基于加权TOPSIS法的药学干预对阿帕替尼处方合理率的影响

Pharmaceutical intervention based on weighted TOPSIS method on the rationality rate of apatinib prescription

目的 建立阿帕替尼药物利用评价标准,通过适当的药学干预措施促进阿帕替尼的临床合理使用。方法参考阿帕替尼说明书以及相关临床指南,制定阿帕替尼药物利用评价标准,利用加权优劣解距离法(TOPSIS)对阿帕替尼药物使用情况进行客观评价,根据评价结果分析可能原因,再制定相应的药学干预措施并给予持续干预,最后再利用加权TOPSIS法对干预后的阿帕替尼药物使用情况进行评价。结果 基线调查发现阿帕替尼处方合理率较低,79份病历的相对接近度为0.9~1.0,57份病历的相对接近度为0.6~0.9,各评价指标中,“给药剂量及剂量调整”“适应证”及“临床指南推荐联合使用方案”指标的得分较低,均值分别为5.00、8.10和8.10分。结合基线调查情况制定针对性干预措施,包括利用医院合理用药软件制定阿帕替尼诊断限制规则、发动临床药师深入临床科室开展阿帕替尼合理使用专项培训以及持续开展阿帕替尼专项处方点评等,经过药学干预后处方合理率得到很大改善,146份病历的相对接近度为0.9~1.0,21份病历的相对接近度为0.6~0.9,“适应证”和“临床指南推荐联合使用方案”指标的得分有所改善,均值均上升至9.32分。结论 加权TOPSIS法可以客观、全面地对阿帕替尼使用情况进行评价,便于发现问题并及时干预。

Objective To establish the evaluation criteria for apatinib drug utilisation and to promote the rational use of apatinib in clinical practice through appropriate pharmaceutical interventions.Methods Referring to the instructions of apatinib and related clinical guidelines,the evaluation criteria for the drug utilisation of apatinib were formulated,and the weighted technique for order preference by similarity to an ideal solution(TOPSIS)was used to objectively evaluate the drug use of apatinib.Pharmaceutical intervention measures and continuous intervention were given,and finally the use of apatinib after intervention was evaluated by the weighted TOPSIS method.Results The baseline survey revealed that the reasonable rate of apatinib prescription was low,the relative closeness of 79 medical records was between 0.9 and 1.0,and the relative closeness of 57 medical records was between 0.6 and 0.9.The scores of dose and dose adjustment,indications and combination regimen recommended by clinical guidelines were low,with mean values of 5.00,8.10,and 8.10 points.The researchers combined baseline investigations to formulate targeted interventions,including the utilization of hospital rational-drug-use software to formulate apatinib diagnostic-restriction rules,mobilising clinical pharmacists to go deep into clinical departments to conduct special training on apatinib rational use,and continuing to conduct apatinib special prescription reviews.The prescription rationality rate greatly improved after pharmaceutical intervention,the relative closeness of 146 medical records was between 0.9 and 1.0,and the relative closeness of 21 medical records was between 0.6 and 0.9.The scores of the"combination regimen recommended by clinical guidelines"index improved,and the mean value increased to 9.32 points.Conclusion The weighted TOPSIS method can objectively and comprehensively evaluate the use of apatinib,which is convenient for problem detection and timely intervention.