个体化合理用药监测平台在促进慢病患者合理用药中的应用

Application of individualized rational drug use monitoring platform in promoting rational drug use of patients with chronic diseases

目的 为提高医疗机构合理用药水平、加强患者个体化用药监控提供参考。方法 利用医院信息系统(HIS)调取患者就诊信息和诊疗信息,在事前审方的基础上增加慢病用药实时监测和患者就诊频次监控模块以构建个体化合理用药监控平台。以降糖药为例,比较个体化合理用药监测平台运行前后(2018年1-4月为运行前,2019、2021年1-4月为运行后)克拉玛依市中心医院(以下简称“我院”)每月开具该药≥3次的患者数,同时比较该平台运行后(2019年1-4月和2021年1-4月)的风险处方(每天重复开具同一种药品≥3次以上的患者处方)数和不合理处方数。结果 2021年1-4月我院超量开具二甲双胍片的患者比例显著低于2018年同期,差异有统计学意义(16.65%vs. 27.17%,P<0.05)。2019年1-4月,我院有35.3%的风险处方为不合格处方;2021年同期,我院风险处方中的不合格处方数占比降至12.82%,与2019年比较差异有统计学意义(P<0.05)。结论 我院从就诊患者实际情况出发,利用HIS建立的个体化合理用药监测平台符合临床用药的实际需求。该平台的投入使用明显减少了多次就诊的患者数和不合理处方数,促进了合理用药;同时,该平台也使我院处方点评制度得到了进一步强化,提高了药学服务水平。

OBJECTIVE To provide reference for improving rational drug use in medical institutions and strengthening individualized rational drug use monitoring. METHODS The hospital information system(HIS)was used to retrieve the patient’s medical information and the doctor’s medical information;on the basis of pre-examination of prescriptions,the chronic disease medication monitoring and visiting frequency monitoring modules were added to construct individualized rational drug use monitoring platform. Taking hypoglycemic drugs as an example,the number of patients who were prescribed the drug≥3 times a month in Karamay Central Hospital(hereinafter referred to as“our hospital”)was compared before and after the operation of the individualized rational drug use monitoring platform(Jan. to Apr. 2018 regarded as before operation,Jan. to Apr. 2019 and 2021regarded as after operation). At the same time,the number of risk prescriptions(repeatedly prescribing the same drug≥3 times a day) and unreasonable prescriptions after the operation of the individualized rational drug use monitoring platform(Jan. to Apr.2019 and Jan. to Apr. 2021) in our hospital were compared. RESULTS The proportion of patients who were over prescribed Diformin tablets from Jan. to Apr. in 2021 was lower than the same period in 2018 significantly(16.65% vs. 27.17%,P<0.05).From Jan. to Apr. 2019,35.3% of the risk prescriptions in our hospital were unqualified prescriptions;in the same period of 2021,the proportion of unqualified prescriptions in risk prescriptions in our hospital decreased to 12.82%,which was statistically significant compared with 2019(P<0.05). CONCLUSIONS Based on the actual situation of patients,our hospital establishes the individualized rational drug use monitoring platform by using HIS to meet the actual needs of clinical drug use. The use of the platform has significantly reduced the number of patients visiting doctors many times and unreasonable prescriptions,and promotes rational drug use. At the same time,the platform also further strengthens the prescription review system of our hospital and improves the level of pharmaceutical care.