区域医联体全处方点评实践分析

Practice of whole prescriptions comment in a regional medical consortium

目的探讨区域医联体内全处方点评实践对提高区域合理用药水平的影响,促进“药学信息”向“信息药学”发展。方法根据已上市药品的药品说明书、临床指南、《中华人民共和国药品管理法》等有关法律规范,于2019年1月起建立合理用药知识规则库。于2019年5月起运用处方点评软件与人工点评相结合的模式对区域医联体内上海市静安区闸北中心医院等五家单位——进行全处方点评分析、干预、反馈。通过各家医疗机构的HIS系统提取2019年5—7月每月月初10日内门诊全部处方作为对照组,提取2019年10—12月每月同期的门诊全部处方作为观察组,比较两组处方合格率变化。结果通过医联体内全处方点评、干预和反馈,区域医联体处方合格率由点评干预前的89.08%上升至点评干预后的93.65%(χ^(2)=48.939,P<0.001)。结论区域医联体全处方点评干预模式不仅提高了处方质量和处方合理率,也保障了医疗安全,为各医院间知识库信息资源共享、区域同质化管理提供了参考价值。

Objective To explore the influence of the whole prescriptions comment in a regional medical consortium on improving the level of rational medication use in the region,and to promote the transformation from"pharmaceutical information"to"information pharmacy".Methods A knowledge base of rules for rational drug use was established in January 2019 based on the instructions of drugs marketed,clinical guidelines,and the applicable laws and regulations,such as the Pharmaceutical Administration Law of the People's Republic of China.Since May 2019,the mode of prescription review software combined with manual review was used to carry out the prescription comment,intervention,feedback for five hospitals in the regional medical consortium including Zhabei Central Hospital of Jing'an District,Shanghai.All outpatient prescriptions within the first 10 days of each month from May to July in 2019 were extracted from hospital information system(HIS)of each medical institution as the control group,and all outpatient prescriptions during the same period of each month from October to December in 2019 were extracted as the observation group,and the change of prescription pass rate between the two groups was compared.Results Through the measures of whole prescriptions comment,intervention and feedback,the percentage of pass in the medical consortium increased from 89.08%to 93.65%(χ^(2)=48.939,P<0.001).Conclusion The whole prescriptions comment and intervention model adopted by the regional medical consortium not only improved the prescription quality and percentage of pass,but also guaranteed healthcare safety,providing a reference for sharing resources of the knowledge base among hospitals and implementing regional homogenous management.