Application effect of prescription pre-audit system in medication management of PPIs
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摘要:
目的 探究处方前置审核系统在质子泵抑制剂(PPIs)用药精细管理中的应用效果，促进临床合理用药。 方法 通过处方前置审核系统建立规则库，根据本院PPIs实际用药情况，对PPIs的适应证、用法用量、联合用药规则、疗程等实施精细化设置。统计精细管理前(2021年1—4月)与管理后(2021年5—8月)PPIs使用情况，选取医院PPIs开方、审方相关工作的医务人员23名，比较管理前后医务人员满意度。 结果 精细管理后本院PPIs使用减少，由管理前的51.56万元下降至管理后的10.49万元(5月)、14.31万元(6月)、8.39万元(7月)、9.78万元(8月)，PPIs用药金额整体呈下降趋势。精细管理后本院PPIs处方不合理情况发生率降低，用法用量不适由管理前的14.2%下降至管理后的5.1%(5月)、3.6%(6月)、2.0%(7月)、1.3%(8月)；适应证不适宜由管理前的15.5%下降至管理后的7.4%、5.4%、2.6%、0.8%；联合用药不适宜由管理前的1.3%下降至管理后的0.6%、0、0、0；疗程不适宜由管理前的16.8%下降至管理后的4.6%、1.8%、0、0。管理后医务人员总满意率高于管理前[95.65%(22/23) vs. 69.57%(16/23)，χ2=5.447，P＜0.05]。 结论 处方前置审核系统用于PPIs精细管理能够促进临床合理用药，提高医务工作者满意度。 Abstract:Objective To explore the application effect of pre-prescription review system in the fine management of proton pump inhibitor (PPIs) medication, and to promote clinical rational drug use. Methods The rule-base system was established for the pre-prescription review process, and based on actual PPIs usage patterns in our hospital, we refined the indications, usage and dosage, combined medication rules, and course of treatment of PPIs. The use of PPIs before (January to April 2021) and after (May to August 2021) fine management was counted. A total of 23 medical staff working in prescription and review of PPIs were selected, and the satisfaction of medical staff before and after management was compared. Results The use of PPIs in our hospital decreased after fine management, from 515 600 yuan before management to 104 900 yuan (May), 143 100 yuan (June), 83 900 yuan (July), 97 800 yuan (August) after management. The total amount of PPIs medication showed a downward trend. After careful management, the incidence of unreasonable PPIs prescriptions in our hospital decreased. The unsuitable usage and dosage decreased from 14.2% before management to 5.1% (May), 3.6% (June), 2.0% (July), 1.3% (August). Indications inappropriate also decreased from 15.5% before management to 7.4%, 5.4%, 2.6%, 0.8% after management. Inappropriate combination medication decreased from 1.3% before management to 0.6%, 0, 0, 0 after management. Similarly, the inappropriate course of treatment decreased from 16.8% before management to 4.6%, 1.8%, 0, 0 after management. The overall satisfaction rate of medical staff increased following this new system [95.65% (22/23) vs. 69.57% (16/23), χ2=5.447, P < 0.05]. Conclusion Pre-prescription review system used in PPIs fine management can effectively promote clinical rational drug use and improve the satisfaction of medical workers. -
Key words:
- Proton pump inhibitors /
- Pre-prescription review /
- Fine management /
- Rational drug use
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表 1 PPIs用法用量
Table 1. Usage and dosage of PPIs
PPIs名称 口服剂型 注射剂型 奥美拉唑 奥美拉唑肠溶片 20 mg，1 d/次 40 mg，1 d/次 奥美拉唑肠溶胶囊 20 mg，1 d/次 40 mg，1 d/次 兰索拉唑肠溶片 15 mg，1 d/次 30 mg，1 d/次 泮托拉唑 泮托拉唑钠肠溶片 40 mg，1 d/次 40 mg，1 d/次 泮托拉唑钠肠溶胶囊 40 mg，1 d/次 40 mg，1 d/次 雷贝拉唑 雷贝拉唑钠肠溶片 10 mg，1 d/次 40 mg，1 d/次 雷贝拉唑钠肠溶胶囊 20 mg，1 d/次 40 mg，1 d/次 艾司奥美拉唑 艾司奥美拉唑肠溶胶囊 20 mg，1 d/次 40 mg，1 d/次 艾司奥美拉唑镁肠溶片 20 mg，1 d/次 40 mg，1 d/次 
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表 2 PPIs特殊人群用药
Table 2. Use of PPIs for special populations
特殊人群 奥美拉唑 艾司奥美拉唑 雷贝拉唑 泮托拉唑 兰索拉唑 儿童 经验有限 不使用 不使用 不使用 不使用 老年人 剂量无需调整 剂量无需调整 剂量无需调整 剂量无需调整 慎用 肝功能异常 严重者≤20 mg/d 严重者≤20 mg/d 严重者需慎用 重度≤20 mg/d 慎用15 mg/d 肾功能异常 剂量无需调整 剂量无需调整 剂量无需调整 剂量无需调整 15 mg/d 妊娠期用药 可使用 慎用 利>弊时应用 利>弊时应用 利>弊时应用 哺乳期用药 暂停哺乳 暂停哺乳 暂停哺乳 暂停哺乳 暂停哺乳
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表 3 PPIs处方合理情况(%)
Table 3. Reasonable prescription of PPIs (%)
时间(2021年) 用法用量不适 适应证不适宜 联合用药不适宜 疗程不适宜 1—4月 14.2(89/625) 15.5(97/625) 1.3(8/625) 16.8(105/625) 5月 5.1(9/175) 7.4(13/175) 0.6(1/175) 4.6(8/175) 6月 3.6(6/168) 5.4(9/168) 0 1.8(3/168) 7月 2.0(3/152) 2.6(4/152) 0 0 8月 1.3(3/235) 0.8(2/235) 0 0 χ2值 60.576 60.821 7.326 103.841 P值 ＜0.001 ＜0.001 0.120 ＜0.001
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表 4 管理前后医务人员满意度比较[人(%)]
Table 4. Comparison of satisfaction of medical staff before and after management[cases (%)]
时间 人数 满意 一般 不满意 总满意 管理前 23 7(30.43) 9(39.13) 7(30.43) 16(69.57) 管理后 23 17(73.91) 5(21.74) 1(4.35) 22(95.65) 注：管理前后总满意率比较，χ2=5.447，P=0.020。
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