基于Granada-Ⅱ分类法评价住院患者应用医保限制性中成药注射剂的药物相关问题

Evaluation of Drug-Related Problems of Inpatients Using Chinese Patent Medicine Injections Restricted by Medical Insurance Based on Granada-ⅡClassification

目的促进医保限制性中成药注射剂的合理使用,降低医保拒付风险。方法抽取四川省射洪市第三人民医院医院信息系统2021年1月至12月应用医保限制性中成药注射剂出院患者的病历1166份,采用Granada-Ⅱ分类法对药物相关问题(DRPs)进行识别与分析。结果1166份病历中,有422例(36.19%)患者发生了DRPs,累计发生515药次DRPs,涉及10个药物。发生DRPs排前2位的科室分别为内科(51.07%)和中医科(31.84%),包括183药次(35.53%)DRP2(超适应证及超医保限定的适应证用药),148药次(28.74%)DRP4(疗程过短、剂量过低),113药次(21.94%)DRP6(超剂量、超疗程用药),71药次(13.79%)DRP5(禁忌证用药、药品不良反应、溶剂选择不合理)。发生DRPs较多的中成药注射剂为参麦注射液(104药次,占20.19%)和清开灵注射液(101药次,占19.61%)。结论该院住院患者使用医保限制性中成药注射剂存在超适应证用药、用药疗程不适宜、溶剂选择不合理等DRPs,应加强医保限制性中成药注射剂的培训与管控。

Objective To promote the rational use of Chinese patent medicine injections restricted by medical insurance,and to reduce the risk of medical insurance refusal.Methods A total of 1166 medical records of discharged patients using Chinese patent medicine injections restricted by medical insurance were selected from the hospital information system(HIS)of the Shehong Third People's Hospital from January to December 2021,and drug-related problems(DRPs)were identified and analyzed by the Granada-Ⅱclassification.Results DRPs occurred in 422 patients(36.19%)out of 1166 medical records,with a cumulative occurrence of 515 DRPs involving 10 drugs.The top two departments with high incidence of DRPs were the Department of Internal Medicine(51.07%)and the Department of Traditional Chinese Medicine(31.84%),including 183 DRP2(35.53%,off-label use and illegal use of restricted medical insurance drugs),148 DRP4(28.74%,insufficient treatment course and low dose),113 DRP6(21.94%,overdose use and over treatment course),71 DRP5(13.79%,contraindications,adverse drug reactions,unreasonable choice of solvent).DRPs occurred more frequently in Chinese patent medicine injections such as Shenmai Injection(104 DRPs,20.19%)and Qingkailing Injection(101 DRPs,19.61%).Conclusion The use of Chinese patent medicine injections restricted by medical insurance by inpatients in this hospital has DRPs such as over indication medication,inappropriate medication course and unreasonable choice of solvent.Therefore,training and control of Chinese patent medicine injections restricted by medical insurance should be strengthened.