2018-2020年新疆39家县域医疗机构门诊抗菌药物合理用药评价

Evaluation of rational use of antibiotics in outpatient clinics of 39 county-level medical institutions in Xinjiang from 2018 to 2020

目的 评价新疆39家县域医疗机构门诊抗菌药物合理使用情况。方法 收集2018-2020年新疆39家县域医疗机构门诊处方月度抽样数据,选取11项常见诊断计算抗菌药物处方率;根据药品解剖学治疗学及化学分类系统(Anatomical therapeutic chemical, ATC)分类;采用新疆抗菌药物分级目录和WHO AWaRe分级目录分析抗菌药物使用结构。选取6项替代指标分析抗菌药物使用合理性。结果 共纳入47 211张处方,其中含抗菌药物处方7 877张。2018-2020年,处方占比前5位的类别为:青霉素(含β-内酰胺酶抑制剂)、第二代头孢菌素、第三代头孢菌素、大环内酯类和广谱青霉素类;非限制、限制、特殊使用级处方占比在二级和基层医疗机构之间使用水平差异无统计学意义(P>0.05);可用级和备用级处方占比在二级和基层医疗机构之间无显著差异,二级医疗机构慎用级和不推荐使用处方占比显著高于基层医疗机构,差异有统计学意义(P<0.05);二级医疗机构急性上呼吸道感染等诊断抗菌药物处方率显著高于基层医疗机构,差异有统计学意义(P<0.05);总抗菌药物处方的季节性变化指标由17.3%下降至-0.4%,非常规推荐抗菌药物处方率由10.4%上升到15.7%,抗菌药物联用全身用非甾体类抗炎药处方率由16.1%下降到11.9%,差异有统计学意义(P<0.05)。结论 近年来新疆县域医疗机构抗菌药物使用总体情况持续改善,不同级别医疗机构间差异明显,各级别医疗机构抗菌药物合理使用水平均有待进一步提高。

Objective Evaluate the rational use of antibiotics in outpatient clinics of 39 county-level medical institutions in Xinjiang.Methods The monthly sampling data of outpatient prescriptions from 39 healthcare institution in Xinjiang from 2018 to 2020 were collected.The rate of antibiotic prescriptions of the 11 common diagnoses selected was calculated.The structure of antibiotic use was analyzed according to the anatomical therapeutic chemical(ATC)classification,the antibiotic restriction list for clinical use in Xinjiang,and the WHO AWaRe classification.The rational use of antibiotics was analyzed adopting 6 proxy indicators.Results A total of 47211 prescriptions were included with 7877 prescriptions containing antibiotics.From 2018 to 2020,the research found that:Top 5 categories of the proportion of antibiotic prescriptions were combinations of penicillins,including beta-lactamase inhibitors,second-generation cephalosporins,third-generation cephalosporins,macrolides,and penicillins with extended spectrum.There was no significant difference in the proportion of antibiotic prescriptions at non-restricted class,restricted class,and highly-restricted class between secondary hospitals and primary healthcare institutions(P>0.05).There was no significant difference in proportion of prescriptions at Access class and Reserve class between the secondary hospitals and the primary healthcare institutions,and the proportion of prescriptions at the Watch class and the Not-recommended class in secondary hospitals were significantly higher than that in primary healthcare institutions(P<0.05).The antibiotic prescription rates at acute upper respiratory tract infection and so on in secondary hospitals were significantly higher than that in primary healthcare institutions(P<0.05).The seasonal variation in total antibiotic prescriptions were decreased from 17.3%to-0.4%,and the prescriptions did not indicate antibiotics with increasing from 10.4%to 15.7%,and the co-prescription of antibiotic+systemic NSAIDs was decreased from 16.1%to 11.9%(P<0.05).Conclusion In recent years,there was continuous improvement in the overall level of antibiotic use in rural healthcare institutions from Xinjiang.However,there were obvious differences in the antibiotic use among the healthcare institutions at different levels and the level of rational use of antibiotics in healthcare institutions at all levels needs to be further improved.