医疗机构阿片类药物使用剂量两种分析方法比较

Comparison of two analysis methods of opioid consumption sum in medical institutions

目的比较两种剂量分析方法在分析综合三级甲等医疗机构阿片类药物使用情况中的异同,为医疗机构阿片类药物管理提供参考。方法采用限定日剂量(DDD)与口服吗啡等效当量(OME)两种方法统计山西省5家综合三级甲等医疗机构(编号H1~H5)2020年阿片类药物的处方数据,计算阿片类药物用量、年人均用量、患者费用负担排序、不同品种药物用量占比等指标,比较两种剂量分析方法呈现的指标结果,探索两种评估方法各自的优势应用场景。结果使用两种方法计算5家样本医疗机构阿片类药物用量和患者费用负担的排序相同,人均用量的排序不同。以5家医疗机构为总体,两种方法比较各品种阿片类药物用量占比前4位排序相同,从大到小依次为瑞芬太尼>舒芬太尼>羟考酮>吗啡;瑞芬太尼的占比接近50%。比较各医疗机构内药物用量占比排序时,除H1医疗机构外,其余医疗机构用两种方法计算的结果排序不同。使用DDD法所得芬太尼的用量占比明显高于OME法;而使用OME法所得瑞芬太尼的用量占比明显高于DDD法。围术期患者的用量占比均为最高,约50%。使用DDD法所得H3医疗机构急重症患者和H5医疗机构的住院癌痛患者及其他患者的用量占比高于OME法。使用两种方法计算不同类别患者的费用负担排序有差异。结论DDD法可较准确地反映阿片类药物的用量,便于对用量的监测管理;而OME法可更多地反映镇痛效果以及比较患者的费用负担。

OBJECTIVE To compare the similarities and differences of the two methods in analyzing the use of opioids in third grade class A medical institutions and provide a reference for the management of opioids in medical institutions.METHODS Two methods,Defined Daily Dose(DDD)and Oral Morphine Equivalent(OME),were used to count the opioid prescription data of five comprehensive medical institutions of third grade class A(named H1-H5)in Shanxi province in 2020,calculate consumption sum of opioid,annual per capita consumption sum,patient cost burden and drug consumption sum ratio,compare the index results presented by the two analysis methods,and explore the application scenarios of the advantages of each of the two evaluation methods.RESULTS The ranking of consumption sum of opioid and patient cost burden calculated by the two methods was the same in the five sample medical institutions,but the ranking of per capita consumption sum was different.Taking the 5 medical institutions as a whole,the top 4 rankings of consumption sum ratio for each species of opioid compared by both methods were the same,i.e.remifentanil>sufentanil>oxycodone>morphine.The ratio of remifentanil was close to 50%.When comparing the ranking of consumption sum ratio in each medical institution,the ranking calculated by the two methods was different for those medical institutions except for H1 medical institutions.The consumption sum ratio of fentanyl calculated by DDD method was significantly higher than that of OME method;whereas consumption sum ratio of remifentanil calculated by OME method was significantly higher than that of DDD method.Perioperative patients had the highest consumption sum ratio,about 50%.The consumption sum ratio of critically ill patients in H3 medical institutions and inpatient patients with cancer pain and other patients in H5 medical institutions calculated by DDD method was significantly higher than that by OME method.There were differences in the order of cost burden of different types of patients calculated by two methods.CONCLUSIONS DDD method can accurately reflect the dosage of opioid drugs and facilitate the monitoring and management of the dosage;OME method can more reflect the analgesic effect and compare the cost burden of patients.