延伸处方实施过程中的安全用药研究

Study on safe drug use during the extended prescription implementation

延伸处方政策现已在上海市绝大多数社区卫生服务中心全面执行,因其便捷、经济、高效而受到患者的普遍认同。目前1+X也在试行,延伸处方目录将进一步扩大,专科用药逐渐增加,社区卫生服务中心需加强合理用药监管,保障患者居家合理使用药物。利用医院处方点评系统进行合理性评价,将不合理问题反馈至家庭医生,并通过系统嵌入药品说明书即时查阅功能,提升处方合理性。通过问卷调查的形式对开具延伸处方的患者进行用药后随访,对患者用药的用法用量、用药依从性、复诊情况、药物使用注意事项的知晓情况、药物不良反应、所患基础疾病及联合用药情况等进行调查,了解患者的需求与对延伸处方的意见。延伸处方的处方人群约90%是60岁以上人群,联用3个以上的药物占75%;注意事项知晓率为40%,不良反应发生率为10%,遵循3个月复诊率仅30%。多数患者依从性较好,能遵循药物正确用法用量,延伸处方患者的好评率为100%。患者对延伸药品的配送满意度为95%,偶有未及时收到药品情况。30%患者希望延伸处方的药品品种再丰富一些。延伸处方深受好评,需药剂师协同家庭医生对用药品种多、年龄大、医药学知识欠缺的患者进行专业指导,从而保证患者居家合理用药。

The extended prescription policy has been fully implemented in most community health service centers in Shanghai,because of its convenience,economy and efficiency,it is widely recognized by patients.Now 1+X is also being tried out,The extended prescription list will be further expanded,with a gradual increase in specialty drugs,community health service centers should strengthen the supervision of rational drug use to ensure the rational use of drugs at home.The rationality evaluation is carried out by using the hospital prescription review system,and the unreasonable problems are fed back to the family doctor,and the function of checking the drug instructions is embedded in the system to improve the rationality of prescription.The patients who were given the extended prescription were followed up after medication in the form of questionnaire,to investigate the usage and dosage of medication,medication compliance,follow-up visits,awareness of medication precautions,adverse drug reactions,underlying diseases and combined medication situations of patients,and to understand the needs of patients and their opinions on extended prescription.About 90%of the patients with extended prescriptions are over 60 years old,and 75%of the patients with three or more drugs.The awareness rate of precautions was 40%,the incidence of adverse reactions was 10%,and the rate of follow-up visits within 3 months was only 30%.Most of the patients had good compliance,and could follow the correct usage and dosage of drugs.The positive rate of patients with extended prescription was 100%.The patients'satisfaction with the distribution of extended drugs was 95%,and occasionally the drugs were not received in time.30%of patients want to the variety of extended prescription drugs is a few more rich.The extended prescription has been well received.Pharmacists and family doctors are required to provide professional guidance for patients with many drug varieties,old age and lack of medical knowledge,so as to ensure rational drug use at home.