基本药物制度实施前后基层医院门诊处方抗菌药使用率的Meta分析

Meta Analysis on Use Rate of Antibiotics in Outpatient Prescriptions of Primary Hospitals before and after the Implementation of Essential Drug Policy

目的:系统评价基本药物制度的实施对基层医院抗菌药合理使用的影响程度。方法:检索CNKI、万方和维普中文期刊数据库,收集基本药物制度实施后抗菌药使用情况的文献,确定纳入文献,运用Rev Man 5.3和Stata 12.0软件对纳入文献数据进行Meta分析。结果:对43篇纳入文献数据进行Meta分析,基层医院基本药物制度实施后,门诊处方抗菌药使用率下降,与实施前比较,风险差具有统计学意义[RD=-0.03,95%CI(-0.04,-0.03),P<0.000 01],但抗菌药使用率仍然偏高(46.16%)。漏斗图的对称性良好,Egger’s检验结果显示发表偏倚无显著性差异(P=0.571);但文献研究结果间存在高度异质性(I2=94%,P<0.000 01);按不同医院和地区进行亚组分析,结果显示,文献研究者的研究方法、地区基本药物制度实施措施的差异性促进了研究之间高异质性的形成。结论:在建立统一的调查研究质量评价标准来降低研究间的异质性;建立与基本药物制度配套的措施来切实降低基层医院门诊处方抗菌药使用率。

Objective： To systematically evaluate the influence of the implementation of essential drug policy（ EDP） on prescription use rate of antibiotics in primary hospitals. Methods： Based on CNKI,Wanfang and VIP of China journal databases,all literatures were adopted including the data of the prescription use rate of antibiotics in primary hospitals. Rev Man5.3 and Stata 12.0 software were used to conduct the Meta analysis. Results： Totally 43 literatures were included in the study according to the evaluation selection criteria. After the implementation of EDP,the prescription use rate of antibiotics in primary hospitals was decreased,and compared with that before the implementation of EDP,the risk difference value was significant [RD =-0.03,95% CI（-0.04,-0.03）,P 〈0.000 01],while the use rate was still high（ 46.16%）. The result of Egger＇s test indicated the publication bias of the 43 literatures was not significant（ P = 0.571）. However,there was high heterogeneity（ I2= 94%,P〈0.000 01） among the different studies. Based on the classification of hospital type and different areas,the results of sub-group analysis showed the differences of study methods in the literatures and regional implementation measures of EDP contributed to the high heterogeneity among the different studies. Conclusion： In order to reduce the heterogeneity of studies,a unified evaluation criteria for the research quality of the cross-section survey should be established.And special policies related to EDP should be taken to effectively decrease the use rate of antibiotics in primary hospitals.