基于区域前置审方中心的多病共存慢病病种和用药分析

Analysis of chronic disease types and drug use of multiple chronic diseases based on regional pretrial center

目的 为基层医疗机构慢病管理提供参考。方法 介绍上海市长宁区区域前置审方中心的系统结构设计和审核级别设置等情况;统计该中心上线后至2022年2月28日的处方/医嘱数量,并对系统拦截处方/医嘱、医师干预处方/医嘱、区域内多病共存慢病病种及其用药情况等进行统计分析。结果 与该中心2021年9月上线时的数据相比,2022年2月的总体处方/医嘱合格率明显提高(97.67%vs. 86.42%),系统拦截和药师干预的处方/医嘱数量分别下降了55.39%和72.67%。排名前5位的疾病依次是高血压(占26.52%)、冠心病(占20.53%)、睡眠障碍(占16.71%)、糖尿病(占15.24%)和骨病(占14.09%),其中涉及冠心病、睡眠障碍和骨病的问题处方较多。结论 社区居民的慢病发病率居高不下,除冠心病、高血压和糖尿病等基层常见的慢病病种外,睡眠障碍和骨病等病种的发病率也越来越高。借助区域前置审方中心,可以及时调整慢病管理的重点,实时开展药品监管,提高基层医疗机构的合理用药水平。

OBJECTIVE To provide reference for chronic disease management in grass-root institution. METHODS System structure design and audit class setting of the regional pretrial center in Changning district of Shanghai were introduced. The number of prescriptions/medical orders from the start of application to February 28,2022 were counted. The prescriptions/medical orders intercepted by the system,prescriptions/medical orders intervened by physicians,chronic disease types and drug use of regional multiple chronic diseases were counted and analyzed. RESULTS Compared with the data when the center was on line in September2021,total qualified rate of prescriptions/medical orders(97.67% vs. 86.42%)significantly increased,the number of prescriptions/medical orders intercepted by the system and intervened by physicians decreased by 55.39% and 72.67% in February 2022,respectively. The top five diseases were hypertension(26.52%),coronary heart disease(20.53%),sleep disorders(16.71%),diabetes(15.24%)and bone diseases(14.09%).Among them, there were many problematic prescriptions involving coronary heart disease, sleep disorder and bone disease. CONCLUSIONS The incidence of chronic diseases among community residents remains high. In addition to common chronic diseases such as coronary heart disease,hypertension and diabetes,the incidence of sleep disorders and bone diseases is also increasing. With the help of the regional pretrial center,the focus of chronic disease management can be adjusted timely,drug supervision can be carried out in real time so as to improve the level of rational drug use in grass-root institution.