基本药物制度对宁夏基层医疗卫生机构门诊处方合理用药的影响

目的通过对宁夏乡镇卫生院的处方抽样,分析国家基本药物制度实施前后乡镇卫生院门诊合理用药的变化情况。方法结合世界卫生组织推荐的合理用药指标,对医改前后宁夏地区医疗机构门诊患者用药情况进行回顾性调查和研究。结果 2009、2010和2011年单处方平均用药种数分别为3.23种、3.12种和3.15种;含抗生素的门诊处方数分别为549张、736张和601张。各占当年处方总数的比例为53.1%、60.4%和54.2%;含注射剂的门诊处方数分剐为293张、341张和248张,各占当年处方总数的比例为28.3%、28.0%和22.4%;使用激素的门诊处方数分别为17、28和21张。结论基本药物制度对基层医疗卫生机构合理用药有促进作用,但抗生素、注射剂的使用情况仍待改善。政府应加强对抗生素和注射剂的监管力度,以提高其合理用药程度。     

A comparison of the home‐care and healthcare service use and costs of older Australians randomised to receive a restorative or a conventional home‐care service

Restorative home‐care services, or re‐ablement home‐care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home‐care services had only been investigated in terms of singular outcomes such as length of home‐care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure – the use and cost of the home‐care and healthcare services received over the 2‐year period following service commencement. Seven hundred and fifty older individuals referred for government‐funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home‐care hours (mean [SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home‐care costs (AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care (N [%], 171 [55.2] vs. 249 [63.0]) during follow‐up. They were also less likely to have presented at an emergency department (OR = 0.69, 95% CI = 0.50–0.94) or have had an unplanned hospital admission [OR (95% CI), 0.69 (0.50–0.95)]. Additionally, the aggregated health and home‐care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72–0.96) over the 2‐year follow‐up (AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost‐effective option than providing conventional home care.     

A review of the factors associated with the non‐use of respite services by carers of people with dementia: implications for policy and practice

The use of respite services by carers has been shown to extend the length of time people with dementia can remain living in the community with family support. However, the use of respite services by informal carers of people with dementia is often low and does not appear to match carer need. To better understand how to address carers' unmet need for respite, the factors that impede respite service use must be identified. To achieve this, a narrative synthesis of published academic literature (1990–2011) was undertaken regarding factors associated with not utilising different types of respite services utilising Anderson's Behavioural Model of Service Use. The review reinforces the importance of the assessment and matching of services to the needs of individual carers and care recipients at the local level. It also highlights the need to move beyond care pathways for individuals. To support respite use there is a need for local action to be augmented at a community or population level by strategies to address attitudinal and resource barriers that influence sub‐groups of the carer population who may be more vulnerable to service non‐use.     

浅谈医院常见不合理用药

目的：浅谈医院常见不合理用药。方法：分析临床查房中关于抗生素及部分辅助用药的不合理使用。结果：医院过多的好药新药使临床费用增加,病人负担骄加重。结论：减少药物滥用可以减轻病人负担。     

我院2009～2013年口服降糖药用药分析

目的分析我院2009～2013年近5年来降糖药用药情况,为临床合理用药提供参考。方法通过医院信息管理系统,对2009～2013年我院口服降糖药的销售金额、用药频度（DDDs）、日均费用（DDDc）等进行回顾性分析。结果我院近5年来口服降糖药销售金额排序前2位的是磺酰脲类、胰岛素增敏药;罗格列酮的销售金额始终位居第1位;DDDs值排名位居第1位的是二甲双胍,而DDC排名最低;其中瑞格列奈的用药金额排序和DDDs排序同步性较好。结论我院的口服降糖药使用基本合理,新药用量呈上升趋势,质优价廉的降糖药在临床应用中占优势。     

某三甲和二甲医院2012年门诊处方抗菌药物应用分析

目的对两家医院门诊处方抗菌药物应用情况进行统计分析,了解门诊患者抗菌药物应用情况,为规范抗菌药物合理应用提供依据。方法随机抽取2012年门诊处方各1200张,调查其用药情况。结果两家医院处方平均用药品种数分别为2．06种和1．94种,抗菌药物使用率分别为17．25％和11．42％,平均处方金额分别为184．60元和243．33元,平均抗菌药物处方金额为120．71元和188．92元,单用抗菌药物处方各占应用抗菌药物处方总数的96．78％和92．7％,联用抗菌药物处方各占应用抗菌药物处方总数的3．22％和7.3％。结论不同规模医院的抗菌药物指标差异较大,大医院处方平均金额、应用抗菌药物处方平均金额偏大,更应加强对抗菌药物应用的管理。     

Giving and receiving social support in online substance use disorder forums: How self-efficacy moderates effects on relapse

ObjectiveIndividuals in recovery for substance use disorders (SUDs) increasingly use online social support forums, necessitating research on how communicating through these forums can affect recovery. This study examines how giving and receiving support within an SUDs recovery forum predict substance use, and considers whether effects vary according to participants’ self-efficacy.MethodsWe applied content analysis to 3440 messages that were posted by 231 participants in an online SUDs forum. Surveys assessed social support reception and substance use at three timepoints. We assessed relationships between giving and receiving support and substance use (risky drinking days, illicit drug use days), and the interactions between self-efficacy and social support in predicting substance use outcomes.ResultsReceiving more emotional support was associated with reduced illicit drug use at 6 and 12 months. For those with low self-efficacy, giving more emotional support predicted less risky drinking at month 12, whereas giving more informational support predicted more risky drinking at month 12.ConclusionThese results suggest conditional benefits of exchanging support in an online SUDs forum, depending upon type of support (informational versus emotional), the participants’ role (giver or receiver), and their self-efficacy.Practice implicationsWe discuss implications for designing and using peer-to-peer support platforms.     

Fluoroquinolone use for uncomplicated urinary tract infections in women: a retrospective cohort study

ObjectivesThe United States Food & Drug Administration released an advisory in 2016 that fluoroquinolones be relegated to second-line agents for uncomplicated urinary tract infections (UTIs) given reports of rare but serious side effects; similar warnings have followed from Health Canada and the European Medicines Agency. The objective was to determine whether alternative non-fluoroquinolone agents are as effective as fluoroquinolones in the treatment of UTIs.MethodsWe conducted a retrospective population-based cohort study using administrative health data from six Canadian provinces. We identified women (n = 1 585 997) receiving antibiotic treatment for episodes of uncomplicated UTIs (n = 2 857 243) between January 1 2005 and December 31 2015. Clinical outcomes within 30 days from the initial antibiotic dispensation were compared among patients treated with a fluoroquinolone versus non-fluoroquinolone agents. High-dimensional propensity score adjustments were used to ensure comparable treatment groups and to minimize residual confounding.ResultsFluoroquinolone use for UTI declined over the study period in five of six Canadian provinces and accounted for 22.3–48.5% of treatments overall. The pooled effect across the provinces indicated that fluoroquinolones were associated with fewer return outpatient visits (OR 0.89, 95%CI 0.87–0.92), emergency department visits (OR 0.74, 95%CI 0.61–0.89), hospitalizations (OR 0.83, 95%CI 0.77–0.88), and repeat antibiotic dispensations (OR 0.77, 95%CI 0.75–0.80) within 30 days.ConclusionsFluoroquinolones are associated with improved clinical outcomes among women with uncomplicated UTIs. This benefit must be weighed against the risk of fluoroquinolone resistance and rare but serious fluoroquinolone side effects when selecting first-line treatment for these patients.     

Contrasting lexical similarity and formal definitions in SNOMED CT: Consistency and implications

ObjectiveTo quantify the presence of and evaluate an approach for detection of inconsistencies in the formal definitions of SNOMED CT (SCT) concepts utilizing a lexical method.Material and methodUtilizing SCT’s Procedure hierarchy, we algorithmically formulated similarity sets: groups of concepts with similar lexical structure of their fully specified name. We formulated five random samples, each with 50 similarity sets, based on the same parameter: number of parents, attributes, groups, all the former as well as a randomly selected control sample. All samples’ sets were reviewed for types of formal definition inconsistencies: hierarchical, attribute assignment, attribute target values, groups, and definitional.ResultsFor the Procedure hierarchy, 2111 similarity sets were formulated, covering 18.1% of eligible concepts. The evaluation revealed that 38 (Control) to 70% (Different relationships) of similarity sets within the samples exhibited significant inconsistencies. The rate of inconsistencies for the sample with different relationships was highly significant compared to Control, as well as the number of attribute assignment and hierarchical inconsistencies within their respective samples.Discussion and conclusionWhile, at this time of the HITECH initiative, the formal definitions of SCT are only a minor consideration, in the grand scheme of sophisticated, meaningful use of captured clinical data, they are essential. However, significant portion of the concepts in the most semantically complex hierarchy of SCT, the Procedure hierarchy, are modeled inconsistently in a manner that affects their computability. Lexical methods can efficiently identify such inconsistencies and possibly allow for their algorithmic resolution.