门急诊大金额处方22 898张点评与分析

Review and Analysis of 22 898 Large-amount Outpatient and Emergency Prescriptions

目的:为提高门急诊合理用药水平提供参考,推进医保控费工作。方法:抽取赣南医学院第一附属医院2019年12月至2020年10月门急诊金额超300元的电子处方,对处方的药品金额、药品种数、抗菌药物使用率、注射剂使用率、科室及诊断分布等基本指标进行统计分析,同时进行处方用药合理性点评,并对点评结果做分类汇总分析。结果:共点评22 898张门急诊大金额处方,平均月点评处方2 081张,处方平均金额691.69元,处方平均药品种数2.49种,抗菌药物使用率3.92%,注射剂使用率25.97%,科室和诊断分布表明慢病科室、慢病患者大金额处方比例较高;不合理处方共计301张,不合格率1.31%,处方平均金额688.80元,处方平均药品种数2.89种,抗菌药物使用率7.31%,注射剂使用率18.94%,不合理类型主要为适应证不适宜和用法用量不适宜,占比分别为65.45%和18.94%,其次为年龄缺项(2.99%)、诊断不规范或缺项(9.63%)、特殊管理药品不符合规定(0.33%)、遴选的药品不适宜(1.33%)、联合用药不适宜(0.33%)、药品剂型或给药途径不适宜(0.33%)以及重复用药(2.66%)。结论:门急诊大金额处方主要是慢病用药,基本符合相关规范要求;也存在一定用药不合理情况,以适应证不适宜和用法用量不适宜最为常见。

Objective: To provide the reference for improving the rational level of drug use, and advancing the process of health insurance cost control. Methods: Extract the outpatient and emergency electronic prescriptions with an amount of more than 300 yuan from December 2019 to October 2020, and analyze basic information of this prescriptions such as the amount of prescriptions, the number of drugs used, the application rate of antibiotics, the application rate of injections, the distribution of departments and diagnosis. Make comments on the rationality of prescriptions and analyze the results by classification. Results: A total of 22 898 outpatient and emergency large-amount prescriptions were reviewed, and the average number of reviewed prescriptions per month was 2 081. The average amount of prescriptions was 691.69 yuan. The average number of drugs was 2.49. The application rate of antibiotics was 3.92%, and application rate of injections was 25.97%. Departments and diagnosis distribution show that chronic disease departments and chronic disease patients have a higher proportion of largeamount prescriptions. A total of 301 irrational prescriptions, with an irrational rate of 1.31%. The average prescription amount was 688.80 yuan. The average number of drugs used was 2.89. The application rate of antibiotics was 7.31%, and application rate of injection was 18.94%. Unreasonable types are mainly inappropriate indications and inappropriate usage or dosage, accounting for 65.45% and 18.94% respectively, followed by missing items for age(2.99%), irregular diagnosis or missing items(9.63%), inappropriate used of special managed drugs(0.33%), inappropriate of selected drugs(1.33%), inappropriate combination of drugs(0.33%), inappropriate formulations or routes of drugs(0.33%), and repeated drugs(2.66%). Conclusion: The large-amount outpatient and emergency prescriptions are mainly for chronic disease, and the analysis of basic indicators is generally normal, but the use of injections still needs further management. There are certain irrational medications. Among them, inappropriate indications and inappropriate usage or dosage are the most common. The professional ability of physicians and pharmacists should be strengthened to learn and improve.