2016-2019年北京医院抗菌药物不合理处方的调查研究

Irrational prescriptions of antibiotics in Beijing Hospital from 2016 to 2019

目的分析北京医院抗菌药物处方点评数据,了解抗菌药物的用药合理性。方法随机抽取2016-2019年北京医院抗菌药物处方点评数据,分析4年中抗菌药物不合理处方及其涉及的抗菌药物,比较不同年度抗菌药物使用及处方不合理情况。结果对2016-2019年含抗菌药物的79 701张门诊处方进行合理用药点评。门诊抗菌药物不合理处方率排名前5位的10个药品主要为头孢菌素类和喹诺酮类,分别占50%和30%。不合理的主要问题依次为处方超量(消化内科、皮肤科较多)、适应证不适宜(耳鼻喉科较多)、用法用量不适宜(泌尿外科、皮肤科、消化内科较多)和未写临床诊断或临床诊断书写不全(妇产科、普外科较多)。随着管理政策的加强,抗菌药物处方所占比例、处方不合理率逐年下降。结论北京医院门诊抗菌药物使用管理已初现成效,但仍存在一定问题,应进一步加强对抗菌药物的管理,强化用药合理性培训和学习,促进临床合理用药。

Objective To evaluate the rationality of antibiotics use by analyzing the prescription reviewing results. Methods The review data of antibiotic prescriptions in Beijing Hospital was randomly selected from 2016 to 2019, from which unreasonable prescriptions and the antimicrobial agents were analyzed, and the use of antibiotics and unreasonable prescriptions annually were compared. Results The evaluation of rational use of antibiotics involved 79701 outpatient prescriptions from 2016 to 2019. There were 10 drugs in the top five irrational rates of outpatient antibiotics, primarily cephalosporin and quinolones, accounting for 50% and 30%, respectively. The primarily unreasonable problems were over prescription(common in gastroenterology and dermatology), unsuitable indications(common in otolaryngology), inappropriate usage and dosage(common in urology, dermatology and gastroenterology),and failure to write clinical diagnosis or incomplete clinical diagnosis(common in obstetrics and gynecology and general surgery). During the four years, the proportion of antibiotics prescriptions and the irrational rate decreased annually.Conclusions The use of antibiotics in outpatient department of Beijing Hospital has achieved initial results, however,there are still some problems. We should further strengthen the management of antibiotics usage, strengthen training and learning, and increase medical cooperation to promote rational drug use in clinic.