门诊中药饮片处方点评及合理用药对策研究

Study on Prescription Review and Rational Drug Use of TCM Decoction Pieces in Outpatient Department

目的对目前门诊的处方(中药饮片)执行的具体情况进行总结、分析,为安全合理用药提供参考。方法抽取2021年1—12月常熟市中医院门诊就诊的3600例患者作为研究对象,开具3600张中药饮片处方。归纳患者疾病类型、就诊科室,计算各季度不合理处方发生率,分析不合理处方的具体状况,探讨中药饮片配伍禁忌及应用频次等。结果纳入本次研究的3600例患者中,疾病类型占比前3位的分别为消化系统疾病、妇科病、呼吸系统疾病,占比依次为30.73%、23.75%、15.78%。处方由中医内科、中医外科、妇科、皮肤科、儿科、骨科门诊抽取,分别为1223张、463张、727张、304张、562张、321张。不合理处方有532张,占比14.78%(532/3600),其中包括不适宜处方87张,不规范处方143张、超常处方302张。单药处方>10~15种占比最高,为40.78%,其次为>15~20种,占比38.11%。第一、二、三、四季度不合理处方数占比分别为5.44%、4.53%、2.97%、1.83%。饮片配伍禁忌以半夏-附子、浙贝母-附子等为主。结论常熟市中医院的门诊中药饮片处方基本合理,但依然存在着一些问题,在临床工作中,中药师自先需加强与医师间的交流。指导其开展合理与科学的正确处方。这样所开具的中药饮片能确保患者的用药安全,改善疾病预后。

Objective To summarize the implementation of traditonal Chinese medicine(TCM)decoction piece prescription review in outpatient department and explore suggestions and countermeasures for promoting rational drug use.Methods A total of 3600 patients from January to December 2021 of department of outpatient,Changshu Hospital of Traditional Chinese Medicine were selected as the research objects,and 3600 prescriptions of TCM decoction pieces were issued,the disease types and departments of patients were summarized,the incidence rate of unreasonable prescription was calculated in each quarter,the specific situation of unreasonable prescription was analyzed,and the incompatibility of TCM decoction pieces and the frequency of application were discussed.Results Among the 3600 patients included in this study,the top three diseases were digestive system diseases,gynecological diseases and respiratory diseases,accounting for 30.73%、23.75%、15.78%respectively.Prescriptions were drawn from the departments of internal medicine,surgery,gynecology,dermatology,pediatrics and orthopedics,which were 1223 pieces,463 pieces,727 pieces,304 pieces,562 pieces,321 pieces,respectively.There were 532 irrational prescriptions,accounting for 14.78%(532/3600),including 87 inappropriate prescriptions,143 non-standard prescriptions and 302 abnormal prescriptions.The proportion of single drug prescriptions ranging from>10 to 15 was the highest(40.78%),followed by>15 to 20(38.11%).The proportion of unreasonable prescriptions in the first,second,third and fourth quarters was 5.44%,4.53%,2.97%and 1.83%,respectively.The incompatibility of decoction pieces is mainly pinellia-aconite,fritillary-aconite,etc.Conclusion The prescription of TCM decoction pieces in the outpatient department of Changshu Hospital of Traditional Chinese Medicine is basically reasonable,but there are still some problems.Clinical TCM pharmacists should continue to strengthen the interaction and communication with clinicians,supervise them to prescribe TCM prescription scientifically and reasonably,and use TCM decoction pieces to ensure the safety of medication for patients and improve the prognosis of diseases.