不同级别医院药师对552张处方点评结果的Kappa一致性分析

Kappa analysis of different levels of hospital pharmacists in 552 prescriptions comments results

目的研究不同级别医院药师对处方点评标准的个体间差异,分析在药事服务中点评标准的稳定性。方法将来自不同级别医院、不同岗位的甲、乙、丙、丁4位药师分别对552张相同处方进行点评,判断处方是否合理以及对判定为不合理处方进行归类。利用Kappa一致性检验来评价不同药师间点评结果的一致性。结果丙药师与丁药师的点评结果一致性最强,Kappa值为0.843 0,差异无统计学意义(0.1<P<0.25);其次是甲药师与丁药师,Kappa值为0.803 8,差异有统计学意义(0.01<P<0.025);乙药师与丙药师点评结果的一致性相对最差,Kappa值为0.624 0,差异有统计学意义(0.01<P<0.025)。结论不同级别医院药师对处方点评结果的差异较大,不一致性的根本原因在于点评标准的个体间差异,包括药师个人主观的理解认知以及医院客观的限制条件。

Objective To study the individual difference of prescription comment standard from different lev-els of hospital pharmacists, and analyze the stability of the prescription comment standard in pharmacy prac-tice. Methods Four pharmacists from different levels of hospitals made comments on 552 prescriptions respectively, and the rationality of prescription was determined. The consistency of different pharmacists′comments was evaluated by Kappa consistency test. Results The comments consistency of pharmacist C and pharmacist D was strongest,Kappa value was 0.843 0,with no significant difference （0.1〈P〈0.25）;the Kappa value of pharmacist A and pharmacist D was 0.803 8,there was significant difference （0.01〈P〈0.025）;the comments consistency of pharmacist B and phar-macist C was the worst,the Kappa value was 0.624 0,there was significant difference （0.01〈P〈0.025）. Conclusion The prescription comment results by pharmacists from different hospitals have obvious differences,the root cause of the inconsistency is the differences between individuals comment standard,including pharmacist′s personal subjective understanding of the cognitive and objective conditions of hospital.