国家规范合理用药的“利剑”——《中国国家处方集》出台前后

2010年2月7日，卫生部发布了由国内百余名医药学专家历时两年编写的《中国国家处方集（化学药品与生物制品卷）》（以下简称《国家处方集》）。据卫生部医政司司长王羽介绍，这是我国制定的第一部国家级的处方集，是规范临床用药行为、指导和促进临床合理用药的专业指导文件。能够为规范医疗行为、提高临床药物应用水平、落实临床路径管理等工作奠定基础，     

利用药品处方集为医院用药服务

目的:编写本院药品处方集,提供药品通用名、药品编码、原商品名查询、药品最小包装数量、规格、剂量、剂型、常用量、医保用药范畴等药品信息,以方便查询,减少临床用药错误,帮助医、护、患解决实际问题,方便用药。方法:以电子表格形式编排或印刷成册,借助Excel查寻系统通过汉字拼音码、药品编码、汉字录入等多种途径获取药品相关信息。结果:为医院工作者正确选取药品、开具处方、合理用药、安全用药提供服务,为建立的处方点评制度提供工具。结论:编写处方集十分必要,在实际工作中为查询本院用药信息药品,推动医生处方的规范化,促进临床用药安全发挥作用。     

2013年10月份我院门诊电子处方点评及分析

目的通过对门诊电子处方进行点评,了解本院的抗菌药物及注射剂使用情况,以提高医院处方质量,促进临床合理用药。方法随机抽取2013年10月某天的门诊电子处方,以《处方管理办法》及本院建立的门诊处方点评制度为根据,进行点评分析。结果 498张处方中,抗菌药物的使用率为40.16%,注射剂的使用率为28.5%。各科室中,儿科的抗菌药物使用率和注射剂使用率最高。结论本院门诊处方在使用抗菌药物和注射剂方面仍有不合理现象,应加强处方管理及《处方管理办法》和《抗菌药物临床应用指导原则》的学习,提高医院处方质量,促进临床合理用药。     

应用《药品手册》服务指导临床

为贯彻执行卫生部《处方管理办法》（卫生部令第53号）,方便医师开具处方,编写了本院《药品手册》。本手册提供2007年6月1日以前全院所用全部药品（包括自制制剂）的相关信息,分别包括了药品通用名、英文名、商品名、剂型、规格及医保类别等内容,方便临床医生查询,为临床医生正确选取药品,开具处方,合理、安全用药提供服务。手册为建立处方点评制度提供工具,为药品生产厂家提供合理的竞争平台。编写医院《药品手册》十分必要,在实际工作中为查询本院药品信息,推动医生处方的规范书写,促进临床安全用药发挥重大的作用。     

透视我院《处方集》——浅析医药市场的发展趋势

目的 分析总结我院《处方集》特点,评估药品应用现状及趋势.方法 利用Excel表对2007版、2011版《处方集》进行统计分析.结果 与结论 2011版《处方集》分为前言、总论、各论、附录、索引五个部分,同时借鉴《中国国家处方集》,具有专业性和指导性;结合本院用药特色定期增补而具有时效性.目前临床使用的药品新品种、新规格、新剂型呈快速增长趋势.     

我院门诊电子处方点评分析

目的:通过对本院门诊电子处方的审核,将存在的问题进行点评分析,以提高医院门诊处方质量及临床医师合理用药水平,保障患者的用药安全.方法:抽查本院2014年6月-2015年5月电子处方共3 600张,按照《处方管理办法》、《抗菌药物临床应用指导原则》、《医院处方点评管理规范(试行)》,对门诊电子处方进行综合分析.结果:在抽查的3 600张处方中,有248张处方为不规范处方,占抽查处方的6.89％.有129张处方为用药不适宜处方,占抽查处方的3.56％.有62张处方为超常处方,占抽查处方的1.72％.结论:本院门诊电子处方中还存在诸多问题,需要通过制定相应的措施,提高临床医师与药师的业务水平、责任心,完善门诊电子处方信息系统,以提高处方质量,保证患者用药的安全、合理、经济、有效.     

我院临床药师参与处方监督管理的实践和策略

目的对射洪县人民医院处方实施监督管理与评价分析，促进临床医生合理用药。方法建立处方点评制度，填写处方评价表，分析不合理用药处方，及时干预不合理用药。结果本院临床药师对处方的监督管理工作促进临床用药的合理性，加强《处方管理办法》的执行。结论本院认真贯彻执行《处方管理办法》已取得一定成效，但还需要医院各科室的全面配合，提高和加强临床药师的权利和义务。     

某院门诊不合理用药处方分析

目的通过对无锡第九医院门诊处方中用药情况的调查和分析,了解无锡第九医院处方不合理用药的情况,归纳和总结常见的问题,提高药师参与临床合理用药的能力,为合理、安全、有效、经济地使用药品提供指导,更好的为患者服务。方法采用回顾性调查方法,随机抽查2011年1月至2011年5月5个月中,每月某5d的门诊处方,根据药品说明书,《处方管理办法》、《药物临床信息参考》(2005版),《临床用药须知》(2005版)及有关文献,对不合理用药处方进行统计和分析。结果共抽查处方10674张,其中不合理用药处方456张,占抽查处方总数的4.27%。结论无锡第九医院存在一定的不合理用药现象,应采取相应措施从多方面促进合理用药。     

处方点评结果及典型处方分析

目的通过比较《医院处方点评管理规范(试行)》实施四个季度以来的处方点评实施情况,监测和评价本院门诊用药现状,促进临床合理用药。方法 随机抽取本院2010-04～2011-03每月105张处方按处方点评的指标分别进行点评,然后按季度汇总分析。结果每个季度的处方不合格率呈下降趋势。结论《医院处方点评管理规范(试行)》的实施,促进了我院的处方质量的改进,提高了临床医师合理用药的水平。     

处方点评结果及典型处方分析

目的通过比较《医院处方点评管理规范(试行)》实施四个季度以来的处方点评实施情况,监测和评价本院门诊用药现状,促进临床合理用药。方法 随机抽取本院2010-04～2011-03每月105张处方按处方点评的指标分别进行点评,然后按季度汇总分析。结果每个季度的处方不合格率呈下降趋势。结论《医院处方点评管理规范(试行)》的实施,促进了我院的处方质量的改进,提高了临床医师合理用药的水平。     

医院处方集应用中存在的问题及对策探讨

医院处方集是医院药学信息服务工作的一项重要内容,是提高医院药事管理水平、促进合理用药的重要工具和手段。处方集的编制和管理也成为医院药事管理中非常重要的一项工作内容,但依靠传统模式编制、管理的处方集,在应用中存在的不足或弊端已不能满足医院合理用药及药事管理发展的需要。本文分析了医院处方集目前的应用现状及存在问题,对医院处方集建设的发展思路进行探讨。     

医院处方集的基本概念和建立方法

医院处方集是医院药学信息服务工作的一项重要内容，也是提高合理用药水平的重要工具。本丈综述了医院处方集的概念、发展、目的、内容，以及建立医院处方集的基本原则和方法，目的是为编制和管理医院处方集，合理用药服务提供一个参考。     

《WHO示范处方集》对医疗机构处方集编写的启示

目的：介绍WHO示范处方集的历史、内容．阐述WHO示范处方集对医疗机构编写处方集的启示。方法：互联网及数据库文献检索．综合分析并评论。结果和结论：处方集包括前记部分、药物和药品信息部分、附录和索引;编写处方集包括几个步骤：选择编入处方集的药物,组织前记部分：编写正文：编写附录;完成草稿,回顾和完成内容修改。     

Perspectives on the hospital formulary

The hospital formulary system will become increasingly important in future years with the transition to target-rate third party reimbursement. This paper provides an overview of the hospital formulary and its management. A brief history of the formulary system is provided along with some key definitions. The potential benefits and actual effectiveness of a formulary system are described. Various potential problems in managing a hospital formulary are identified along with recommendations to minimize their occurrence.     

Total formulary review--the easy way

In an effort to minimize drug costs, many hospital pharmacy services have limited their drug inventories through the development of a formulary. Evaluation of drug products for addition to the formulary is the responsibility of the Pharmacy and Therapeutics (P & T) Committee. The deletion of rarely used or outdated products is often overlooked. As a means to "clean up" the formulary, Hamot Medical Center (HMC) underwent a total formulary review. Drugs were separated into classes as defined by the American Hospital Formulary Service (AHFS). Approximately three drug classes were evaluated each month by the P & C Committee. Evaluation criteria was based on the following factors: current formulary status, usage statistics, negative comments appearing in six current publications, hospital acquisition cost, and number of formularies containing each product. A final compilation of all deletions and additions were distributed to all medical staff department and division chiefs. Following receipt of all their comments, a final draft of the formulary was made and prepared for publication. This system is a simple, uncomplicated means of either revising or beginning a formulary. It evaluates a drug based on efficacy, individual hospital usage, and cost of the drug while allowing for input of the medical staff. The end result is a formulary tailored to best fit each institution.     

A survey of selective administration procedures in formulary maintenance

The survey attempts to examine various Pharmacy and Therapeutics (P & T) Committees' activities for indications of a rational and objective approach to drugs and the hospital formulary. The objectives were: 1) to gain insight as to how drug products attain formulary listing by examining select P & T Committee's reasons for adding and deleting drugs; 2) to determine whether P & T Committees are attempting to follow generally accepted guidelines for the operation of the formulary system; and 3) to determine how the hospital pharmacist is responding to the rational and/or irrational drug selection by the P & T Committee. The results showed that the hospitals studied appeared to be acting in agreement with the guidelines presented. Definitive statements concerning the activities of the pharmacist and the rational approach of the P & T Committee to the hospital formulary could not be made. The author recommends that P & T Committees begin documenting the methods they utilize to promote and maintain the formulary system in hospitals. This information should be used as an educational tool by the P & T Committee.     

Formulary decision making: identifying factors that influence P&T committee drug evaluations.

This study identifies outcomes related to hospital formulary decision making and estimates the importance of 16 specific types of data to five P & T Committees during the formulary decision making process. The two most important outcomes, according to the Committee members involved in this study, were the effects of the potential formulary addition on the quality of drug treatments available in the hospital followed by its impact on hospital costs. Information about the therapeutic advantage of the potential drug addition, the relative adverse effect profile, and cost information were viewed as especially important. On the other hand, promotional literature provided by pharmaceutical companies and letters of evaluation from respected physicians at hospitals other than their own, were not viewed as important. By understanding the factors involved in hospital formulary decision making, strategies encouraging optimal formulary decisions may be developed.     

Therapeutic decision-making: a model for formulary evaluation

A systematic approach of evaluating medications for a hospital formulary is discussed. The hospital formulary is a program of objective evaluation, selection, and use of medicinal agents in the hospital. In light of the ever-increasing numbers of new and/or improved therapeutic agents, formulary decisions must be made with an eye to the future. Therefore, it appears that the best means of choosing a medication for formulary addition, both clinically and economically, is to choose an agent based on its clinical indication(s). Examples of such indications are presented. Selecting formulary agents by indication rather than by simple drug cost or pharmacologic class should ensure the most effective utilization of therapeutic agents and hopefully a diminution of overall costs.     

Evaluation of the introduction of an antimicrobial drugs formulary in a general hospital in Slovenia

Objective: To analyse the consumption of antimicrobials in a general hospital prior and after implementation of a drug formulary and the economic evaluation of the implementation.Method: Data were obtained from medical documentation collected over a one-month period for all in-patients in four major hospital departments prior to and after the implementation of a drug formulary. The ATC/DDD methodology was used to analyse consumption of antimicrobials. Patients were grouped in therapeutic groups according to their disease and the clinical and economic outcome of the implemented intervention was estimated. Retrospectively, pharmacoeconomical cost–effectiveness analysis was undertaken from the hospitals point of view.Results: The overall use of antimicrobials after implementation in DDD/100 bed-days increased by 16.8%. However, the drug formulary was successfully implemented in 1999, saving 33.7% DDD/100 bed-days of antimicrobials restricted by the formulary. At the same time, treatment time was shortened by 26.5%, with an overall saving of 35.1% per patient.Conclusions: The importance of a drug formulary for antimicrobials was demonstrated in terms of its clinical and economic outcome. A practical case of co-operation between physicians and clinical pharmacists in such a project was also revealed.