Pharmaceutical intervention based on weighted TOPSIS method on the rationality rate of apatinib prescription
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摘要:
目的 建立阿帕替尼药物利用评价标准，通过适当的药学干预措施促进阿帕替尼的临床合理使用。 方法 参考阿帕替尼说明书以及相关临床指南，制定阿帕替尼药物利用评价标准，利用加权优劣解距离法(TOPSIS)对阿帕替尼药物使用情况进行客观评价，根据评价结果分析可能原因，再制定相应的药学干预措施并给予持续干预，最后再利用加权TOPSIS法对干预后的阿帕替尼药物使用情况进行评价。 结果 基线调查发现阿帕替尼处方合理率较低，79份病历的相对接近度为0.9~1.0，57份病历的相对接近度为0.6~0.9，各评价指标中，“给药剂量及剂量调整”“适应证”及“临床指南推荐联合使用方案”指标的得分较低，均值分别为5.00、8.10和8.10分。结合基线调查情况制定针对性干预措施，包括利用医院合理用药软件制定阿帕替尼诊断限制规则、发动临床药师深入临床科室开展阿帕替尼合理使用专项培训以及持续开展阿帕替尼专项处方点评等，经过药学干预后处方合理率得到很大改善，146份病历的相对接近度为0.9~1.0，21份病历的相对接近度为0.6~0.9，“适应证”和“临床指南推荐联合使用方案”指标的得分有所改善，均值均上升至9.32分。 结论 加权TOPSIS法可以客观、全面地对阿帕替尼使用情况进行评价，便于发现问题并及时干预。 Abstract:Objective To establish the evaluation criteria for apatinib drug utilisation and to promote the rational use of apatinib in clinical practice through appropriate pharmaceutical interventions. Methods Referring to the instructions of apatinib and related clinical guidelines, the evaluation criteria for the drug utilisation of apatinib were formulated, and the weighted technique for order preference by similarity to an ideal solution (TOPSIS) was used to objectively evaluate the drug use of apatinib. Pharmaceutical intervention measures and continuous intervention were given, and finally the use of apatinib after intervention was evaluated by the weighted TOPSIS method. Results The baseline survey revealed that the reasonable rate of apatinib prescription was low, the relative closeness of 79 medical records was between 0.9 and 1.0, and the relative closeness of 57 medical records was between 0.6 and 0.9. The scores of dose and dose adjustment, indications and combination regimen recommended by clinical guidelines were low, with mean values of 5.00, 8.10, and 8.10 points. The researchers combined baseline investigations to formulate targeted interventions, including the utilization of hospital rational-drug-use software to formulate apatinib diagnostic-restriction rules, mobilising clinical pharmacists to go deep into clinical departments to conduct special training on apatinib rational use, and continuing to conduct apatinib special prescription reviews. The prescription rationality rate greatly improved after pharmaceutical intervention, the relative closeness of 146 medical records was between 0.9 and 1.0, and the relative closeness of 21 medical records was between 0.6 and 0.9. The scores of the "combination regimen recommended by clinical guidelines" index improved, and the mean value increased to 9.32 points. Conclusion The weighted TOPSIS method can objectively and comprehensively evaluate the use of apatinib, which is convenient for problem detection and timely intervention. -
Key words:
- Weighted TOPSIS method /
- Apatinib /
- Pharmaceutical intervention
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表 1 阿帕替尼药物利用评价标准
Table 1. Evaluation criteria for apatinib utilization
指标名称 评价依据 评价结果 分值(分) 既往化疗方案(X1) (1)无既往化疗史
(2)有既往化疗史0：符合(1)
1：符合(2)0
10用药顺序(X2) (1)既往化疗失败后选择阿帕替尼
(2)未进行一线化疗，直接使用阿帕替尼0：符合(1)
1：符合(2)10
0给药剂量及剂量调整(X3) (1)推荐剂量：850 mg，1次/d(2)出现骨髓抑制或其他不良反应时，建议暂停用药，持续评估患者病情，尽快恢复用药 0：符合(1)或(2)
1：不符合(1)或(2)，便于下文Ci计算10
5适应证(X4) (1)晚期或转移性胃恶性肿瘤(胃癌)
(2)晚期或转移性肝恶性肿瘤(肝细胞癌)0：符合(1)或(2)
1：不符合(1)或(2)10
0禁忌人群(X5) 出现过敏反应，以及其他患者无法耐受的不良反应 0：符合其中任意一项或多项
1：全部不符合0
10给药途径(X6) 口服，餐后半小时服用(每日服药的时间应尽可能相同) 0：符合
1：不符合10
0给药间隔及周期(X7) 连续服用，直至疾病进展或出现不可耐受的不良反应 0：符合
1：不符合10
0临床指南推荐联合使用方案(X8) 符合中国临床肿瘤学会胃癌或肝癌指南 0：符合
1：不符合10
0
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表 2 阿帕替尼点评各指标判断矩阵及权向量
Table 2. Apatinib review index judgment matrix and weight vector
项目 X1 X2 X3 X4 X5 X6 X7 X8 权向量 X1 0 1/3 1/3 1/3 1/3 1/3 1/2 1/2 0.095 X2 2/3 0 1/2 1/2 1/2 1/2 2/3 2/3 0.143 X3 2/3 1/2 0 2/3 2/3 2/3 3/4 3/4 0.167 X4 2/3 1/2 1/3 0 1/2 1/2 2/3 2/3 0.137 X5 2/3 1/2 1/3 1/2 0 1/2 2/3 2/3 0.137 X6 2/3 1/2 1/3 1/2 1/2 0 2/3 2/3 0.137 X7 1/2 1/2 1/4 1/3 1/3 1/3 0 1/2 0.092 X8 1/2 1/2 1/4 1/3 1/3 1/3 1/2 0 0.092
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表 3 干预前后相对接近度比较
Table 3. Comparison of relative proximity before and after intervention
相对接近度范围 干预前病例数 干预后病例数 1.0≥Ci≥0.9 79 146 0.9>Ci≥0.8 0 0 0.8>Ci≥0.7 57 21 0.7>Ci≥0.6 0 0 0.6>Ci≥0.5 0 0 0.5>Ci≥0.4 0 0 0.4>Ci≥0.3 0 0 0.3>Ci≥0.2 45 27 0.2>Ci≥0.1 0 0 0.1>Ci≥0 19 6
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表 4 干预前后各评价指标评分比较(x±s，分)
Table 4. Comparison of evaluation indexes before and after intervention (x±s, points)
评价指标 干预前评分 干预后评分 t值 P值 既往化疗方案(X1) 6.80±4.67 8.35±3.72 3.668 < 0.001 用药顺序(X2) 6.80±4.67 8.35±3.72 3.668 < 0.001 给药剂量及剂量调整(X3) 5.00±0.00 5.00±0.00 适应证(X4) 8.10±2.43 9.32±1.71 5.822 < 0.001 禁忌人群(X5) 10.00±0.00 10.00±0.00 给药途径(X6) 10.00±0.00 10.00±0.00 给药间隔及周期(X7) 10.00±0.00 10.00±0.00 临床指南推荐联合使用方案(X8) 8.10±2.43 9.32±1.71 5.822 < 0.001
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