基于骨科医学中心的药学服务闭环促进中成药合理应用实践

Promotion of rational application of Chinese patent medicine based on closed-loop of pharmaceutical care in orthopaedic medicine center

目的:回顾分析三级甲等医院骨科医学中心的药学审方事前事中事后服务闭环促进中成药临床合理应用实践。方法:从医院管理和药事管理角度分析骨科医学中心2020至2023年中成药临床合理应用的工作模式,阐述医院药学高质量发展背景下药学审方事前事中事后服务闭环的实践模式。结果:基于中医药临床药学服务建设大型骨科医学中心的药学审方事前事中事后服务闭环模式,按照疾病诊断相关分组统计了基于病种例数的医院前10种骨科单病种中成药合理用药数据,发现骨科医学中心住院患者均次药费从2020年的1620.42元,下降至2021年的1541.08元和2022年的1464.46元,药费占平均住院总费用比例也从2020年的3.92%,下降至2021的3.36%和2022年的3.27%。与此相对的是,中成药费用占平均住院总费用比例从2020年的0.14%上升至2021年的0.34%和2022年的0.41%。中成药不合理应用比例从2021年的12.69%逐步下降至2022年的6.68%和2023年的4.04%。中成药临床应用适应症不适宜、联合应用中成药配伍不当和处方重复的问题显著减少。结论:药学审方的事前事中事后服务闭环改进骨科医学中心中成药临床应用现状。

Objective:To retrospectively analyze the closed-loop service of pharmaceutical prescription review before,during and after treatment to promote the rational clinical application of Chinese patent medicine in the orthopaedic medical center of Grade A tertiary hospitals.Methods:The working mode of rational clinical application of Chinese patent medicine in the orthopaedic medical center from 2020 to 2023 was analyzed from the perspective of hospital management and pharmaceutical management,and the practice mode of closedloop service of pharmaceutical prescription review before,during and after treatment in the context of high-quality development of hospital pharmacy was expounded.Results:Based on clinical pharmaceutical care of traditional Chinese medicine(TCM),the closed-loop service mode of pharmaceutical prescription review before,during and after treatment was established in the large orthopaedic medical center.According to Diagnosis Related Groups(DRG),the data of rational drug use of Chinese patent medicine on the top 10 orthopaedic single diseases in the hospital based on the number of cases were statistically analyzed.It was found that the average drug cost per inpatient per time in the orthopaedic medical center was decreased from 1620.42 yuan in 2020 to 1541.08 yuan in 2021 and 1464.46 yuan in 2022,and the proportion of drug cost in the average total hospitalization cost was also decreased from 3.92%in 2020 to 3.36%in 2021 and 3.27%in 2022.In contrast,the proportion of Chinese patent medicine cost in the average total hospitalization cost was increased from 0.14%in 2020to 0.34%in 2021 and 0.41%in 2022.The proportion of irrational application of Chinese patent medicine was gradually declined from 12.69%in 2021 to 6.68%in 2022 and 4.04%in 2023.The problems of inappropriate indications for clinical application of Chinese patent medicine,improper compatibility of Chinese patent medicine in combined medication,and repeated prescriptions were significantly decreased.Conclusion:The closed-loop service of pharmaceutical prescription review before,during and after treatment promotes the rational clinical application of Chinese patent medicine in the orthopaedic medicine center.