中成药重复用药的精细化设置在门诊前置审核中的应用实践

Application practice of refined setting of repeated medication of Chinese patent medicine in outpatient pre-audit

目的:改善处方前置审核系统对中成药重复用药处方的审核适用性,提高中成药处方审核质量和合理用药水平。方法:通过处方前置审核系统获取许昌市中心医院2022年8月1日至10月31日门诊中成药重复用药不合理问题清单,以循证医学证据为基础,建立明确、科学、统一的审核标准,并以此构建中成药重复用药审核数据库,进一步完善前置审方中成药规则库,评价精细化设置后的效果。结果:经过1个月(2022年11月)规则库的持续修订与完善,门诊中成药重复用药任务数占比从6.31%降至1.73%(χ^(2)=1178.95,P<0.01),系统拦截率从1.05%增加到3.23%(χ^(2)=363.53,P<0.01),系统审核后医生修改率从36.68%提升到53.31%(χ^(2)=525.69,P<0.01),药师审核率从3.14%下降到2.55%(χ^(2)=24.04,P<0.01),平均单张处方金额从(128.5±13.59)元降低到(112.86±11.46)元(t=4.899,P<0.01),差异均有统计学意义。结论:审核规则的精细化设置能有效弥补现有审核系统对中成药重复用药审核的不足,改善审方系统对中成药重复用药处方的审核适用性,显著提高门诊中成药的处方质量,对保障门诊中成药应用安全性、提升药学服务质量具有重要的意义。

OBJECTIVE To improve the applicability of pre-prescription audit system for reviewing repeated prescriptions of Chinese patent medicine and enhance the quality of prescription audit and the level of rational drug use.METHODS Through the pre-prescription audit system,the list of irrational repeated use of Chinese patent medicines at outpatient clinics of Xuchang Cen⁃tral Hospital from October 1 to October 31,2022 was compiled.Based upon evidence-based medical evidence,a definite,scien⁃tific and unified audit standard was established.And a database of repeated use of Chinese patent medicines was constructed for fur⁃ther refining the rule base of pre-prescription Chinese patent medicines and evaluating the effect of refined setting.RESULTS After refining the audit rules,the proportion of repeated drug dosing tasks in outpatient Chinese patent medicines dropped from 6.31%to 1.73%(χ^(2)=1178.95,P<0.01),system interception rate spiked from 1.05%to 3.23%(χ^(2)=363.53,P<0.01),phy⁃sician modification rate jumped from 36.68%to 53.31%(χ^(2)=525.69,P<0.01),and pharmacistaudit rate declined from 3.14%to 2.55%(χ^(2)=24.04,P<0.01).Average amount of single prescription decreased from(128.5±13.59)yuan to(112.86±11.46)yuan(t=4.899,P<0.01),and the difference was statistically significant.CONCLUSION Fine-tuning of audit rules can effectively make up for the shortcomings of existing audit system for repeated use of Chinese patent medicines,improve the appli⁃cability of audit system for repeated use of Chinese patent medicines and significantly enhance the prescription quality of outpatient Chinese patent medicines.It is imperative to ensure the safety of outpatient Chinese patent medicines and boost the quality of phar⁃maceutical services.