基于处方点评的基层医院用药误区分析

Mistakes analysis for medication of primary hospital based on prescription review

目的根据处方点评结果 ,分析基层医院的用药误区,并提出建议,以期提高横琴地区合理用药水平。方法 采用回顾性分析方法,对横琴公立医疗机构的2013~2015年间的处方每月随机抽取200张,并把用药不合理的原因归类统计,从中找出在横琴基层医院中频繁出现的顽固存在的问题进行详细分析,研究数据来源于横琴公立基层医院的HIS系统,调研启动于2014年1月份,完成于2016年4月。结果 在2013~2015年总共7200张点评处方中发现,“氨溴索注射液联用糜蛋白酶雾化吸入祛痰”、“同时联用两种以上退烧药”、“庆大注射液联用地米注射液雾化吸入治疗上呼吸道感染”、“口服碳酸钙治疗过敏性疾病”等4类问题在3年内分别占据处方常见问题的60%以上,为基层医院顽固存在的误区。结论 国家实施抗菌药物和辅助用药的重点监控后,这两类药的滥用已经不是基层医院的主要矛盾,基层医院的主要问题在于一些由于社区医生的知识结构老化、对药理机制模糊不清而导致的顽固存在的用药误区。只有通过对这些误区深入剖析,才能免除隐患,提升药物治疗的安全性和有效性。

Objective To analyze the medication mistakes of primary hospital based on the result of prescription review, and offer some advices in odder to improve the rational medication level of Hengqin district. Methods Using retrospective analysis method, 200 prescriptions in primary hospital randomly extracted every month from 2013 to 2015 were reviewed, the reasons of the irrational drug use were classified and the proportions of them were calculated, and the stubborn and frequently appearing problem in primary hospital were found out and analyzed in detail. The data came from HIS of Public primary hospital in Hengqin, the research was started in January 2014 and completed in April2016. Results In the total 7200 prescriptions, four kinds of problem ＂Ambroxol injection combined with chymotrypsin being used for expectorant by means of atomizing inhalation＂, ＂using two or more than two antipyretics at the same time（including Compound preparation）＂, ＂Gentamicine injection combined with dexamethasone injection being used for upper respiratory tract infection by means of atomizing inhalation＂, ＂Oral calcium carbonate being in the treatment of allergic diseases＂, occupied more than 60% common problems of prescriptions, and were most stubborn mistakes. Conclusion Since the national monitoring of antibiotics and auxiliary drugs were implemented in our country, the abuse of these two medicines had been no longer the main contradiction of primary hospital, but the stubborn mistakes result from the aging knowledge structure and the blurring pharmacological mechanism of the community doctor. Only in-depth analysis of these mistakes can avoid potential risks and improve the safety and effectiveness of drug treatment.