我国300家二级以上医疗机构特殊医学用途配方食品(FSMP)管理及临床应用现状调查

Investigation on the current management and clinical application of formula food for special medical purpose in 300 secondary and above medical institutions in China

目的调查分析我国二级及以上医疗机构特殊医学用途配方食品(FSMP)规范化管理及临床应用现状。方法采用在线问卷形式,通过四川省临床营养质量控制中心及华西医院临床营养学科联盟等平台,对全国34个省/直辖市的医疗机构进行抽样调查。结果共收回300份有效问卷。在FSMP管理方面:24.3%的医疗机构设立了FSMP管理委员会,64.3%的单位制定了本机构《医院特殊医学用途食品目录》;设置FSMP专用仓库、FSMP配制室的医疗机构分别占47.3%、50.7%。40.7%的医疗机构将FSMP纳入信息化管理;43.3%的医疗机构统一编码收费。FSMP临床应用方面:94%的医疗机构在FSMP处方前要求进行营养风险筛查。84.7%的机构要求FSMP处方人员应具备相应资质;近90%的医疗机构由营养医师开具FSMP处方;67.3%的医疗机构要求上级临床医师/营养师对FSMP处方审核后再执行。300家医疗机构均对FSMP使用不良反应进行了监测,仅有30.7%将不良反应的监测数据上报至省/市级临床营养质量控制中心。结论国家应加强专科收费目录的构建及处方资质培训的统一;各级医疗机构,尤其是西部地区医院及全国二级医院应尽快设立FSMP管理委员会,并将FSMP纳入医院信息化系统。临床营养学科应加强FSMP临床规范应用细则的制定和监管系统的建设,强化安全性监测及有效性评估,促使FSMP的营养治疗价值最大化。

Objective To investigate and analyze the standardized management and clinical application of food for special medical purposes(FSMP)in secondary and above medical institutions of China.Methods In the form of online questionnaire,the medical institutions in 34 provinces/municipalities were sampled through the platforms of Sichuan Provincial Clinical Nutrition Quality Control Center and the Clinical Nutrition Discipline Alliance of West China Hospital.Results A total of 300 valid questionnaires were collected.In terms of FSMP management:24.3%of medical institutions set up FSMP management committee;64.3%of medical institutions formulated the catalogue of FSMP.Medical institutions with FSMP warehouses and FSMP preparation rooms accounted for 47.3%and 50.7%,respectively.40.7%of medical institutions incorporated FSMP into information management;43.3%of medical institutions charged unified coding fees.For clinical application of FSMP:94%of medical institutions required nutrition risk screening before FSMP prescription;84.7%of medical institutions required qualified prescribers;nearly 90%of medical institutions prescribed FSMP by nutritionists;67.3%of medical institutions required the superior clinicians/nutritionists to review the FSMP prescription before implementation.The adverse reaction of FSMP use was monitored in all 300 medical institutions,and only 30.7%reported the monitoring data of the adverse reactions to the provincial/municipal clinical nutrition quality control center.Conclusion The government should strengthen the construction of specialized fee catalogue and the unification of prescription qualification training;medical institutions at all levels,especially hospitals in the western region and secondary hospitals nationwide,should set up FSMP management committee as soon as possible,and integrate FSMP into the hospital information system.The clinical nutrition discipline should strengthen the formulation of clinical norms,detailed rules for the application of FSMP and supervision system.Safety monitoring and effectiveness evaluation should be strengthened so as to maximize the value of nutritional treatment of FSMP.