基于间断时间序列分析重点监控药品管控措施对合理用药的影响

Impact of Key Monitoring Drug Management Measures on the Rational Drug Use——Analysis Based on Interrupted Time Series

目的评估重点监控药品管控措施对合理用药的影响,为完善和推进重点监控药品政策提供依据。方法收集2017年1月—2018年12月郑州大学第一附属医院药品使用数据,结合处方点评,采用间断时间序列(ITS)设计,运用分段回归分析(Segmented regression analysis)模型,以全部重点监控药品的使用频度(DDDs)、使用金额占比和处方合格率为观测指标,分析实施重点监控药品管控措施前后重点监控药品的使用量和使用合理性的变化。结果实施重点监控药品管控措施后,监控药品的使用频度和使用金额占比均由增长转为下降趋势,且差异有统计学意义(斜率=-15774.78,P=0.003;斜率=-0.0051195,P=0.000)。点评药物的处方合格率显著提高(P=0.009),呈升高趋势且差异有统计学意义(斜率=0.0092992,P=0.000)。结论实施重点监控药品管控措施有效降低了监控药品的使用量,提高了监控药品的用药合理性。

Objective To evaluate the impact of key monitoring drug management on the consumption and rational use of drugs,and to provide a basis to promote and improve key monitoring drugs management policy.Methods Data regarding DDDs and consumption proportion of key monitored drugs in our hospital from January 2017 to December 2018 were collected.Combining with comments on prescription,we assessed trends of consumption and rationality of key monitored drugs by using an interrupted time series design and segmented regression analysis.Results After the management implementation,the significant downward trends of DDDs and consumption proportion in key monitored drugs were observed(slope:-15774.78,P=0.003;slope:-0.0051195,P=0.000).The rates of qualified prescriptions were significantly increased(P=0.009)with statistic difference in upward trend(slope:0.0092992,P=0.000).Conclusion Key monitoring drugs management significantly reduced the use of monitored drugs and promoted the rational use of drugs in the monitoring catalog.