干预前后特殊使用级抗菌药物应用分析

目的：对特殊使用级抗菌药物临床应用进行干预,探索抗菌药物分级管理的有效措施。方法：调取我院干预前和2次干预后使用特殊使用级抗菌药物的运行病历共76例,对处方权限是否越级、是否填写特殊使用级抗菌药物审批表、是否进行微生物送检进行统计、分析。并对干预前和2次干预后我院出院患者特殊使用级抗菌药物的销售金额和用药频度（DDDs）进行统计、分析。结果：干预前特殊使用级抗菌药物的处方医师权限合格率、审批表填写合格率、微生物送检率分别为34.15%（14/41）、7.32%（3/41）和80.49%（33/41）,经2次药学干预后分别提高到了77.78%（7/9,P〈0.05）、88.89%（8/9,P〈0.01）和100.00%（9/9,P〈0.01）。出院患者特殊使用级抗菌药物的销售金额和DDDs分别降低了48.30%（43 566.65/90 206.39）和63.81%（119.25/186.88）。结论：对特殊使用级抗菌药物临床应用干预效果明显,加强特殊使用级抗菌药物的管理是提高抗菌药物合理使用、减少细菌耐药的重要措施。     

药学干预前后门诊处方抗菌药物应用分析

目的:分析药学干预前后医院门诊处方抗菌药物的使用情况,对处方完整性和用药合理性进行分析、评价,为临床合理用药提供参考。方法:根据《处方管理办法》、《抗菌药物临床应用指导原则》、医院制定的《处方评价制度》和有关文献,构建抗菌药物计算机管理系统,组建抗菌药物合理使用考核组,综合制定干预抗菌药物应用的措施。以随机抽样法抽取2009年9、10月(干预前)及2010年9、10月(干预后)处方各5 000张,制作电子表格对应用抗菌药物的处方进行统计、分析。结果:2009年9、10月5 000张处方中,应用抗菌药物处方1 956张(占39%),2种及2种以上抗菌药物联合应用处方23张(占1.18%),不合理处方98张(占抗菌药物处方的5.01%);2010年9、10月5 000张处方中应用抗菌药物处方813张(占16.26%),2种及2种以上抗菌药物联合应用处方7张(占0.86%),不合理处方38张(占抗菌药物处方的4.67%)。通过采取处方点评干预措施,不合理用药明显减少,处方质量显著提高。结论:采取综合干预措施可降低抗菌药物使用率,使其应用更趋合理。     

临床药师干预前后外科围手术期抗菌药物使用分析

目的了解医院外科围手术期患者在临床药师干预前后抗菌药物的应用情况。方法对2010年1月至5月90例Ⅰ类切口手术患者和2010年6月至10月100例Ⅰ类切口手术患者的用药情况进行回顾性调查分析。结果 2010年6月至10月的外科围手术期患者使用抗菌药物在品种选择、使用时机及时间上更加合理,提示临床药师干预后预防性使用抗菌药物的合理性大有提高。结论临床药师参与临床治疗,能够促进临床抗菌药物的正确选择和使用。     

专项整治活动前后医院抗菌药物应用情况比较

目的:介绍抗菌药物临床应用专项整治活动在襄阳市第一人民医院的实施情况,对比专项整治前后我院抗菌药物的使用情况。方法:对2011年我院开展专项整治活动以来的工作进行总结、分析,并和2010年同期横向对比。结果:通过全院医务工作者的共同努力,抗菌药物临床应用的合理性有较大提高。结论:抗菌药物临床应用专项整治活动的开展很有必要,我院抗菌药物临床应用专项整治工作取得初步成效。     

Use of centrally developed pharmacoeconomic assessments for local formulary decisions.

PURPOSE: The distribution, content, timeliness, use, and influence of pharmacoeconomic assessments (PEAs) of drugs in New Zealand public hospitals were examined. METHODS: In April 2005, a questionnaire-based, cross-sectional survey was sent to chief pharmacists at all 29 New Zealand hospitals employing a pharmacist. The questionnaire asked pharmacists about the use and influence of PEAs in their hospitals' formulary decision-making process. Answers were given using a scale of 1 to 6, with 1 being the most positive response. RESULTS: Of the 29 surveys mailed, 24 (83%) were completed. Data on 12 PEAs were analyzed. Assessments were seen and summaries read in most hospitals (median, 77% and 65%, respectively). Full documents were read in fewer hospitals (35%). In general, the PEAs were considered moderately easy to understand, provided a concise summary, and contained adequate detail of the methodology. Of the 24 respondent hospitals, 21 had assessment processes for new medicines; hence, a total of 252 hospital evaluations of Pharmaceutical Management Agency (PHARMAC)-assessed drugs were possible. A total of 132 possible evaluations (52%) were undertaken. More evaluations (106 [42%]) took place before PHARMAC's PEAs were distributed and fewer (26 [10%]) after distribution. Where used, the PEAs appeared to have a modest effect on hospital decisions. CONCLUSION: The provision of 12 PEAS by PHARMAC to hospitals in New Zealand had only a modest influence on their formulary decision-making process, mostly due to the lack of timeliness of the PEAs. The timely delivery of centrally developed PEAs may be essential to generating a greater effect on the formulary decisions at a wider level.     

综合干预前后围术期预防性应用抗菌药物分析

目的：了解贵阳医学院附属白云医院实施综合干预措施前后围术期抗菌药物的应用情况。方法：将2011年7-12月（干预前）的110份病历设为对照组,2012年1-6月（干预后）的110份病历设为干预组,对2组患者围术期预防性应用抗菌药物的情况进行对比分析。结果：预防性应用抗菌药物品种选择的不合理率从干预前的15．45％下降至干预后的5．45％,预防性给药时间不合理率从干预前的39．09％下降至干预后的11．82％,预防性用药时间合理率（≤24h）从干预前的13．64％上升至干预后的21．82％。结论：采取综合干预措施干预围术期预防性应用抗菌药物,可促进抗菌药物的合理应用。     

专项整治前后我院抗菌药物应用情况调查

目的:了解我院专项整治前、后抗菌药物应用各项指标的变化。方法:调取我院2010年7-11月(整治前)和2011年7-11月(整治后)抗菌药物应用基础数据,并分别计算住院患者抗菌药物应用比例、使用强度(AUD)、特殊使用类抗菌药物用量占抗菌药物总用量比例、住院患者人均应用抗菌药物费用、抗菌药物费用占药品总费用比例和Ⅰ类切口手术预防用抗菌药物比例等6项指标。结果:与整治前比较,整治后我院住院患者抗菌药物应用比例、AUD、特殊使用类抗菌药物用量占抗菌药物总用量比例、住院患者人均应用抗菌药物费用、抗菌药物费用占药品总费用比例和Ⅰ类切口手术预防用抗菌药物比例等指标的变化幅度分别为-3.10%、-18.56%、1.22%、-19.17%、-17.42%和-6.46%,其中手术科室的变化较为显著。整治后,全院50%的科室抗菌药物应用率<60%,52%的科室抗菌药物AUD<40DDDs/100人/天。结论:整治后,我院大多数科室的抗菌药物应用较整治前均有明显改善,但Ⅰ类切口手术预防用抗菌药物不十分理想,还需进一步加强宣传培训和管理。     

干预前后我院门诊患者抗菌药物应用情况分析

目的:了解我院实施干预措施前、后门诊患者抗菌药物的应用情况。方法:将我院2009年10月-2010年9月抽查的1843张处方设为干预前组,2010年10月-2011年9月抽查的1829张处方设为干预后组,比较2组患者应用抗菌药物的合理性。结果:经过干预,我院第3代头孢菌素应用率从干预前的46.30%下降至干预后的18.68%,第2代头孢菌素应用率从干预前的11.85%上升至干预后的20.94%,第1代头孢菌素应用率从干预前的9.75%上升至干预后的21.51%,平均用药时间由干预前的6.12d下降至干预后的3.32d,平均用药金额从干预前的275.41元下降至干预后的136.84元。结论:通过采取行政干预、药学干预等一系列措施,加强医务人员培训,设立有力的监督、干预机制,可促进抗菌药物合理应用。     

综合干预 促进肿瘤辅助治疗药物的合理使用

目的：评价本院综合干预在肿瘤辅助治疗药物临床使用管理中的效果,为临床合理使用和管理此类药物提供参考依据。方法：采用回顾性分析方法,从医院计算机信息管理系统中调取2015 ~ 2017年的肿瘤辅助治疗药物的使用数据,统计分析肿瘤辅助治疗药物的使用特点及变化趋势,并每年抽取200份肿瘤治疗病历,对肿瘤辅助治疗药物使用的合理性进行点评。结果：3年间肿瘤辅助治疗药物销售金额总体呈下降趋势,辅助药物药占比逐年下降,肿瘤辅助治疗药物人均费用逐年降低;各类肿瘤辅助治疗药物和DDDs排名前10的注射用肿瘤辅助治疗药物均趋于合理化;3年来人均注射用肿瘤辅助治疗药物品种数逐年下降,不合理用药现象逐年减少。结论：通过用药前、后综合干预措施3年来肿瘤辅助治疗药物在临床的使用趋于合理,有效减少了患者的医疗费用。     

专项整治活动后我院抗菌药物应用分析

目的：对我院住院患者抗菌药物的使用进行分析,了解抗菌药物整治效果,并为下一步的管理提出建议。方法：采用回顾性分析方法,对2011、2012年我院住院患者抗菌药物临床应用数据进行统计、分析。结果：2012年抗菌药物在销售金额、用药频度（DDDs）、抗菌药物使用强度（AUD）、使用率、分级使用、基本药物应用等方面比2011年均有明显下降。结论：2012年我院抗菌药物的应用都有明显好转,整治效果显著,但AUD还未达标。医院仍应加强系统化管理,注重对经验治疗用药的分析,对价格昂贵且用药频次高的品种重点跟踪监测,规范抗菌药物的临床应用。     

Effect of patient notification of formulary change on formulary adherence

OBJECTIVE: To evaluate the impact of patient notification of impending formulary changes on formulary adherence. METHODS: This pilot program in a large, Midwest-based health insurer utilized a randomized controlled trial research design. A list of 30 chronic-use medications that were to change formulary status were selected for the pilot. A review of adjudicated pharmacy claims records was performed to identify patients receiving one or more of the formulary change medications on the list. Members of 112 individual health plans of this large health insurer, all of whom were subject to the same drug formulary, were randomized to either the intervention (letter) or control arm. Patients in the intervention arm were sent a targeted communication that described the patient.s formulary change medication(s) and provided therapeutic option(s) for the formulary change medication(s). Pharmacy claims for patients in both arms were examined at 110 days after the date of the mailing to determine if there was a switch to a formulary alternative. Multivariate regression modeling was performed to adjust for baseline differences between the arms. RESULTS: A total of 7,247 unique formulary change medication regimens were identified (3,817 in the control arm and 3,430 in the letter arm) for 6,518 subjects (3,387 in the control arm and 3,131 in the letter arm). A higher proportion of formulary change medication regimens in the intervention arm were switched to a formulary alternative compared with the control arm (19.2% vs. 12.0%, P<0.001). After adjustment for baseline differences, regression modeling indicated that subjects in the intervention arm were 1.33 times more likely to switch to a formulary alternative (P<0.001). CONCLUSION: A letter-based, formulary change notification program is a pragmatic and effective strategy to increase drug formulary adherence. Such a program does not restrict access to medications but, rather, provides education and personalized information that may allow patients to participate more actively in their pharmacotherapy decision making.     

干预前后我院抗菌药使用情况与细菌耐药分析

目的：分析干预前后我院抗菌药临床应用情况及临床分离菌对常用抗菌药的耐药情况。方法：利用信息检索系统,查询我院2012第一季度（干预前）、2013年第一季度（干预后）抗菌药消耗量,对抗菌药的用药频度（DDDs）进行排名及细菌对临床常见抗菌药耐药率进行分析。结果：干预前后排名前十的抗菌药相差较大,但仍都以头孢菌素类为主,DDDs整体下降明显。细菌的分离率和分布情况基本保持不变。肠杆菌科大肠埃希菌ESBLs产酶率降低了7.61%,肺炎克雷伯菌ESBLs产酶率降低了1.34%,对常用抗菌药的耐药率整体下降。相比革兰阳性葡萄球菌对常用抗菌药的耐药率降低。革兰阳性肠球菌对常用抗菌药的耐药率相差较大。结论：干预后我院抗菌药DDDs和细菌的耐药率整体下降,但并不是所有细菌的耐药率均下降,因此,临床治疗用抗菌药时应尽早做药敏试验,根据药敏试验结果选药。     

Use of antimicrobial drugs in adults before and after removal of a restriction policy

The effects on the quantity and quality of antimicrobial drug use of removing an antimicrobial restriction policy are reported. Monthly totals for the number of courses of antimicrobial therapy and expenditures based on grams used were obtained from pharmacy records on adult inpatients for a portion (July-December 1987) of the restriction policy term and for the six months (July-December 1988) immediately after the policy ended. Data were obtained for nine restricted drugs and for three that were never restricted. Retrospective drug-use reviews were conducted for ceftazidime and imipenem-cilastatin. For the restricted agents, the total number of courses of therapy increased by 158% after the restriction policy was removed, and total expenditures increased by 103%. There were no significant changes in the number of courses of therapy or cost for the unrestricted antimicrobials. In the postrestriction period, ceftazidime and imipenem-cilastatin were used more often in patients who were less critically ill. Inappropriate use of imipenem-cilastatin occurred significantly more often after the restrictions were removed. Other factors potentially affecting the use of antimicrobials, such as patient age and the incidence of nosocomial infections, did not differ substantially between the two periods. The removal of an antimicrobial restriction policy resulted in increased use of and higher expenditures for previously restricted agents, as well as an increase in the inappropriate use of at least one agent.