Controlling financial variables--changing prescribing patterns

Techniques of formulary management, pharmacy and therapeutics committee intervention, and the use of clinical pharmacy services to change prescribing patterns and contain costs in hospital pharmacy departments are reviewed. Methods of using the formulary to contain costs include deletion of generic and therapeutic equivalents, inclusion of therapeutic categories and cost codes, and regular reviews and updates of its contents. Drug monographs for formulary evaluation prepared for the P & T committee should include a comparative review of other drugs in the therapeutic category and a cost impact statement. The P & T committee can help contain costs by developing policies for automatic stop orders and restricted drug use. Clinical pharmacy activities that can result in cost savings include physician education (focused on prescribing), target drug programs, target disease programs, pharmacist participation on TPN and i.v. therapy teams, and patient training programs for home care. A matrix for evaluating cost-containment activities is presented. By tailoring the described methods to departmental personnel resources and hospital needs, the pharmacy can be effective in controlling costs.     

2007—2009年口服非甾体抗炎药应用分析

目的:总结非甾体抗炎药(NSAID)的临床应用特点,分析用药趋势和合理性。方法:统计2007—2009年门、急诊药房所使用的口服NSAID的品种、数量、消耗金额,分析比较用药频度(DDDs)、日均费用(DDC),分析用药特点和趋势;抽取某月门、急诊处方中的NSAID处方,计算药物利用指数(DUI),分析用药的合理性。结果:我院口服NSAID年用药金额逐年增长,用药频度最高的是高选择性环氧化酶-2(COX-2)抑制剂尼美舒利分散片,居第2位和第3位的是布洛芬缓释胶囊和双氯芬酸钠双释放肠溶胶囊;NSAID处方分析提示本院常用NSAID品种临床使用中存在不合理情况。结论:我院NSAID用药趋势正向着高效、低毒、新剂型、新品种方向发展,但临床要加强NSAID的合理应用。     

Analysis of the costs of NSAID-associated gastropathy. Experience in a US health maintenance organisation

Clinicians recognise nonsteroidal anti-inflammatory drugs (NSAIDs) as valuable first-line agents in the treatment of rheumatic disorders and as dangerous irritants to the gastrointestinal tract. This has led to questions about the economic impact of NSAID-induced gastropathy in populations. This study estimated the 1992 costs of NSAID-associated gastropathy episodes, and calculated an iatrogenic cost factor for NSAID-associated gastropathy among elderly members of a health maintenance organisation (HMO), the Northwest Region of Kaiser Permanente. Using data retrieved from automated databases and from medical records, NSAID and antiulcer drug costs were calculated, and estimates were made of the incidence rates of inpatient and outpatient NSAID-associated gastropathies, the services provided to treat them, and the cost of those services. Kaiser Permanente Northwest spent $US0.35 for each $US1.00 spent on NSAID therapy for the elderly, an iatrogenic cost factor of 1.35. The estimated average treatment per NSAID-associated gastropathy episode was $US2172. The average outpatient pharmacy cost per elderly NSAID user was $US80 and estimated average NSAID-associated treatment cost per elderly NSAID user was $US43. Although the findings were specific to the HMO because of the databases used, the methodology employed and the drug formulary influence on NSAID selection, they show that a substantial amount of resources were used to treat NSAID-induced gastropathies in the elderly, underscoring the risk of prescribing NSAIDs and reinforcing the need for their prudent use in elderly patients.     

门诊处方不合理用药调查结果分析及措施

目的：探讨医院门诊处方不合理用药的调查情况,并研究具体的措施加以干预。方法：我院临床药学组将我院2013年7月～2015年12月共28个月每月随机抽取的门诊处方150张共4200张作为本次研究对象。按处方点评根据药物选择不合理、用药方式选择不恰当、药物配伍以及联用不合理、药物未合理使用、出现滥用药物的情况以及药物使用剂量不当等展开统计分析。结果：经过统计分析发现,在所有应用处方中,不合理用药处方共包括136张,占3.23%;其中药物滥用21例,用药剂量不正确14例,配伍以及联用药物不合理50例,药物使用方法不合理15例,用药方式选择不当11例,选择药物不合理16例,药物应用时间不正确13例。结论：我院门诊处方还存在不合理用药情况,建议医务科、质控科、临床药学室要针对不合理用药情况进行分析,选择有效方法针对性干预,提高临床用药的合理性,对患者的利益进行有效保护。     

Microcost analysis of inpatient dispensing and administration of oral solids

The labor cost of dispensing, administering, and monitoring unit dose oral solid dosage forms (UDs) in a large teaching hospital was determined by microcost analysis. The costs associated with UDs dispensed by the midnight central pharmacy and by a satellite pharmacy were evaluated by use of both work-sampling and time-and-motion studies. Pharmacy personnel activities were classified as direct, auxiliary, or nonproductive. A nursing productivity index was used to determine the nursing time consumed in the administration and monitoring of UDs. The pharmacy labor cost was lowest ($0.14 each) for UDs dispensed from the central pharmacy in the 24-hour medication cart. For each UD that was not dispensed in the 24-hour cart, the labor cost was $0.25 for the central pharmacy and $1.37 for the satellite pharmacy. It took nurses 223.8 sec to administer and monitor a scheduled UD, for a cost of $0.82. The total nursing time spent per nonscheduled UD for administration and monitoring was 574.2 sec; the cost was $2.11. Microcost analysis can be used to isolate the costs of dispensing oral solids in an inpatient setting.     

对49328张处方中不合理用药处方分析及措施

目的对门诊不合理用药情况进行分析。方法对我院2010年9月-2011年2月49 328张门诊处方中的不合理用药处方进行分析。结果不合理用药处方占所审核处方的8.6%;不合理用药主要体现在自然项目、皮试、用法用量、相互作用、诊断与用药不符等方面。结论应针对存在的问题制定相应对策,如:加强处方电子系统的及时更新和监管,定期把处方点评的结果反馈给临床医师,培养医务工作者的细致工作作风等。门诊药师加强处方审核有助于提升合理用药水平。