我院降低药占比的干预策略及成效分析研究

Effectiveness of intervention strategies to lower drug proportion in our hospital

目的介绍医院药占比下降的干预策略,并评估实施后取得的成效。方法依据医院2018年全年的药占比数据及2019年上半年的药占比数据建立灰色模型GM(1,1),并据此对2019年7、8、9月的药占比数据进行预测,预测结果显示,2019年7月药占比为32.19%,仍大于30%,鉴于此,医院进一步强化行政干预,采取药品供应策略及临床药学技术干预策略,即借助信息化手段实现运行病历医嘱的全量点评,借助合理用药指标的监控进一步加强抗菌药物的监管,针对有突出问题的药品品种开展专项点评,强化药师会诊制度的建立以进一步提升合理用药水平,借助质量控制图持续监控药占比等,进一步强化行政干预及临床药学专业技术干预。结果经过2019年7、8月份2个月的强化管控,药占比于2019年9月降至29.50%,10月降至27.90%。临床药学部形成了多个品种专项点评及依托信息化全量医嘱信息点评的工作模式,抗菌药物使用强度保持在40DDDs以下。结论基于预测-干预-持续改进的策略有利于三级甲等医院降低药占比。

Objective Drug proportion is the ratio of drug income to total hospital income.This article describes the intervention strategies to lower drug proportion in our hospital and assesses their effectiveness.Methods Using a grey model GM(1,1)established based on the hospital’s drug proportion data for the whole year of 2018 and the first half of 2019,the drug proportion for July,August,and September 2019 was predicted.The results showed that the drug proportion in July 2019 was 32.19%,which was still higher than 30%.Thus,the hospital further strengthened administrative interventions and adopted a series of drug supply strategies and clinical technical intervention strategies.These strategies included:full-volume review of medical prescriptions in medical records by means of information technology;strengthening supervision of use of antimicrobial drugs according to the rational drug use indicators;special reviews for drug types with prominent problems;establishing a pharmacist consultation system to further improve rational drug use;and continuous monitoring of drug proportion using quality control charts.Results After 2 months of intensive control in July and August 2019,the drug proportion decreased to 29.5%in September 2019 and 27.9%in October 2019.The clinical pharmacy department developed a working model composed of specific reviews of multiple drug types and information technology-based reviews of the fullvolume medical prescriptions,and the intensity of antimicrobial drug use was maintained below 40 DDDs.Conclusions The strategy based on a prediction-intervention-continuous improvement model is beneficial for lowering the drug proportion in tertiary hospitals.