中成药重复用药的现状、问题和对策(一)

Repeated usage of Chinese patent medicines:current status,problems and countermeasures

中成药联合用药和重复用药是国内医疗常态,也是医疗机构处方点评和医疗质量管理的焦点和难点。本文从国内现状和相关政策出发,尝试梳理中成药重复用药的现状和主要问题,并给出解决对策。中成药重复用药是指不适当的同种或同类药物的叠加使用,但也保留有根据具体药品和临床实际权衡的空间。医疗机构对于中成药重复用药十分重视,但认知角度各异,相关评价依据包括说明书功能主治、组方药味、功效类别、衍生关系、毒性成分、中西药复方制剂、联用药品数目等不同侧重点及其组合。缺少理论(主观评价)和实践(客观有效性和安全性)两个层面的基本共识是目前的最大问题。明确历史源流,整合评价方法和开展科学研究是解决问题的基本对策。

The combined use and repeated use of Chinese patent medicines are quite common, which has already been the focus of prescription review and medical quality control in national hospitals. This paper tried to analyze the current status and problems of this issue, and give save rational countermeasures. The repeated use of Chinese patent medicines was defined as the unreasonable repeated use of the same medicine or medicines with similar action. The repeated used of medication was paid much attention to in hospitals but judged by different key points and their combinations, including the efficacy of drug instruction, the component herbs, the action categories, the derivation relations, the toxicity herbs, the added chemical drugs and the number of repeated patent medicines. However, the lack of common views in the level of subjective evaluation and objective practices was the main problems, which may be solved by analyzing the historical background, integrating the different evaluation methods and implementing the scientific research.