头孢,第二代头孢（推荐药物）利用率最低;县级医院第四代头孢逐步被第二代头孢和第三代头孢所替代。甲硝唑（推荐药物）利用率低,逐步被替硝唑和奥硝唑取代,以县级医院最为明显。结论：新农合县乡定点医疗机构抗菌药物利用规范性较差,主要体现为推荐药物利用不足,被质量规范外药物替代,且其规范性在2007—2011年间无明显改善。

Objective： To explore means of process quality assessment for antibacterial drug utilization among acute appendicitis patients under the New Rural Cooperative Medical Scheme（ NCMS） through the use of the explicit method in order to provide evidence for the rationality of drug utilization in NRCMS. Methods： Data was collected from the NCMS information system of one county in Shandong Province from 2007 to 2011 and included 1,721 cases of acute appendicitis in county and town-level hospitals. The explicit method was employed,which adopted the adherence rate to represent drug process quality by comparing the actual antibacterial drug utilized with those recommended by quality standards. Descriptive statistics were used to analyze quantitative data with Excel 2007,Microsoft SQL 2005 and SPSS 17. 0. Results： The average overall adherence rate from 2007 to 2011 was 22. 4%（ SD =22. 3%） at the individual level. The overall adherence rate of township health centers was very low,between 14. 6%and 19. 6%,with no significant difference among the five years. The utilization of cephalosporin drugs was relatively stable at town-level hospitals,that is,third-generation cephalosporins was used most frequently,while cephalosporin,recommended by quality standards,was the least utilized in all five years. At county-level hospitals,fourth-generation drugs were gradually substituted with second and third-generation drugs. Utilization of the recommended drug metronidazole of the nitromidazoles drug group decreased over time at both the town and county-level hospitals,and the drug was gradually substituted by tinidazole and ornidazole,especially in county-level hospitals. Conclusions：From 2007 to 2011,the rationality of drug utilization was low in the NCMS designated hospitals at both town and county-level hospitals,particularly in town-level hospitals. The underuse of recommended quality standard drugs was the main issue at hand,and this situation experienced no significant changes during the study period.