中国药物警戒 ›› 2021, Vol. 18 ›› Issue (12): 1166-1170.
DOI: 10.19803/j.1672-8629.2021.12.15

• 安全与合理用药 • 上一篇    下一篇

基于多学科协作构建临床用药综合评价体系对重点监控药品合理使用的影响

张文, 彭静, 陈炬, 刘俊, 杨春艳, 王培培, 杨小骏, 杨魁, 刘晓云, 章浩然, 钟正灵, 赵军, 汤增辉, 栾家杰*   

  1. 皖南医学院弋矶山医院,安徽 芜湖 241001
  • 收稿日期:2020-02-21 出版日期:2021-12-15 发布日期:2021-12-16
  • 通讯作者: *栾家杰,男,博士,主任药师,教授,临床药学与药事管理。E-mail：119871190@qq.com
  • 作者简介:张文,女,硕士,副主任药师,临床药学与药事管理。
  • 基金资助:
    安徽省科技攻关项目（1604a0802097）; 2019年皖南医学院中青年科研基金项目（WKS2019F03）; 2019年皖医弋矶山医院管理与服务创新重点项目（CX2019023）; 2019年皖医弋矶山医院管理与服务创新重大项目（CX2019005）

Rational Use of Key Monitored Drugs Influenced by a Comprehensive Evaluation System for Clinical Medicine Based on Multidisciplinary Collaboration

ZHANG Wen, PENG Jing, CHEN Ju, LIU Jun, YANG Chunyan, WANG Peipei, YANG Xiaojun, YANG Kui, LIU Xiaoyun, ZHANG Haoran, ZHONG Zhengling, ZHAO Jun, TANG Zenghui, LUAN Jiajie*   

  1. Yijishan Hospital of Wannan Medical College, Wuhu Anhui 241001, China
  • Received:2020-02-21 Online:2021-12-15 Published:2021-12-16

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摘要： 目的 探讨基于多学科协作模式构建的临床合理用药评估标准体系,在推进医院重点监控药品管理中的应用效果及推广价值。方法 基于多学科协作模式构建临床合理用药评估标准体系,对我院重点监控药品目录内药品施行全程管理,分析其中纳入第一批国家重点监控合理用药药品目录内的8种药品在实施监管后的药品不合理使用率的变化趋势,利用有对照的间断时间序列模型对比分析监管前后此8种药品的不良反应、用量及金额变化趋势。同时统计分析4种第一批国家重点监控合理用药药品目录内药品（但未纳入我院重点药品监控目录内药品）在我院实施重点药品监管前后的用量和金额变化趋势。结果 自2018年9月实施重点药品监管后,纳入我院重点监控目录的8种药品不合理使用率呈线性下降趋势（P<0.01）,实施重点监管后第9个月起药品不合理使用率控制在<10%。监管后（2019年6月）较监管前（2018年9月）的8种药品临床不合理使用率的下降有统计学差异（P<0.01）,其中无适应证用药、用法用量不当及不符合注意事项的发生率下降在组间比较亦有统计学差异（P<0.01或P<0.05）。重点药品监管前后的药品不良反应报告数及发生率均无明显变化趋势。在实施重点监管后,我院重点监控目录内8种药品用量（β3 =-3.79,P<0. 01）、金额（β3=-4.256,P<0. 01）的下降均有统计学差异,而未纳入我院重点监控目录的4种药品用量（β3 =-0.857,P> 0. 05）、金额（β3 =-3.262,P>0. 05）的下降均无统计学差异。结论 基于多学科协作模式构建的临床合理用药评估标准体系,可以有效促进重点监控药品的临床合理使用,使其药品用量、金额显著下降,是一种效果确切、值得推广的管理模式。

关键词: 重点监控药品, 合理用药, 多学科协作, 评估标准体系, 间断时间序列分析, 药品不良反应

Abstract: Objective To explore the applicability of the evaluation standard system for clinical rational drug use based on multi-disciplinary collaboration in enhancing the management of key monitored drugs.Methods Based on the multi-disciplinary collaboration model, an evaluation standard system for clinical rational drug use was established before drugs in the catalogue of key monitored drugs were traced throughout the hospital. The data on eight drugs in the first batch of the national key monitored drug catalogue was collected, while the changes of the irrational drug use rate were statistically analyzed. The interrupted time series (ITS) model was used to analyze the changes of adverse reactions,dosage and amount of these eight drugs before and after monitoring. At the same time, the changes of dosage and amount of four types of drugs of the first batch of key monitored drugs in the national catalogue (but not in the catalogue of key monitored drugs for our hospital) before and after monitoring were also statistically analyzed. Results Since the key drugs were monitored in September 2018, the rate of irrational use of eight types of drugs included in the key monitored catalogue of our hospital trended down (P<0.01). Nine months into monitoring of key drugs, the rate of irrational use of drugs remained less than 10%. The incidence of irrational clinical use of the eight types of drugs, irrational drug use, improper usage and dosage and failure to comply with the instructions was significantly lower in June 2019 than in September 2018 (P<0.01 or P<0.05). The number of ADR reports and incidence of ADRs before and after the monitoring of key drugs were not significantly different. After monitoring of key drugs, the amount of these eight types of drugs used (β3=-3.79, P<0.01), and the amount of money (β3=-4.256, P<0.01) involved decreased significantly, unlike the four types of drugs not included in the catalogue of key monitored drugs in our hospital.Conclusion The evaluation standard system for clinical rational use of drugs based on the multi-disciplinary collaboration model can effectively promote the clinical rational use of key monitored drugs..It is an effective model that should be popularized.

Key words: key monitoring drug, rational drug use, multidisciplinary collaboration, evaluation standard system, interrupted time series analysis, adverse drug reaction

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