医院药品存货管理的缺陷

药品存货管理研究如何用最低成本来存贮最优数量的药品 ,以满足各临床科室所需。其核心问题有两点 ,即药品存货成本最低化和药品库存量最优化。而我国目前药品存货管理在上述两方面都存在着缺陷 ,具体表现为 :(1)成本方面 :①购置成本过高 ,②贮存成本过大 ,③订购成本难以控制 ;(2 )库存量方面 :①药房管理人员素质较低 ,难以确定科学的库存量 ,②与临床联系不够紧密 ,很难确定准确的库存量 ,③不能根据外界条件变化 ,及时调整库存量。文章就这两方面的问题进行探讨     

医院经营的成本管理与决策

一、存货控制中的成本决策存货控制是成为医院成本管理中的重要问题。存货控制的主要目的是发现、保持库存物资在满足医院正常运作条件下的最优水平。医院传统的存货量的思维定式是要充分保证医疗活动的顺利进行。安全系数越高越好 ,存货越充沛越佳。这种思维定式忽视了库存量大小对医疗成本的影响。由于存货过量 ,必然会大大地增加仓储费用和保管费用 ,扩大了人为或非人为因素对存货灭失、失效、变质、降值等风险程度 ,从而导致存货总费用的大幅度上升。医院的存货一般包括 :中西药品、卫生材料、低值易耗品、一般材料等。由于存货特定的用…     

医院药品存货的管理

现代医院成本管理已从闭环式的生产过程扩大到开环式的整个生产经营过程.随着成本管理范围的不断扩大,药品存货控制已成为医院成本管理中的一个重要问题.如何使药品存货的总费用最低,是药品存货控制所要研究的核心问题.医院药品存货管理和企业存货管理一样,是研究如何以最低成本来达到最佳库存,以达到满足临床科室和生产部门良好运行的需要.但它和企业又不一样,医院药品存货存在不确定性,有些急、常用药品不储备不行,储备多了又不一定用.所以,药品存货管理主要有两点:一是药品存货成本需最低化,药品存货成本一般包括资金成本、储存成本、订购成本、其他成本.二是储存药品的品种数量需最佳化.而最佳存货成本和最优储存结构的结合点就是医院药品存货管理的最佳状态.……     

运用库存模型制定中成药采购存贮方案

运用库存模型制定中成药采购存贮方案陈惠清冯皓作者单位：１０００５０北京友谊医院（陈惠清）；北京医科大学（冯皓）医院药房药品的合理采购和储备是保障医院医疗活动正常进行的重要环节。如果药品采购和库存量缺乏科学计划，采购量和库存量不足或过多，常可造成部分药...     

浅谈对医药分开核算、分别管理的思考

背景 20世纪90年代，医疗费用持续增长，超过GNP的增长速度。医疗费用上升中药品费用占很大比重。原因分析 医疗财政补偿持续不足，药品市场管理混乱，卫生系统的行业形象下降，社会要求卫生系统进行改革，为了解决药品费用上涨过快的问题，卫生部门尝试医药分开核算、分别管理政策。讨论 医药分开核算、分别管理不同于医药分业，也不等于医药分家。政策实行后有引发许多新的问题：（1）医院补偿依然乏力；（2）病人的负担有增无减；（3）医疗质量保证难度加大等等。因此首先必须加强领导组织协调。     

上海市农村社区卫生服务站药品管理调查分析

目的：了解上海市郊区社区卫生服务站（村卫生室）药品管理的现状，分析存在的问题，为制定《上海市农村社区卫生服务站基本药物目录》提供依据。方法：采用分层随机抽样的方法，进行问卷调查。结果：调查的72个社区卫生服务站（村卫生室）在药品管理中药品管理部门和药品采购部门的不统一、部分单位药品没有做到日清月结等；在药品使用过程中药物品种配备范围太大、部分村卫生室没有配备中成药等；在用药过程中，部分乡村医生对选择首选药品等存在错误认识。结论要统一药品管理部门和药品采购渠道，加强社区卫生服务站（村卫生室）药品的日常管理，制定上海市农村社区卫生服务站基本药物目录，提高乡村医生药品管理和使用药品的水平。     

运用ABC分类法管理库存药品上下限量研究

目的：探讨药品库存ABC分类管理的采购模式，合理控制药品库存量，提高药品使用率。方法：运用药品ABC分类定期定量的方法管理库存，确定药品上下限量，把安全库存量作为采购周期内的补充库存。结果：本法有效地把采购间隔期内的药品库存量控制车7天库存量内，加速医院资金周转，减少购药频率。结论：药品ABC分类定期定量方法使药品上下限量的设定更为合理，体现了微机对库存限额管理的优越性。适用于中等型医院药品库存分类管理的。     

美国药品利益管理公司的服务内容

药品利益管理公司（PBMs）的综合服务内容包括：管理并制订药品报销目录，同时为制定国家药品目录提供信息支持及指导；建立提供药品的服务网络，为相关会员服务，通常是通过邮购或B to C(Business to Client）的方式为慢性病患者提供大宗的处方药物；通过建立信息网络实时处理处方和单据，并记录药品使用和药费等数据，以利用这些数据做出多种报告或研究论文；通过信息分析，采用多种形式鼓励有关医疗机构的医生使用普通药品；与药品生产企业商讨药品采购折扣，并进行大宗采购；在病人支出能力范围内和临床工作的基础上，完善疾病管理项目；综合不同地区患者的药物治疗信息提供支出和用药评价等内容。PBMs对控制药品费用起到了积极的作用。     

我院药库管理新模式

目的 探讨药库药品管理，降低库存量，加快资金周转。方法 对我院药库药品实行制度化管理，色标化管理。结果 清退了几十万元的滞销积压药品，在保证临床用药的基础上减少了库存，降低了流动资金的占用，加快了资金周转。结论 我院药库管理的新模式是加强药品管理行之有效的好方法。     

加强过程监管，提高药物临床试验质量

药物临床试验工作的质量控制是药品监管部门关注的重点之一，也是试验机构自身建设的重要内容。本文结合笔者所在单位的经验和体会，就如何提高药物临床试验质量提出四点意见：（1）牢固法规意识，依法实施监管；（2）关注工作细节，建立标准操作规程；（3）完善制度建设，构建三级质控体系；（4）着重管理效能，及时进行奖惩。     

六西格玛在医院滞料品预防中的应用

[目的]减少库存滞料品,以降低医院成本。[方法]运用六西格玛定义-测量-分析-改进-控制（DMAIC）的流程改善方法对医院库存品进行研究。首先,通过头脑风暴法、鱼骨图和柏拉图方法,找出造成滞料品的主要原因;其次,制定集中处理方法;最后,制定预防滞料品产生的新流程。[结果]医院资材管理流程能力从2.4个西格玛提升至5个西格玛,为医院节约了与之相关的人力成本和存货成本。[结论]本法可减少库存滞料品,降低医院成本。     

Simplifying ART cohort monitoring: Can pharmacy stocks provide accurate estimates of patients retained on antiretroviral therapy in Malawi?

ABSTRACT: INTRODUCTION: Routine monitoring of patients on antiretroviral therapy (ART) is crucial for measuring program success and accurate drug forecasting. However, compiling data from patient registers to measure retention in ART is labour-intensive. To address this challenge, we conducted a pilot study in Malawi to assess whether patient ART retention could be determined using pharmacy records as compared to estimates of retention based on standardized paper- or electronic based cohort reports. .Methods: Twelve ART facilities were included in the study: six used paper-based registers and six used electronic data systems. One ART facility implemented an electronic data system in quarter three and was included as a paper-based system facility in quarter two only. Routine patient retention cohort reports, paper or electronic, were collected from facilities for both quarter two [April-June] and quarter three [July-September], 2010. Pharmacy stock data were also collected from the 12 ART facilities over the same period. Numbers of ART continuation bottles recorded on pharmacy stock cards at the beginning and end of each quarter were documented. These pharmacy data were used to calculate the total bottles dispensed to patients in each quarter with intent to estimate the number of patients retained on ART. Information for time required to determine ART retention was gathered through interviews with clinicians tasked with compiling the data. RESULTS: Among ART clinics with paper-based systems, three of six facilities in quarter two and four of five facilities in quarter three had similar patient numbers of patients retained on ART comparing cohort reports to pharmacy stock records. In ART clinics with electronic systems, five of six facilities in quarter two and five of seven facilities in quarter three had similar numbers of ART patients when comparing retention numbers from electronically generated cohort reports to pharmacy stock records. Among paper-based facilities, an average of 13 hours was needed to calculate patient retention for cohort report using patient registers as compared to 2.25 hours using pharmacy stock cards. CONCLUSION: The numbers of patients retained on ART as estimated using pharmacy stock records were largely similar to estimates based on either paper registers or an electronic data system. Furthermore, less time and staff effort was needed to estimate ART patient retention using pharmacy stock records versus paper-based registers. Reinforcing ARV stock management may improve the precision of estimates.     

Heterogeneity in the sensitivity of stocks and clones of Giardia to metronidazole and ornidazole

The sensitivity in vitro to metronidazole and ornidazole of 7 stocks and of the cloned lines of 5 stocks of Giardia isolated from humans, rodents and monkeys was studied by the growth inhibition test. All 7 stocks of Giardia, irrespective of the host, differed in their sensitivity to these drugs, commonly used in therapy of human giardiasis. The differences were greater with ornidazole than with metronidazole. The 5 Giardia stocks from which clones were prepared were found to consist of populations with significantly (P less than 0.05) differing sensitivities to ornidazole and metronidazole. There was a positive correlation between high resistance in vitro to both drugs of all clones of one parent stock and treatment failures of giardiasis in the patient from which the parasite stock had been isolated. The spectra of sensitivity of Giardia to anti-giardial drugs may have implications concerning the suspected zoonotic character of human giardiasis.     

The sheep as a potential reservoir of human trypanosomiasis in the Republic of the Congo

The identical electrophoretic isoenzyme patterns of a human-plasma-resistant Trypanozoon stock from a sheep and of two other stocks from trypanosomiasis patients in the Congo Republic indicated that the sheep stock was probably infective to man. These, and one further human stock from the Congo, closely resembled stocks isolated from man in Liberia and Ivory Coast.     

Characterization of Leishmania spp. from Kuwait by isoenzyme electrophoresis

Leishmania stocks isolated from skin lesions of 26 patients in Kuwait were compared among themselves and with Leishmania stocks collected from other parts of the Old and New Worlds on the basis of their isoenzyme patterns for seven enzymes by means of thin layer starch gel electrophoresis. The enzymes examined were: alanine aminotransferase (ALAT) E.C.2.6.1.2; aspartate aminotransferase (ASAT) E.C.2.6.1.1; glucose-phosphate isomerase (GPI) E.C.5.3.1.9; glucose-6-phosphate dehydrogenase (G6PD) E.C.1.1.1.49; malate dehydrogenase (MDH) E.C.1.1.1.37; malic enzyme (ME) E.C.1.1.1.40 and phosphoglucomutase (PGM) E.C.2.7.5.1.The isoenzyme patterns obtained fell clearly into 11 groups for the stocks of Leishmania tested. The Kuwaiti stocks separated into six groups. The patterns obtained with 15 Kuwaiti stocks were identical with those obtained with Leishmania tropica major (identified on clinical and geographical characteristics); seven stocks were identical with L. tropica minor similarly identified; three stocks had isoenzyme patterns different from each other and from all other leishmanias examined in this study; and one stock gave isoenzyme patterns identical with those of an L. donovani isolated in the Sudan.The isoenzyme patterns were the same in three stocks classified as L. tropica minor, L. aethiopica and a Leishmania isolated in Baghdad which caused a visceral disease in rats.     

Simplified methods of determining treatment retention in Malawi: ART cohort reports vs. pharmacy stock cards

Setting:

Rapid scale-up of antiretroviral therapy (ART) has challenged the health system in Malawi to monitor large numbers of patients effectively.

Objective:

To compare two methods of determining retention on treatment: quarterly ART clinic data aggregation vs. pharmacy stock cards.

Design:

Between October 2010 and March 2011, data on ART outcomes were extracted from monitoring tools at five facilities. Pharmacy data on ART consumption were extracted. Workload for each method was observed and timed. We used intraclass correlation and Bland-Altman plots to compare the agreeability of both methods to determine treatment retention.

Results:

There is wide variability between ART clinic cohort data and pharmacy data to determine treatment retention due to divergence in data at sites with large numbers of patients. However, there is a non-significant trend towards agreeability between the two methods (intraclass correlation coefficient > 0.9; P > 0.05). Pharmacy stock card monitoring is more time-efficient than quarterly ART data aggregation (81 min vs. 573 min).

Conclusion:

In low-resource settings, pharmacy records could be used to improve drug forecasting and estimate ART retention in a more time-efficient manner than quarterly data aggregation; however, a necessary precondition would be capacity building around pharmacy data management, particularly for large-sized cohorts.     

Candidate targets for Multilocus Sequence Typing of Trypanosoma cruzi: validation using parasite stocks from the Chaco Region and a set of reference strains

A Multilocus Sequence Typing (MLST) scheme was designed and applied to a set of 20 Trypanosoma cruzi stocks belonging to three main discrete typing units (T. cruzi I, V and VI) from a geographically restricted Chagas disease endemic area in Argentina, 12 reference strains comprising two from each of the six main discrete typing units of the parasite (T. cruzi I–VI), and one T. cruzi marinkellei strain. DNA fragments (?400-bp) from 10 housekeeping genes were sequenced. A total of 4178 bp were analyzed for each stock. In all, 154 polymorphic sites were identified. Ninety-five sites were heterozygous in at least one analyzed stock. Seventeen diploid sequence types were identified from 32 studied T. cruzi stocks (including the reference strains). All stocks were correctly assigned to their corresponding discrete typing units. We propose this MLST scheme as provisional, with scope for improvement by studying new gene targets on a more diverse sample of stocks, in order to define an optimized MLST scheme for T. cruzi. This approach is an excellent candidate to become the gold standard for T. cruzi genetic typing. We suggest that MLST will have a strong impact on molecular epidemiological studies of Chagas disease and the phylogenetics of its causative agent.     

出院病人区段费用分布情况探讨

目的 通过对出院病人区段费用情况分析,摸清病人＂主干＂病源的病例质量,分析大部分临床科室经济效益与社会效益不高的原因.方法 导出病人费用明细,对费用、人次、住院天数分区段汇总比较.定义低于6 000元为普通费用区段,6000元及以上为高费用区段,费用构成/人次构成为系数α,费用构成/住院天数构成为系数β.结果 低于6 000元的普通费用区段人次,占总例数的87.02%,6000元及以上高费用区段住院病人2 262人,占12.98%.普通费用区段α系数为0.65,即每1%的普通费用病人可提供0.65%的费用;高费用区段α系数为3.32,即每1%的高费用区段病人可提供3.32%的费用.高费用区段病人的贡献能力是普通费用区段病人的5.11倍.普通费用区段β系数为0.88,高费用区段β系数1.23,该区段是普通费用区段的1.40倍.高费用区段α和β的综合系数是普通费用区段的7.15倍.结论 通过费用分布情况分析,调整病源结构,规范临床治疗,加强区域影响力以及核心优势.改变临床科室收支结余情况,借鉴其他医院先进经验,结合绩效管理方案进行整合.     

Phylogenetic diversity of bat trypanosomes of subgenus Schizotrypanum based on multilocus enzyme electrophoresis, random amplified polymorphic DNA, and cytochrome b nucleotide sequence analyses.

Trypanosome stocks isolated from bats (Chiroptera) and belonging to the subgenus Schizotrypanum were analyzed by multilocus enzyme electrophoresis (MLEE) at 22 loci, random amplified polymorphic DNA (RAPD) with 14 primers and/or cytochrome b nucleotide sequence. Bat trypanosomes belonged to the species Trypanosoma cruzi marinkellei (10 stocks), Trypanosoma dionisii (four stocks) and Trypanosoma vespertilionis (three stocks). One T. rangeli stock and seven stocks of T. cruzi sensu stricto, the agent of Chagas disease, were included for comparison. The homology of several RAPD fragments shared by distinct species was verified by hybridization. The sequence of a 516-nucleotide portion of the maxicircle-encoded cytochrome b (CYb) coding region was determined in representative stocks of the species under study. Phylogenetic analysis of the data confirmed the previous taxonomic attribution of these bat trypanosomes based on biological, epidemiological and ecological features. However, a new finding was that within T. cruzi marinkellei two major subdivisions could be distinguished, T.c.m. I, found in the spear-nose bats Phyllostomus discolor and Phyllostomus hastatus, and T.c.m. II, from P. discolor. In addition, the T. c. marinkellei 'Z' stock from a short-tailed bat (Carollia perspicillata) was distantly related to these two subdivisions, and the monophyly of T. c. marinkellei is unclear based on the present data. Based on the present sample, the European species T. dionisii and T. vespertilionis appeared to be more homogeneous. RAPD and CYb data both suggested the monophyly of a group composed of T. cruzi and the two major subdivisions of T. cruzi marinkellei. This study shows that MLEE, RAPD and CYb can be used for taxonomic assignment and provide valuable phylogenetic information for strains and taxa within the subgenus Schizotrypanum. An evolutionary scenario in which the broad host-range parasite T. cruzi would be derived from a bat-restricted trypanosome ancestor is discussed.