多部门协作干预模式在降低住院患者质子泵抑制剂静脉使用率的实践

Practice of multi-departmental cooperative intervention model in reducing the intravenous use rate of proton pump inhibitors in hospitalized patients

目的:探索通过多部门协作干预模式,降低住院患者质子泵抑制剂静脉使用率,减少临床不合理用药。方法:根据相关指导原则和药品说明书,制定静脉使用质子泵抑制药的点评标准,对中国科学技术大学附属第一医院相关临床科室住院患者使用静脉质子泵抑制剂的病例进行专项处方点评,初步结果反馈给对应的临床科室医师,收集临床反馈建议,组织相关专家进行合理性终评。根据点评结果中发现的问题,分管院长、医务处、药学部、临床科室、学科规划办、纪检监察室、信息中心等多部门合作,通报、督促、落实临床科室制定的整改措施,并进行跟踪管理,对比干预效果。对2020年、2021年、2022年的住院患者使用静脉质子泵抑制药总的使用率进行统计、分析。结果:第1次点评总不合理率为58.39%,第2次点评总不合理率为29.09%,不合理使用情况得到明显改善(P<0.01);第2次较第1次在总用药指征不适宜(无适应证用药)、遴选药物不适宜、用药疗程不适宜、给药时机不适宜等方面均有明显改善(P<0.05)。2020年、2021年、2022年住院患者使用静脉质子泵抑制剂总的使用率分别为34.44%、23.77%、17.34%,呈逐年下降趋势。结论:通过对该院住院患者使用静脉质子泵抑制剂的病例的专项处方点评和多部门有效干预,明显提高了药物使用合理率,降低住院患者质子泵抑制剂静脉使用率,降低药品使用费用的支出,节约宝贵的医疗资源。

OBJECTIVE To explore a multi-departmental collaborative intervention model to reduce the intravenous use rate of proton pump inhibitors in hospitalized patients and clinical unreasonable medication.METHODS According to the relevant guiding principles and package inserts,the evaluation criteria for intravenous use of proton pump inhibitors were formulated.The special prescription evaluation was conducted for inpatients treated with intravenous proton pump inhibitors in the relevant clinical departments of The First Affiliated Hospital of University of Science and Technology of China.The preliminary results were fed back to the corresponding clinical physicians,clinical feedback suggestions were collected,and relevant experts were organized to conduct the final evaluation of rationality.Based on the issues identified in the review results,multiple departments such as the dean in charge,medical department,pharmacy department,clinical department,discipline planning office,disciplinary inspection and supervision office,and information center collaborated to report,supervise,and implement the corrective measures formulated by the clinical department,and conducted tracking management to compare the effectiveness of intervention.Statistics and analysis were conducted on the total usage rate of intravenous proton pump inhibitors among hospitalized patients in 2020,2021 and 2022.RESULTS The total unreasonable rate of the first review was 58.39%,and the total unreasonable rate of the second review was 29.09%.The unreasonable use situation was significantly improved(P<0.01);compared with the first trial,the second trial showed significant improvement in terms of overall inappropriate drug indications(no indication for medication),inappropriate drug selection,inappropriate medication duration,and inappropriate administration timing(P<0.05).The total usage rates of intravenous proton pump inhibitors among hospitalized patients in 2020,2021 and 2022 were 34.44%,23.77%and 17.34%,respectively,showing a decreasing trend year by year.CONCLUSION Through special prescription review and effective intervention from multiple departments on the use of intravenous proton pump inhibitors in hospitalized patients in the hospital,the rational drug use rate has been significantly improved,the intravenous use rate of proton pump inhibitors in hospitalized patients has been reduced,the expenses for the use of drugs have been reduced,and precious medical resources have been saved.