我院抗肿瘤药物合理应用评价体系的建立及实施效果评价

Establishment and Effects Evaluation of Evaluation System for Rational Use of Anti-tumor Drugs in Our Hospital

目的:构建我院抗肿瘤药物合理应用评价体系并评价其实施效果。方法:结合我院2014年1-10月1 927例恶性肿瘤患者的病历,采用德尔菲法确定评价指标;查阅国内外权威指南、相关文献和药品说明书等,按照循证药学方法从化疗方案、给药剂量、药物预处理、溶剂选择、给药浓度、给药频次等6个方面入手,构建我院抗肿瘤药物合理应用评价体系。选取我院2015年5月(干预前组,98例)、12月(干预后组,87例)肿瘤化疗患者,以上述体系为标准进行专项点评,比较干预前后两组患者抗肿瘤药物的使用情况。结果:干预前组患者的抗肿瘤药物不合理使用率为62.2%,干预后组为29.9%;其中给药剂量、药物预处理、给药浓度、化疗方案的不合理率分别由30.6%、21.4%、8.2%、6.1%下降至12.6%、6.9%、4.6%、2.3%,差异均有统计学意义(P<0.05);但溶剂选择和给药频次不合理使用情况未能得到明显改善,差异均无统计学意义(P>0.05)。结论:通过建立抗肿瘤药物合理应用评价体系,能够较好地改善我院抗肿瘤药物的不合理使用现象,具有一定的可行性,可为临床药师规范抗肿瘤药物的临床使用提供参考。

OBJECTIVE： To construct evaluation system for rational use of anti-tumor drugs and evaluate the effects. METHODS： Based on medical records of 1 927 malignant tumor patients in our hospital during Jan.-Oct. 2014, the study adopted Delphi method to determine the evaluation indexes. Referring to foreign and domestic authoritative guidelines, related literatures and drug package inserts, according to evidence-based pharmacy method, the evaluation system for rational use of anti-tumor drugs in our hospital was established from 6 aspects such as chemotherapy plan, drug dose, drug pretreatment, solvent selection, drug concen- tration, dosing frequency. The tumor patients receiving chemotherapy were selected from our hospital in May （pre-intervention group, 98 cases） and Dec. （post-intervention group, 87 cases） in 2015, the special comment was conducted by using above sys- tem. The utilization of anti-tumor drugs was compared between 2 groups before and after intervention. RESULTS： The unreason- able utilization rate of anti-tumor drugs was 62.2% in pre-intervention group and 29.9% in post-intervention group; the unreason- able rates of drug dose, drug pretreatment, drug concentration and chemotherapy plan decreased from 30.6%, 21.4%, 8.2%, 6.1% to 12.6%, 6.9%, 4.6%, 2.3%, respectively, with statistical significance （P〈0.05）. Irrational solvent selection and dosing frequency had not been improved significantly, without statistical significance （P〈0.05）. CONCLUSIONS： The establishment of evaluation system for rational use of anti-tumor drugs can improve irrational use of anti-tumor drugs. It is certainly feasible and can provide reference for clinical pharmacists standardizing clinical use of anti-tumor drugs.