基于属性层次模型加权逼近理想解排序法的阿哌沙班药物利用评价

Drug Use Evaluation of Apixaban Based on Attribute Hierarchical Model Weighted Technique for Order Preference by Similarity to Ideal Solution

目的促进临床合理使用阿哌沙班。方法以阿哌沙班药品说明书为基础,参考相关指南和文献,建立阿哌沙班药物利用评价(DUE)标准。采用属性层次模型(AHM)对DUE标准的指标进行赋权,采用逼近理想解排序(TOPSIS)法对医院2021年8月至2022年7月使用阿哌沙班的病历进行用药合理性评价。结果共形成3个一级指标,12个二级指标。共纳入102份病历(涉及患者102例),其中男52例,女50例,以非瓣膜性房颤(52例)和预防静脉血栓(30例)为主要用药指征。二级指标中相对权重系数较高的为适应证(0.108)、药物转换(0.107)、禁忌证(0.089),不合理率排前3的为用法用量(61.76%)、适应证(44.12%)、联合用药(38.24%)。评价为合理用药[与最优方案相对接近度(C_(i))≥0.8]、基本合理用药(0.6≤C_(i)<0.8)、不合理用药(C_(i)<0.6)的分别有15例(14.71%),61例(59.80%),26例(25.49%)。结论基于AHM加权TOPSIS法进行阿哌沙班药物利用合理性评价具有可行性。该院阿哌沙班的使用基本合理,但在适应证、联合用药、用法用量等方面仍存在问题,临床医师和药师应加强干预,进一步提高该药使用的规范性。

Objective To promote the rational use of apixaban in clinical practice.Methods According to the drug instruction,the drug use evaluation(DUE)criteria for apixaban was formulated based on relevant guidelines and literature.The indicators of the DUE criteria for apixaban were weighted by the attribute hierarchy model(AHM),the rationality of medical records of patients using apixaban in the hospital from August 2021 to July 2022 was evaluated by the technique for order preference by similarity to ideal solution(TOPSIS)method.Results A total of three primary indicators and 12 secondary indicators were formed.A total of 102 medical records(involving 102 patients)were included,including 52 males and 50 females,with non-valvular atrial fibrillation(52 cases)and prevention of venous thrombosis(30 cases)as the main indications for medication.The secondary indicators with high relative weight coefficients were the indications(0.108),drug conversion(0.107)and contraindications(0.089);the top three secondary indicators with high irrational rate were usage and dosage(61.76%),indications(44.12%)and combined medication(38.24%).The drug use in 15 cases(14.71%),61 cases(59.80%),26 cases(25.49%)were evaluated as rational[relative closeness to optimal plan(C_(i))≥0.8],generally rational(0.6≤C_(i)<0.8),irrational(C_(i)<0.6)respectively.Conclusion It is feasible to evaluate the rationality of apixaban use based on AHM weighted TOPSIS method.The use of apixaban in this hospital is generally rational,but there are still problems in indications,combined medication,usage and dosage.Clinicians and pharmacists should strengthen the intervention to promote the rational use of apixaban.