某医院门诊阿戈美拉汀不合理用药问题分析

Irrational Use of Agomelatine among Outpatients at a Hospital

目的分析某医院门诊阿戈美拉汀处方点评中存在的不合理问题,针对不合理情况提出相应建议,以及切实可行的整改措施,为临床合理用药提供参考。方法采用PLSQL Developer从HIS数据库中调取某医院2022年5月-2023年4月包含阿戈美拉汀片的医嘱3374条,并从阿戈美拉汀的适应证、使用剂量、患者人群等方面依据药品说明书进行分析,统计处方中不合理用药情况并予以回顾性分析。结果阿戈美拉汀使用量较多的两个科室为神经内科和精神心理科。3374条医嘱经处方点评发现不合理医嘱942条(不合理医嘱如有两种以上不合理现象分别计数)。其中,适应证不适宜727条、超年龄段用药145条、超量处方37条、用法用量不适宜33条;通过查阅文献,判定目前尚无足够证据支持阿戈美拉汀的上述使用情况。结论精神心理科和神经内科使用阿戈美拉汀较为普遍,不合理处方问题发生较多。为进一步促进合理用药,应加强处方点评,加强药师与临床医师沟通,对于出现频率较高的用药合理性和剂量问题,定期归类总结并讨论,以减少不合理处方的产生,进一步促进临床合理用药。

Objective To analyse the problems with the usage of agomelatine found during a review of prescriptions at a big hospital in order to provide a reference for clinical rational drug use.Methods Medical orders involving agomelatine tablets given between May 2022 and April 2023 in a hospital were retrieved from the HIS database using PLSQL Developer.A total of 3374 medical orders were analyzed in terms of indications,dosage and users according to the drug instructions.Cases of irrational drug use in the prescriptions were analyzed statistically and retrospectively.Results The two departments with the highest usage of agomelatine were the Department of Neurology and Department of Psychiatry.A total of 942 medical orders were identified as problematic.A total of 727 prescriptions were identified as involving improper indications.A total of 145 drugs were not used in the right age group.Thirty-seven prescriptions were identified as related to off-label use.The usage and dosage were improper in 33 medical orders.A review of literature revealed the lack of evidence to support the aforementioned use of agomelatine.Conclusion The use of agomelatine in psychiatry and neurology is prevalent,and cases of irrational prescriptions are frequent.It is recommended that prescriptions be reviewed more rigorously and countermeasures be taken as soon as possible.Pharmacists should interact with clinicians more frequently to minimize the incidence of substandard prescriptions.