Villalobos J L, Tutau F, Mora R, Mazure R, Mínguez A, Rodríguez F, García-Coronel M
Servicio de Farmacia Hospitalaria, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España.
Nutr Hosp. 2000 Mar-Apr;15(2):71-8.
In order to improve the quality of prescription and reduce expenditure, the artificial nutrition department has designed a new usage protocol: justification sheet, table of indications for parenteral nutrition (PN), nutritional assessment, etc. The Pharmacy Department is in charge of the follow-up of this programme and maintaining the database derived from it. Comparing the data for the year before (1996) and after (1998) implementation of this programme, we can see that as a result 9 patients/day switched from total parenteral nutrition by central administration to hypocaloric peripheral nutrition, with the prevalence of the former dropping to 1.4% of admissions and 2% of stays. The share of enteral nutrition (30.6%) and hypocaloric peripheral nutrition (27.8%) increases in the overall expenditure on artificial nutrition, with a reduction in the total parenteral nutrition (41.6%). The costs of parenteral nutrition per admission and stay are reduced by 39.3% and 33.5%, respectively, to 1,625 and 183 pesetas. This represents a saving of 16.5 million pesetas. The expenditure on PN elements declines by two percentage points to 2.2% of pharmaceutical expenditure. As an additional benefit, it is possible to identify each of the clinical situations which give rise to this indication and to allocate costs by diagnosis and department. Together with the containment of expenditure, it has been possible to increase the participation of everyone in the rational use of clinical nutrition thus highlighting its interdisciplinary nature.
为了提高处方质量并降低费用，人工营养科设计了一种新的使用方案：审批单、肠外营养（PN）适应证表、营养评估等。药剂科负责该方案的跟进并维护由此产生的数据库。对比该方案实施前（1996年）和实施后（1998年）的数据，我们可以看到，结果是每天有9名患者从中心静脉全胃肠外营养转为低热量外周营养，前者的发生率降至入院患者的1.4%和住院患者的2%。肠内营养（30.6%）和低热量外周营养（27.8%）在人工营养总费用中的占比增加，而全胃肠外营养（41.6%）的占比降低。每次入院和住院的肠外营养费用分别降低了39.3%和33.5%，降至1625比塞塔和183比塞塔。这意味着节省了1650万比塞塔。PN成分的费用在药品费用中的占比下降了两个百分点，降至2.2%。另外一个好处是，可以确定每种导致该适应证的临床情况，并按诊断和科室分配费用。在控制费用的同时，还能够提高每个人对合理使用临床营养的参与度，从而凸显其跨学科性质。
