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医药导报  2019, Vol. 38 Issue (6): 792-796    DOI: 10.3870/j.issn.1004-0781.2019.06.024
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床药师干预心内科质子泵抑制药合理应用的工作模式和效果
张新茹(),谢莉娜,王冬雪,侯继秋,付秀娟()
吉林大学第二医院药学部,长春 130041
Work Model and Effect of Clinical Pharmacist Intervention in the Rational Application of Proton Pump Inhibitor in Cardiology
Xinru ZHANG(),Lina XIE,Dongxue WANG,Jiqiu HOU,Xiujuan FU()
Department of Pharmacy, the Second Hospital of Jilin University, Changchun 130041, China
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摘要 

目的 通过对比干预前后心内科质子泵抑制药(PPI)的应用情况,促进其合理应用并为药事管理提供参考。方法 通过制定合理用药评价标准、开展合理用药培训、点评沟通和行政干预等手段对心内科PPI不合理使用情况进行干预。对比研究干预前后心内科PPI的用药人次、销售金额、使用率和药占比等总体用药情况,并随机抽取干预前后使用注射用PPI的住院患者病历各150份,进行合理性分析。结果 干预前,心内科 PPI的用药2171例次,干预后为1780例次,下降率为18.01%,销售金额干预前为91.39万元,干预后为55.87万元,下降率达38.87%。干预后PPI使用率明显下降(P=0.000),下降率为23.57%。PPI药占比也较干预前明显降低(P=0.000),下降率高达51.12%。干预后,无指征使用注射用PPI的病例所占比例明显减少(P=0.001),由干预前的17.33%降低至5.33%。预防使用注射用PPI的用药指征把握更为严格(P<0.05),超剂量用药情况明显减少(P=0.000),溶媒选择不当和药物相互作用的情况完全消失,用药合理性明显改善。结论 临床药师的药学干预有效促进心内科PPI 的合理使用,其干预方式可以用于其他药品的专项管理。

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张新茹
谢莉娜
王冬雪
侯继秋
付秀娟
关键词 临床药师质子泵抑制药干预效果评价    
Abstract

Objective To promote its rational application and provide reference for drug administration by comparing the application of proton pump inhibitors before and after intervention. Methods The unreasonable use of proton pump inhibitors in the department of cardiology was intervened through the development of evaluation criteria for rational drug use, training on rational drug use, comments and communication.and administrative intervention.The total medication use of PPI in cardiology department before and after intervention was compared, including sales amount, utilization rate and drug proportion. 150 cases of hospitalized patients using PPI injection before and after the intervention were randomly selected for rationality analysis. Results Before the intervention, the number of patients with PPI was 2171, it was 1780 after intervention, the decrease rate was 18.01%; The sales amount was changed from 0.9139 million to 0.5587 million, the decline rate was 38.87%.After intervention, the utilization rate of PPI decreased significantly, by 23.57% (P=0.000), and the proportion of PPI drugs was significantly lower than before, too, the decline rate was as high as 51.12%(P=0.000).The proportion of patients who did not have indication of PPI injection was significantly reduced from 17.33% to 5.33%(P=0.001).Prevention using PPI medication indications grasp tighter (P<0.05), and the situation of overdose medication was significantly reduced (P=0.000), the situation of improper drug selection and drug interaction disappeared completely, and the rationality of medication was significantly improved. Conclusion The pharmaceutical intervention of clinical pharmacists can effectively promote the rational use of PPI in cardiology department, and the intervention mode can be used for the special management of other drugs.

Key wordsClinical pharmacist    Proton pump inhibitors    Evaluation of intervention effect
收稿日期: 2018-04-24      出版日期: 2019-06-11
引用本文:   
张新茹,谢莉娜,王冬雪,侯继秋,付秀娟. 床药师干预心内科质子泵抑制药合理应用的工作模式和效果[J]. 医药导报, 2019, 38(6): 792-796.
Xinru ZHANG,Lina XIE,Dongxue WANG,Jiqiu HOU,Xiujuan FU. Work Model and Effect of Clinical Pharmacist Intervention in the Rational Application of Proton Pump Inhibitor in Cardiology. Herald of Medicine, 2019, 38(6): 792-796.
链接本文:  
http://www.yydbzz.com/CN/10.3870/j.issn.1004-0781.2019.06.024      或      http://www.yydbzz.com/CN/Y2019/V38/I6/792
组别 总出院
例次
药品销售
总金额/万元
PPI用药
例次
PPI销售
金额/万元
PPI使用率 PPI药占比
%
干预前 4935 2551.70 2171 91.39 43.99 3.58
干预后 5295 3189.27 1780 55.87 33.62 1.75
表1  干预前后总体使用情况比较
组别 注射剂型 口服剂型
用药
例次
使用率/
%
用药
例次
使用率/
%
干预前 1927 39.05 244 4.94
干预后 1393 26.31 387 7.31
表2  干预前后剂型变化比较
用药指征 干预前(n=150) 干预后(n=150) χ2 P
% %
治疗用药 14 9.33 16 10.67 0.15 0.700
预防用药
3个以上危险因素 22 14.67 38 25.33 5.33 0.021
2个危险因素 41 27.33 57 38.00 3.88 0.049
1个危险因素 47 31.33 31 20.67 4.44 0.035
无用药指征 26 17.33 8 5.33 10.75 0.001
表3  干预前后用药指征比较
不合理类型 干预前
(n=150)
干预后
(n=150)
χ2 P
% %
超剂量用药 37 24.67 5 3.33 28.35 0.000
溶媒选择不当 12 8.00 0 0 12.500 0.000
药物相互作用 5 3.33 0 0 5.085 0.024
表4  干预前后不合理用药情况比较
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