药物利用评估的研究及在老年患者合理用药中的作用

随着我国逐渐进入老龄化社会,老年人合理化用药问题成为社会关注的焦点。本文介绍了药物利用评估的兴起与发展,并阐述药物利用评估的概念及在老年人合理化用药中的作用。     

539例老年住院患者不合理用药原因分析

为研究老年住院患者用药现状及不合理用药原因,在2015年5月~2016年12月期间,药师对我院1325例老年住院患者指导用药,将此过程中发现的不合理用药案例进行回顾性分析。研究发现,1325例患者中有539例（40.68%）患者存在不合理用药情况,共涉及978种次用药问题,其中涉及患者不合理用药高达713种次（72.90%）,医生不合理用药150种次（15.34%）,护士不合理用药115种次（11.76%）。经药师干预后,不合理用药种次比例下降了90.70% 。国内不合理用药相关研究多数为医嘱回顾分析,对住院患者合理性用药的研究较少。而本研究中药师在审核医嘱同时也指导患者用药,作为药物使用终端的患者不合理用药占比最多,这一结果不能孤立地认为是某一方的原因,防止不合理用药,保证患者用药安全需要医生、药师、护士、患者四方共同努力来实现。     

神经内科老年住院患者用药分析

目的：了解神经内科老年（≥60岁）住院患者用药情况。方法：采用回顾性调查方法,对2013—2014年神经内科1000例老年住院患者的用药情况进行统计分析。结果：1000例患者中,脑梗死患者居多（758例）,其他为脑供血不足、脑出血、眩晕症、癫痫等患者;其中,脑梗死合并高血压病患者436例、脑梗死合并高脂血症患者154例。针对脑梗死患者采用的主要治疗药物包括静脉给药的舒血宁注射液、奥扎格雷钠、奥拉西坦和口服给药的逐瘀通脉胶囊、灯盏生脉胶囊、阿司匹林肠溶片等。针对脑梗死合并高血压病患者,主要使用缬沙坦氨氯地平、左氨氯地平、缬沙坦等控制血压;针对脑梗死合并高血脂患者,主要使用阿托伐他丁钙、瑞舒伐他丁钙调节血脂。结论：神经内科老年住院患者以脑血管疾病患者居多,其中以脑梗死患者为主,针对脑梗死的治疗药物多以活血化瘀类中药和神经系统用药为主,针对脑梗死合并症的治疗药物多以钙通道阻滞剂类抗高血压药和他汀类调节血脂药为主。神经内科的临床用药基本合理。     

12614例老年住院患者用药分析

目的:了解老年住院患者(≥65a)的用药现状及用药需求。方法:对我院2005年7月～2006年6月≥65a的12614例老年住院患者的用药情况进行统计、分析。结果:老年住院患者共使用药物1347种,给药方式主要以口服和注射给药为主,注射药品销售金额占药品总销售金额的85.81%;肿瘤系统疾病和心脑血管疾病较多见,且老年男性患病率高于女性。结论:老年住院患者用药品种较多,注射药品费用占药品总费用的主要部分,心脑血管疾病及肿瘤是危害老年身体健康的主要疾病。     

Patterns and determinants of psychoactive drug use in Lisbon University students – a population-based study

OBJECTIVE: To study the patterns and determinants of psychoactive drug use by Lisbon University students. MATERIALS AND METHODS: A cross-sectional survey was conducted, from January to April 2000, in a probabilistic sample of 1,147 students. Information about use of psychoactive drugs and co-variates was collected by a questionnaire administered by trained interviewers. Psychoactive drugs were considered to be all medicines classified in group N (nervous system) of the ATC system except the anesthetics (subgroup N01) and the analgesics (subgroup N02). RESULTS: 91 students (7.9%) had taken psychoactive drugs during the fortnight before the interview, 39 of whom (42.8%) mentioned continuous use. The prevalence of use was significantly higher in females (9.6%), older than 25 years (13.1%), married (16%), who considered themselves to have a weak health status (21.7%), as under intense stress (15.5%). After adjustment by multivariate analysis the variables sex, self-evaluation of health status and daily stress retained a higher significant association with psychoactive drug use. A total of 132 drugs were reported as being used in that period. Tranquilizers (ATC = N05B or N05C) were used by 82 students (7.2%), while 22 (1.9%) consumed psychoactive stimulants (N06B) and 19 (1.7%) antidepressants (N06A). In all of these therapeutical subgroups, females had higher consumption prevalence than males, but the difference was statistically significant only for tranquilizers (P < 0.001). Anxiety, depression and insomnia were the most frequently stated health problems. More than 90% of drug consumers considered they had a compliant attitude and about 60% considered themselves well-informed about adverse effects of the drug used. The reported prevalence of self-medication for psychoactive drugs used was 12.8%. CONCLUSIONS: The prevalence of psychoactive drug use among students of Lisbon University was higher than expected, considering age group and the usual health status of this population. The administration of a questionnaire was a very useful tool to characterise the pattern of use and the consumer's knowledge about the drugs consumed.     

盐城地区医疗机构基本药物合理使用情况分析

摘 要 目的：对盐城地区21家综合医疗机构的基本药物合理使用情况进行回顾性分析,以促进基本药物的合理使用。方法：随机抽取盐城地区21家综合医疗机构2015年10月～2016年9月的住院病历,对基本药物的种类、名称、剂型、用法用量、金额等进行调查,并依据药品说明书、诊疗指南等对基本药物的合理使用情况进行评价分析。 结果：共抽取一、二、三级医疗机构住院病历217,761,570份,其基本药物使用率分别为100.0%,97.1%,96.8%。各级医疗机构单个病例平均基本药物使用种数为（8.2±4.0）,（6.8±3.9）,（6.5±4.1）种,基本药物金额占药品金额比例分别为（92.9±20.9）%,（28.0±29.6）%,（19.7±21.5）%。一级医疗机构中药制剂类和头孢菌素类抗菌药物使用率较高;二级医疗机构中药制剂类和水、电解质平衡调节药使用率较高;三级医疗机构肾上腺皮质激素类药物和胃肠解痉药及胃动力药使用率较高。基本药物不合理使用问题主要体现在头孢菌素类药物、中药制剂类等药物用法用量不适宜方面。结论：盐城地区基本药物使用中仍存在一些问题,合理用药水平尚需提高。     

2006～2008年我院肾病中心中成药应用分析

目的：分析我院肾病中心中成药应用情况,为临床合理用药提供科学依据。方法：利用医院“军卫一号”信息系统数据库,检索肾病中心2006～2008年中成药使用数据,对年用药金额、用药频度、日用药金额进行统计分析。结果：百令胶囊、复方肾炎片、丹参片应用较为广泛。我院自制制剂具有很好的发展前景,具有很大的价格优势。结论：我院口服中成药应用基本合理,疗效确切、价格适中、剂型先进的中成药在临床应用中占有优势。     

建立网络药品查询系统，指导患者合理用药

目的：指导患者合理用药。方法：提出开发和建立基于互联网基础的药品查询系统的设想,为患者提供一个指导合理用药的良好平台。结果：药品信息系统的开发应用．将大大方便患者直接获取药品信息和用药知识,并能帮助辨别药品的正确与否,增加患者的用药依从性,减少不合理用药的发生。结论：网络药品查询系统可指导患者合理用药。     

Assessing the effects of an intervention by a pharmacist on prescribing and administration of hypnotics in nursing homes

Introduction: We have previously reported sub optimal use of hypnotics in geriatric institutions. In the present study we examined the intervention by a pharmacist on the prescribing and administration of hypnotics in nursing homes. Thus a follow up study was performed in 5 nursing homes included in the previous study.Method: In the period between the two surveys the pharmacist provided drug information on the rational use of hypnotics, both written and verbal, to the staff of the institutions. Data on the administration of hypnotics was obtained from the Cardex system in the institutions. Data were compared to a control group in other nursing homes, where no intervention was carried out.Results: Although the population was older in 2000 than in 1995, the proportion of patients using hypnotics (24%) was similar. Use of benzodiazepines was reduced from 81% to 40%, use of long acting benzodiazepines was reduced from 62% to 22%, and use of shortacting hypnotics (zopiclone, zolpidem) increased from 9% to 53%. Furthermore, hypnotics administered before 9 p.m. were reduced from 40% to 14%, and the time of administration showed less variation than before. In the control population we also observed the use of short acting hypnotics in favour of benzodiazepines, similar to the results in the 5 institutions. However, in this population a significantly higher proportion of patients used hypnotics, used more than 1 hypnotic and the hypnotics were administered earlier in the evening.Conclusion: The results demonstrate an important effect of written and verbal drug information provided by a pharmacist to improve the prescribing and administration on the use of hypnotics in nursing homes.     

心胸外科605例出院患者用药情况分析

目的:综合评估某"三甲"医院心胸外科出院患者的用药情况,分析其中存在的问题。方法:采用回顾性方法,将该院2013年1—6月心胸外科605例出院患者的病历分为手术组和非手术组,依据《处方管理办法》《医院处方点评管理规范(试行)》《抗菌药物临床应用指导原则》等相关法律法规和治疗指南,对患者的用药进行评价,对不合理用药情况进行分析。结果:用药医嘱存在少数不合理用药情况,主要表现为适应证不适宜和超说明书用药等。结论:该院用药情况基本合理,手术组用药较规范。临床医师还需加强用药知识的学习,临床药师也应更多地参与患者用药方案的制订,共同提高个体化用药水平。     

2013年北京医院门诊老年患者华法林处方不合理用药分析

目的:了解北京医院(以下简称"我院")华法林的使用情况,探讨其用药合理性。方法:从我院信息系统中筛选出2013年门诊60岁及以上患者使用华法林的处方1 621张,对处方用药的合理性进行点评、分析。结果:1 621张处方中,需要关注的问题处方有840张,占51.82%。其中,处方中存在药物不良相互作用的问题最为突出;其次为联合用药不适宜、用法与用量不适宜等。结论:应加强华法林在临床的合理应用,以提高治疗效果,减少不良反应的发生。     

门诊老年心血管病患者口服药联用分析

目的：采用回顾性调查方式了解我院心血管病老年患者口服药物联合使用情况,并分析其相互作用及可能导致的不良反应。方法：抽取2010年我院门诊老年心血管疾病患者（〉60岁）处方（包含慢性病处方）5000张进行分析,统计患者基本情况及口服药应用种类,分析处方中存在的药物相互作用及可能导致的不良反应。结果：超过30%的老年心血管病患者同时口服5种或以上药物,775张处方有潜在的药物相互作用。结论：该院门诊为老年心血管疾病患者开具的存在药物相互作用的处方多为同时患有多种疾病的患者,其口服药种类过多可致患者产生不良反应的机率大大增加,部份处方存在可导致患者产生严重不良反应的药物联合应用,应加强对处方的审查和评价。     

某基层医院2011年门诊中药使用情况分析

目的摸索中药的使用规律,为中药材的合理采购和使用及中药房的管理与建设提供参考。方法利用医院信息系统（HIS）,随机抽取医院门诊2011年1月、6月、8月、11月的中药处方,回顾性调查与分析中药的供应和使用情况。结果中药的供应和使用基本合理。以清热药、补虚药、化痰止咳平喘药、活血化瘀药为主,使用中药的人群以中老年患者为主。结论基层综合性医院门诊中药的供应和使用有其特点和规律,管理部门可以遵循其规律,搞好中药材供应和中药房建设。     

三级肿瘤专科医院基本药物应用情况调查分析

目的：了解国家基本药物制度在三级肿瘤专科医院的实施现状,为优化基本药物品种目录和肿瘤专科医院基本药物考核指标提供参考。方法：以本院作为样本,对2013~2015年使用的基本药物品种数及销售金额进行汇总、统计、分析。结果：按照《国家基本药物目录（2012版）》（简称《目录》）和《江苏省基层医疗卫生机构增补药物目录（2011版）》统计,本院2013~2015年平均基本药物品种配备率为38.51％;基本药物销售百分比：2013年为11.74%,2014年为10.90％,2015年为10.16％。肿瘤专科用药前10名的药物中仅紫杉醇注射液在《目录》中。结论：《目录》中收载的肿瘤专科用药品种少,很多临床常见肿瘤的治疗药物品种未收录,难以满足肿瘤专科医院用药需求。希望在今后修订《目录》时,应考虑增加肿瘤专科用药品种,对肿瘤专科医院的基本药物考核指标可参照同级别综合性医院的考核指标,作适当的下调,更好地满足临床用药需求。     

2006～2010年住院患者抗菌药使用强度分析

目的:分析某医院住院患者抗菌药使用情况,为合理使用抗菌药提供参考依据。方法:收集该院2006～2010年住院患者抗菌药使用记录,以限定日剂量(DDD)为单位,计算抗菌药使用强度(AUD)并进行分析。结果:该院住院患者AUD 5年间波动不大,头孢菌素类、β-内酰胺酶抑制药复合制剂和青霉素类排名AUD前3位;排名AUD前10位的药品大部分来自于头孢菌素类、β-内酰胺酶抑制药复合制剂、硝咪唑类和喹诺酮类。结论:该院可能存在用药集中、广谱抗菌药的使用率高等问题;应严格限制头孢菌素类、β-内酰胺酶抑制药复合制剂和喹诺酮类的临床应用,避免AUD的过快增长。     

Perceptions of the Causes of Drug Use in a Series of Articles in The International Journal of the Addictions

There is now considerable evidence of historical variation in the definition of problem drug use. Less well studied has been contemporary variations in the perception of drug use. To remedy this, an examination of a series titled “From Theory to Practice: The Planned Treatment of Drug Users,” published in The International Journal of the Addictions, was undertaken. The analysis shows little agreement on the causes of drug usage. The implications of this disagreement for policy is illustrated by showing how different perceptions of the causes of drug use imply different ways of responding to that use     

某医院 2010 年至 2012 年基本药物使用情况分析

目的调查基本药物在医院的使用情况,为了解基本药物的使用现状和制订相关政策提供基础数据。方法利用医院信息管理系统（HIS）,回顾性分析2010年至2012年医院基本药物使用的相关数据,应用药物金额排序法及用药频度（DDDs）排序法进行统计、分析。结果2010年至2012年基本药物销售金额占药品总金额比例分别为10．74％,11．16％,14．68％。3年来,销售金额排序前10位的化学药品和中成药品种变化均不大,化学药品中多烯磷脂酰胆碱注射剂、红花黄色素注射剂、头孢硫脒注射剂均稳年居前5位,中成药以祛瘀剂为主（如血塞通软胶囊、血塞通注射剂、血栓通冻干粉针、参附注射剂）;从销售金额排序前10位的化学药品DDDs统计,品种变化也不大,以心血管系统用药、内分泌系统用药为主。结论该院基本药物使用比例均连续大于10％,符合云南省相关卫生行政管理部门的最低要求,但仍有必要制订相关的制度和措施鼓励临床使用更多的基本药物。     

Evaluation of a tool to benchmark hospital antibiotic prescribing in the United Kingdom

Objective: To investigate whether Defined Daily Dose/Finished Consultant Episode (DDD/FCE) ratio is sensitive to changes in prescribing patterns and could be used as a prescribing indicator in hospitals. Method: The study comprised two phases. In phase 1 the weekly DDD/FCE ratios for two antibiotics were calculated and monitored in one acute NHS hospital before and after the implementation of prescribing guidelines, which impacted on the use of the antibiotics. In phase 2 data on the use of four antibiotics over one year was collected from fifty-eight medium to large acute hospitals in England, together with corresponding FCE data. DDD/FCE ratios for each antibiotic in each hospital were compared. Main Outcome measure: Whether the DDD/FCE ratio for two antibiotics changed in one hospital following the introduction of prescribing guidelines for these antibiotics. The variability in DDD/FCE ratio for two broad spectrum antibiotics compared to two narrow spectrum antibiotics across a number of acute hospitals in England. Results: In phase 1 the DDD/FCE ratios for the two antibiotics were lower post implementation of the guidelines indicating that the ratio was sensitive to changes in prescribing. In phase 2 the median DDD/FCE ratios of the two broad spectrum antibiotics from all fifty eight hospitals were much higher (0.126, and 0.265) than for the two narrow spectrum antibiotics (0.048, and 0.021), indicating higher use of the broad spectrum antibiotics. Furthermore, the variation in prescribing between the hospitals, as indicated by the inter-quartile range about the median, was greater for the two broad spectrum agents (0.201 and 0.193), than for the narrow spectrum agents (0.06, and 0.042), as was expected. Conclusion: The DDD/FCE ratio is sensitive to changes in prescribing and can reflect differences in the use of antibiotics between hospitals, after accounting for differences in activity. DDD/FCE ratio has the potential to be used to also account for differences in case mix between hospitals although further work is needed in this area. At the time of undertaking this work Ms Edwards was Clinical Pharmacist Royal Shrewsbury Hospital.     

某农村地区医院内科住院患者抗生素应用分析

目的：了解农村地区抗生素使用情况。方法：在广东省粤东地区某县医院随机抽取300例住院病例进行调查分析。结果：内科住院患者抗生素使用率为86．7％,使用率较高的前4位药物为青霉素类、头孢菌素类、喹诺酮类、大环内酯类;联合用药方面存在明显不合理的情况;细菌培养率为4．62％,未进行过药敏试验。结论：该农村地区医院内科住院病人中抗生素药物的使用不合理现象较为严重。