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我院实施中成药分亚类管理在提高门诊中成药处方合格率中的作用与实践
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| 篇名： | 我院实施中成药分亚类管理在提高门诊中成药处方合格率中的作用与实践 |
| TITLE： | Effect and Practice of Sub-category Management of Chinese Patent Medicine in the Improvement of the Qualified Rate for Outpatient Prescriptions of Chinese Patent Medicine |
| 摘要： | 目的：为提高门诊中成药处方合格率、保障患者合理用药提供参考。方法：根据《北京市基本医疗保险药品目录》《临床用药须知》以及美康合理用药信息支持系统中的相关信息，以功能主治为标准并结合疾病证型进行中成药品种亚类划分，分类结果经医院药事委员会专家组成员审核，在医务处备案后嵌入门诊医院信息系统（HIS）并与处方前置审核及点评系统对接。比较2017年第3季度（中成药分亚类管理实施初期）和2019年第4季度我院中成药点评处方总数、重复用药的处方数、HIS系统拦截的重复用药处方数、医师主动修改的处方数、重复用药的处方数占比、医师主动修改率及平均单张处方金额。结果：我院中成药可分为内科用药、外科用药、肿瘤用药、妇科用药、眼科用药、耳鼻喉科用药、骨伤科用药、皮肤科用药等八大类，各含14、1、2、4、2、2、3、1个亚类，部分亚类含更细的小亚类。2017年第3季度我院共点评159610张中成药处方，共计不合理处方421张；其中，重复用药的处方200张，占不合理处方的47.51％；HIS系统自动拦截的重复用药处方676张，拦截后医师主动修改的处方数为476张，主动修改率为70.41％。2019年第4季度我院共点评处方138869张，共计不合理处方381张；其中，重复用药的处方共47张，占不合理处方的12.34％；HIS系统自动拦截的重复用药处方266张，拦截后医师主动修改的处方数为259张，主动修改率为97.37％；重复用药处方占比和医师主动修改率与2017年第3季度比较，差异均有统计学意义（P＜0.01）。平均单张处方金额2017年第3季度为278.78元，2019年第4季度为220.85元，平均单张处方金额降低了20.78％。结论：我院药剂科对中成药品种进行分亚类管理，实现了中成药全部处方前置审核，提高了门诊中成药处方的合格率；有助于医师辩证用药、记忆中成药品种、提高专业水平，有助于审方药师迅速识别重复用药处方、提高处方的信息化审核和管理水平，便于审方药师审核处方用药量、查找我院药品目录的不足；但存在患者个体化用药与部分管理制度冲突、医师和药师对分类划分结果存有分歧等问题。 |
| ABSTRACT： | OBJECTIVE：To provide reference for improving the qualified rate of outpa tient prescriptions of Chinese patent medicines and ensuring the rational use of medicines. METHODS：Refering to the Beijing Basic Medical Insurance Medicines Catalog， Clinical Medicine Instructions and （No.17Z13） MCDEX，Chinese patent medicine were classified according to the main functions indications and disease syndromes types. The classification results were reviewed by the member of expert group of Hospital Pha rmacy Committee ，and were recorded by medical department of the management department ，finally were embedded into the outpatient HIS and were docked with prescription pre-audit and comment system. Total number of reviewed Chinese patent medicine prescriptions ，the number of repeated prescriptions ，the number of repeated prescriptions intercepted by HIS system ，the number of prescriptions actively modified by the prescribing physician ，the ratio of repeated prescriptions ，the frequency of active modification by the prescribing physician and average cost of each prescription were compared between the third quarter of 2017（initial stage of sub-category management of Chinese patent medicine ）and the forth quarter of 2019. RESULTS ：Chinese patent medicines in our hospital could be divided into eight categories as internal medicine ，surgery medicine ，oncology medicine ，gynecology medicine ，ophthalmology medicine，otorhinolaryngology medicine ，orthopedics medicine and dermatology medicine ；they contained 14，1，2，4，2，2，3， 1 sub-categories，respectively；some sub-categories were subdivided again . In the third quarter of 2017，159 610 prescriptions of Chinese patent medicines were reviewed ，and 421 prescriptions were unreasonable. Among which ，there were 200 prescription of repeated prescriptions ，accounting for 47.15％；676 repeated prescriptions were actively intercepted by HIS and 476 intercepted prescriptions were actively modified by prescribing physicians ，with active modification rate of 70.14％. In the forth quarter of 2019，138 869 prescriptions of Chinese patent medicines were reviewed ，and 381 prescriptions were unreasonable. Among which ， there were 47 prescription of repeated prescriptions ，accounting for 12.43％；266 repeated prescriptions were actively intercepted by HIS and 259 intercepted prescriptions were actively modified by prescribing physicians ，with active modification rate of 97.37％. There were statistical significances in the ratio of repeated prescription and the rate of active modification by physicians between initial stage and the forth quarter of 2019（P＜0.01）. The average cost of each prescription were 278.78 yuan in the third quarter of 2017 and 220.85 yuan in the forth quarter of 2019，decreasing by 20.78％ . CONCLUSIONS ：The sub-category management of Chinese patent medicine is adopted in the pharmacy department of our hospital ，which realize the pre-audit of all prescriptions of Chinese patent medicines ，and increased the pass rate of outpatient chinese patent medicine prescriptions . It i s helpful for doctors to dialectically use drugs ，memorize the varieties of Chinese patent medicines and improve their professional level；it is helpful for prescription reviewers to rapidly identify repeated prescriptions ，improve the information audit and management level of prescriptions. It is convenient for facilitate prescription reviewers to check the amount of prescriptions used and found out the deficiency of the medicine list in our hospital. However ，there are also some problems such as the conflict between individualized medication and part of management system ，and doctors and pharmacists have different opinions on medicine classification. |
| 期刊： | 2020年第31卷第16期 |
| 作者： | 陈菲，刘妍，庄伟，唐嫚，崔晓辉，林晓兰 |
| AUTHORS： | CHEN Fei，LIU Yan，ZHUANG Wei，TANG Man，CUI Xiaohui ，LIN Xiaolan |
| 关键字： | 门诊患者；中成药；分亚类管理；处方点评；合格率；合理用药 |
| KEYWORDS： | Outpatient；Chinese patent medicine ；Sub-eategory management ；Prescription review ；Qualified rate ；Rational |
| 阅读数： | 728 次 |
| 本月下载数： | 11 次 |
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