云南省三地居民合理用药现状调查

[目的]了解云南省三地居民合理用药相关知识、态度及行为现状,为开展城乡居民健康教育提供依据。[方法]采用分层整群抽样的方法,随机抽取昆明市五华区、玉溪市红塔区各2个街道的城市居民818名,曲靖市罗平县2个乡镇的农村居民406名,进行自填式问卷调查。[结果]昆明市和玉溪市居民合理用药相关知识、态度和行为正确率明显高于罗平县居民。对“滥用抗生素的后果”的知晓率分别为：昆明28．54％、玉溪42．65％、罗平18．23％;“出现药物不良反应后的处理方法”正确率为：昆明61．29％、玉溪54．94％、罗平35．71％;在购药地点上,城市居民主要在药店购买（73．59％）,农村居民主要在公立医疗机构购买（77．09％）,三地居民合理用药相关知识、态度和行为差异有统计学意义（P〈O．01）。[结论]三地居民对合理用药相关知识有一定的了解,但是还存在许多不合理的用药观念和行为,且城乡差别显著,应分别对城乡居民开展有针对性的健康教育,提高居民合理用药的水平。     

浙江省部分居民家庭合理用药干预研究

目的评估居民家庭合理用药健康教育干预效果,为政府公共卫生决策提供依据。方法在浙江省3个县区12个社区/村所有18～60岁的居民开展合理用药健康教育干预。采用问卷调查的方法评估干预效果。结果干预组居民药物相关知识知晓率为66.00%,错误用药观念的识别率为55.38%,正确储存药品率、定期检查家中药品率和正确处理过期药品率分别为8.03%、18.62%和34.83%,药物不良反应正确处理率为35.15%。与干预前相比,干预组居民的药物相关知识知晓率与错误用药行为识别率和药品不良反应正确处理率有显著提高,但不合理用药行为改善不明显。结论合理用药健康教育干预显著提升了居民的知识水平,今后要继续加强健康教育干预,使居民形成合理用药的健康行为。     

广东省居民用药行为风险KAP调查及影响因素研究

目的 了解广东省居民在用药行为上存在的具体问题,分析影响安全用药知识、态度和行为的相关因素,为提高患者用药安全的各项措施提供依据。方法 采用线上问卷调查法,以电子问卷的形式对广东省居民进行调查,分析受访者接触药品及药品使用、用药行为、获得用药知识的途径、频率和对这些活动的态度。结果 共收集到有效问卷505份。问卷中关于药品使用知识的问题,受访者答题正确率在70%以上。不同受教育程度KAP得分比较差异具有统计学意义。工作状况和医疗保障情况对KAP得分影响最大。30.66%的居民表示从不接触用药知识讲座或用药活动,但78.14%的居民认为有必要或极有必要开展合理用药知识教育活动。结论 大部分广东省居民合理、安全用药意识较好,但在用药前的不良习惯较多,可能导致用药安全隐患。用药知识相关的活动普及度仍然不高,居民对于开展合理用药知识教育的需求迫切。     

农村社区不合理使用抗生素及激素的控制探索

农村不合理用药广泛存在，滥用抗生素、激素现象尤为突出。不合理使用抗生素及激素的原因有医源性因素和非医源性因素。探索控制不合理使用抗生素及激素的干预措施：针对社区居民用药存在的误区进行多种形式的健康教育及相关卫生知识咨询，改变社区居民用药习惯，提高居民主动拒绝不合理用药能力；培训卫生人员合理使用抗生素、激素等相关知识及常见疾病诊疗常规．并对社区用药进行督导，主动控制卫生人员不合理使用药物。通过1年的探索，用药情况得到改善，处方中不合理用药率由98.3％降低到38．1％。     

高校学生药品知识与用药行为调查

[目的]了解高校学生用药知识与行为现状,为进行有针对性的健康教育提供依据。[方法]采用自行设计的问卷,抽取非医学类在校大学生对用药知识与用药行为状况进行调查。[结果]高校学生对药物的合理应用认识不足,用药知识正确率61.6%,不良用药行为率52.9%。[结论]在高校学生中必须加强药物基本知识教育,改变大学生的不良用药习惯,保证其身心健康。     

促进合理用药及相关措施分析

目的:探讨促进合理用药研究进展与建议.方法:查阅相关资料、文献,对当前影响居民合理用药的因素进行总结.结果:现今社会不合理用药存在的原因,除去医疗机构外,最主要的就是自我治疗的患者逐年增多和患者药品知识欠缺.结论:促进合理用药,不仅要从医院的医疗工作人员、药店药师和营业员、药物生产方面下手,还需要改善患者的药物知识和用药习惯,全面了解患者用药习惯,建立研究患者用药行为和因素的机制;宣传普及医学知识、药物基本政策,提高居民合理用药的意识和药学知识;加强对药店的监督管理,提升药店营业员和执业医师的业务素质.     

2011年陕西省咸阳市城区居民用药知识和行为调查

目的调查咸阳市城区居民用药知识和行为,为开展居民合理用药行为干预提供基础资料。方法2011年3—5月,采用多阶段随机抽样方法,抽取18～60岁城区居民400名进行用药知识和行为问卷调查。结果城区居民12项用药知识总知晓率为48.8%。居民知晓抗生素的概念知晓率为68.8%;居民知晓滥用抗生素的后果为19.5%;居民知晓药品的概念及非处方药的概念分别为64%和28%;居民清楚孕妇使用四环素的危害为57.8%。居民有定期检查存放药品的习惯为39.5%;有正确选购药品和正确服用药物行为形成率分别为8.5%和21.4%。结论咸阳市城区居民用药知识欠缺,用药行为水平有待提高,应积极在该地区开展合理用药健康教育干预。     

珠海市社区老年人用药知识及行为调查

目的了解珠海市社区老年人安全用药知识掌握情况及用药行为现状。方法采用整群抽样方法抽取珠海市社区150名≥60岁老年人进行问卷调查，了解其疾病及用药情况，用药知识及用药行为。结果86．75％老年人正在使用药物，平均每人服用2．12种药物。对安全用药知识掌握较低的内容依次为注射用药不一定比口服用药更好、更安全49．28％，合用多种药物易发生不良反应61．59％；不良用药行为主要有用药前不太关心药物的不良反应76．09％，患病时多药并用69．57％，要求医生输液51．45％，病情好转时自行停药或减少药40．85％。结论社区老年人对用药安全的认识不足，存在一些不良用药行为。护士应利用各种机会为社区老年人提供相关信息并进行指导，同时帮助他们进行自我药物管理，使其更加规范、合理地用药。     

福州市居民用药安全知识态度及行为调查

目的了解福州市居民用药安全知识、态度及行为,为居民规范用药行为,降低不良用药行为风险提供参考。方法用《中国居民用药行为风险KAP调查问卷》,采用线上问卷答题方式进行调查。结果福州市大部分居民对药品使用持有良好的知识与态度,包括药物安全性/有效性、用药习惯和对保健品的认识、购药行为、药品存放、用药态度和服用方式等方面的知晓率大部分≥80%,但"查看包装上药品批准文号"的知晓率仅24.1%、"了解药品副作用及其表现"知晓率仅46.4%、"不将过期药品丢弃在垃圾箱"的知晓率仅37.3%,仍有部分居民的认识不全面,并体现于用药行为中,例如"查看包装上药品批准文号"知晓率仅24.1%;"不将过期药品丢弃在垃圾箱"的知晓率仅37.3%等。参加合理用药知识讲座或教育活动者很少,阅读宣传材料者相对偏多,认为开展合理用药教育活动"有必要/极有必要"者均≥65.4%。结论福州市居民对药品使用持有的知识与态度总体较好,但仍有错误的用药认识及用药行为。建议加强居民用药健康教育,采用通俗易懂、乐于接受的宣教方式,提高认识水平,以保障居民用药安全。     

呼和浩特市大学生用药常识及行为情况调查

目的 了解呼和浩特市大学生用药知识及用药行为情况,分析相关影响因素,为指导大学生合理用药提供依据。 方法 采用分层随机抽样方法抽取呼和浩特市高校的973名大学生为研究对象,利用自制调查问卷对研究对象进行问卷调查,以了解大学生用药知识及用药行为情况,分析影响用药知识及用药行为的相关因素。 结果 ⑴本研究选取大学生973人进行问卷调查,回收有效问卷896份,回收有效率为92.09%。对大学生用药知识进行调查发现,药品知识知晓情况良好(≥6分)者623人、占69.53%,不良者273人、占30.47%;⑵问卷中涉及药物知识的条目中,“中药无不良反应,可随意安全服用”答题正确率最高,85.04%;专业性较强的“口服可能引起过敏反应的药物(如青霉素类、头孢类)需做皮试”正确率最低,为30.03%;对药物知识的影响因素进行多因素logistics回归分析发现,专业(医学类)、家庭人均月可支配收入(≥4 000元)、家中是否有从医人员(是)是大学生用药知识知晓的保护性因素(P＜0.05)。⑶对大学生用药行为调查发现,大学生用药行为良好者(≥6分)为565人,占63.06%,不良者331人,占36.94%。药物行为的条目中,“口服药物服用时是否用茶水、汽水、酒等代替温开水或干吞”答题正确率最高,92.97%;但是“每日3次服药时间是否等于3次就餐时间”正确率为31.03%。对药物行为的影响因素进行多因素logistics回归分析发现,家中是否有从医人员(是)、家中是否有长期(六个月及以上)服药经历的成员(是)是大学生用药行为的保护或促进因素(P＜0.05)。 结论 大学生用药知识及用药行为受多种因素的影响,学校应加强合理、正确、安全用药管理,加强对大学生用药的健康教育,以改变不良的用药行为,合理规范用药。     

Effects of the Medicare Part D Comprehensive Medication Review on Racial and Ethnic Disparities in Medication Adherence

BackgroundSubstantial research has documented inequalities between US minorities and whites in meeting the eligibility criteria for the Medicare Part D medication therapy management (MTM) program. Even though the Centers for Medicare & Medicaid Services attempted to relax the eligibility criteria, a critical barrier to effective MTM reform is a lack of stronger evidence about the effects of MTM on minorities'' health outcomes.ObjectiveTo examine the effects of comprehensive medication review (CMR), an MTM core component, on racial and ethnic disparities in adherence to diabetes, hypertension, and hyperlipidemia medications among Medicare beneficiaries aged ≥65 years.MethodsThis study used full-year 2017 Medicare Parts A, B, and D claims data, including MTM data, linked to the Area Health Resources Files. Racial and ethnic disparities in nonadherence to diabetes, hypertension, and hyperlipidemia medications were compared between CMR recipients and nonrecipients matched by their propensity scores. To determine the changes in racial and ethnic disparities after receiving CMR, a difference-in-differences framework was applied, by including in logistic regression analyses interaction terms between dummy variables for CMR receipt and each racial or ethnic minority group.ResultsCompared with CMR nonrecipients, CMR recipients had significantly lower racial and ethnic disparities across the 3 outcome measures, with the exception of the difference between whites and blacks in nonadherence to diabetes medications. For example, compared with CMR nonrecipients, among CMR recipients the differences in the odds of nonadherence to hypertension medications were reduced, respectively, by 8% (95% confidence interval [CI], 0.88–0.96) between whites and blacks; by 18% (95% CI, 0.78–0.86) between whites and Hispanics; by 16% (95% CI, 0.77–0.91) between whites and Asians; and by 9% (95% CI, 0.85–0.98) between whites and other racial and ethnic groups.ConclusionReceiving a CMR reduced the racial and ethnic disparities in adherence to diabetes, hypertension, and hyperlipidemia medications among Medicare beneficiaries aged ≥65 years. These findings provide critical empirical evidence that may inform the future design of the Medicare Part D MTM program, which is valuable for improving pharmacotherapy outcomes and could further realize its potential when additional people from racial and ethnic minorities are enrolled.     

某医院2019—2020年门诊口服抗高血压用药500例处方合理性分析

目的 分析某医院2019—2020年500例门诊口服抗高血压药使用合理性,为更安全有效地使用抗高血压药提供参考。方法 收集500例门诊抗高血压用药处方,从药物品种选择、药物经济学、联合用药等方面进行合理性评价。结果 药品品种选择以CCB、ARB及其复方制剂为主,氨氯地平的使用频度最高,品种和WHO推荐及相关研究相符;DDDs排名前10位的药物DUI均处于0.9～1.0,药品用量基本合理且相对稳定;合理性点评中发现不合理处方28份（占总处方比例的5.60%）,最主要的不合理类型为联合用药不适宜,共12例（占比42.86%）;联合用药处方占比偏高（占比89.00%）,联合用药中以二联用药为主（占比64.27%）,以CCB联合ACEI/ARB为主,较为合理。结论本院门诊口服抗高血压药处方较为规范,但仍存在不合理之处,尤其是联合用药占比较高。抗高血压药物的临床使用应遵循个体化原则,药师需要加强处方审核和临床宣教,进一步提高医院合理用药水平。     

Costs of Medication Nonadherence in Patients with Diabetes Mellitus: A Systematic Review and Critical Analysis of the Literature

Objectives:  Information on the health care costs associated with nonadherence to treatments for diabetes is both limited and inconsistent. We reviewed and critically appraised the literature to identify the main methodological issues that might explain differences among reports in the relationship of nonadherence and costs in patients with diabetes.
Methods:  Two investigators reviewed Medline, EMBASE, Cochrane library and CINAHL and studies with information on costs by level of adherence in patients with diabetes published between January 1, 1997 and September 30th 2007 were included.
Results:  A total of 209 studies were identified and ten fulfilled the inclusion criteria. All included studies analyzed claims data and 70% were based on non-Medicaid and non-Medicare databases. Low medication possession ratios were associated with higher costs. Important differences were found in the ICD-9/ICD-9 CM codes used to identify patients and their diagnoses, data sources, analytic window period, definitions of adherence measures, skewness in cost data and associated statistical issues, adjustment of costs for inflation, adjustment for confounders, clinical outcomes and costs.
Conclusions:  Important variation among cost estimates was evident, even within studies of the same population. Readers should be cautious when comparing estimated coefficients from various studies because methodological issues might explain differences in the results of costs of nonadherence in diabetes. This is particularly important when estimates are used as inputs to pharmacoeconomic models.     

对499张麻醉药品处方的用药分析

评估基层医院近3年麻醉药品应用状况，为合理用药提供参考。方法：调用某医院2011年1月~2013年12月麻醉药品处方499张，从药品用量、用药频度（DDDs）、临床用途进行统计分析。结果：硫酸吗啡缓释片处方最多，DDDs最高，用药金额最大；哌替啶制剂在癌性疼痛治疗中占有较大比例，有待改进。结论：基层医院麻醉药品管理仍需加强。     

Discontinuation of Antidepressant Medication Among Latinos in the USA

Despite recent growth in the variety of antidepressant medications available, many patients discontinue medication prematurely for reasons such as nonresponse, side effects, stigma, and miscommunication. Some analysts have suggested that Latinos may have higher antidepressant discontinuation rates than other US residents. This paper examines Latino antidepressant discontinuation, using data from a national probability survey of Latinos in the USA. In this sample, 8% of Latinos had taken an antidepressant in the preceding 12 months. Among those users, 33.3% had discontinued taking antidepressants at the time of interview, and 18.9% had done so without prior input from their physician. Even controlling for clinical and other variables, patients who reported good or excellent English proficiency were less likely to stop at all. Patients were also less likely to stop if they were older, married, had public or private insurance, or had made eight or more visits to a nonmedical therapist.     

上海市卢湾区居民安全用药知识与行为调查

目的了解上海市卢湾区居民安全用药知识与行为的现状,为下一步开展干预提供参考。方法采用横断面研究设计,通过方便抽样,在卢湾区72个居委中各抽取8人作为调查对象。采用自制的"卢湾区居民安全用药知识与行为调查问卷"进行面对面调查,调查内容包括人口学特征、安全用药知识及药物使用行为等。结果调查对象对儿童药物用量、生病了应尽量打针、吃过保健品可以减少药物的用量、抗生素的合理用法、"OTC"的含义等问题的回答正确率分别为42.2%、64.1%、75.2%、68.2%和38.1%;女性回答的正确率高于男性;文化程度较高的调查对象回答情况较好;医生的建议或推荐仍然是调查对象选择药物的主要途径;药店和医院是调查对象购买药物的主要场所,年龄较大的调查对象更容易接受医生的建议及在医院购买药物;89.6%的调查对象家中备有一些常用药物;59.6%的调查对象会遵从医嘱服用药物;44.7%的调查对象会将过期药物随意丢弃。结论卢湾区居民安全用药知识匮乏,安全意识淡漠,还存在一些不良用药行为,应加大安全用药知识的宣传,减少药物不良反应情况的发生。     

The “Sandwich Mom”: In the Throes of a Medication Safety “Perfect Storm”

America is entering into a proverbial “perfect storm” of medication errors. Medications are more complex and their use is increasing, consumers are more involved in their healthcare decisions, and the population is aging and with it comes diminished cognitive skills. “Sandwich moms” are likely to bear the brunt of the ravages of this storm. These are the women who serve multiple roles as caregivers for their children, spouses, and, increasingly, their parents. This study explores how concerned these caregivers are about potential harm from medication use and how likely they would be to become more involved in medication management activities.     

A survey of herbal and alternative medication use among participants with eating disorder symptoms

OBJECTIVE: The purpose of this survey was to collect data on herbal use in participants with eating disorder symptoms. METHOD: A survey was administered to 100 participants who had either sought treatment at the Eating Disorder Institute (EDI) or had been enrolled in previous research as the result of eating disorder symptoms. RESULTS: Of the 100 participants, 64% used an herbal product for weight loss. The mean monthly expenditure on herbs over the past year was 33.88 dollars +/- 41.10 dollars, with a range of 2 dollars-200 dollars. Dexatrim (Chattem, Chattanooga, TN; N = 27) and St. John's Wort (N = 19) had the highest reported use. Magazines were the most common source of product information (38.3%), with health care professionals being reported less frequently as the source of information. Knowledge of ephedra-related adverse effects was variable, and depended on a previous history of use. The majority (62.3%) of herb users reported an adverse effect. CONCLUSION: Herbal use is frequent among those with eating disorder symptoms, often resulting in substantial financial cost. Health professionals are rarely the source of herbal information. Therefore, there is ample room for educational interventions, which may result in the safer use of herbal products.     

利用信息化手段加强静脉药物合理用药的管理

分析了临床合理用药的重要性,提出了临床合理用药的方法和措施,着重介绍了静脉注射剂体外配伍合理性的审查管理,并对其意义作了充分的阐述.