Schwartzberg E, Rubinovich S, Hassin D, Haspel J, Ben-Moshe A, Oren M, Shani S
Department of Pharmacy, Hillel Yaffe Medical Centre, Hadera, Israel.
J Clin Pharm Ther. 2006 Apr;31(2):179-85. doi: 10.1111/j.1365-2710.2006.00724.x.
Budgetary constraints led the Israeli Hillel Yaffe Medical Center management to implement policies for reducing expenditure while maintaining the quality of care. For this purpose, the pharmacy services management developed and implemented a three-tier intervention feedback model for changing physicians' prescribing habits, and achieving cost-effective changes in antibiotic utilization.
A prospective drug utilization evaluation was conducted to profile antibiotic utilization. The results established a base from which a three-tier feedback, evidence-based intervention model was built. This model corresponds to the following three hierarchical levels: Level 1 activities involved management actions that influenced all levels of staff and concentrated mainly on the creation of guidelines. Level 2 activities involved the reorganization of the restricted antibiotics prescription authorization system, through the co-operation of the clinical pharmacy unit and the hospital infection control specialist. Level 3 focussed on clinical pharmacist activities on the wards. The model was implemented and assessed in the hospital from June 2002 until December 2004.
Implementation of the model resulted in a cumulative decrease of 6,473 i.v. antibiotics daily defined doses (DDDs) and a parallel increase in total oral antibiotic DDDs (Table 1). These changes were especially notable with high-bioavailability antibiotics and co-amoxiclav, where over 2.5 years there was a reduction of 2,472 and 4,752 i.v. DDDs, respectively (P < 0.000). The successful implementation of the model resulted in a reduction of 375,000 NIS ( approximately 66,190 euro) in pharmacy antibiotic costs, equivalent to 10 i.v. DDDs or 570 NIS ( approximately 102 euro) saved per clinical pharmacist working day.
Our study demonstrates the successful implementation of a three-tier model for changing physicians' antibiotic prescribing.
预算限制促使以色列希勒尔·亚菲医疗中心管理层实施相关政策，在维持医疗质量的同时减少开支。为此，药房服务管理部门制定并实施了一个三层干预反馈模型，以改变医生的处方习惯，并在抗生素使用方面实现具有成本效益的变化。
进行了一项前瞻性药物利用评估，以剖析抗生素的使用情况。评估结果为构建一个基于证据的三层反馈干预模型奠定了基础。该模型对应以下三个层次级别：一级活动涉及影响各级员工的管理行动，主要集中在制定指南方面。二级活动涉及通过临床药学部门与医院感染控制专家的合作，对受限抗生素处方授权系统进行重组。三级活动侧重于临床药师在病房的工作。该模型于2002年6月至2004年12月在医院实施并进行评估。
该模型的实施使静脉注射抗生素每日限定剂量（DDD）累计减少了6473个，同时口服抗生素总DDD平行增加（表1）。这些变化在高生物利用度抗生素和阿莫西林克拉维酸钾方面尤为显著，在超过2.5年的时间里，静脉注射DDD分别减少了2472个和4752个（P < 0.000）。该模型的成功实施使药房抗生素成本降低了375,000新谢克尔（约合66,190欧元）相当于每个临床药师工作日节省10个静脉注射DDD或570新谢克尔（约合102欧元）。
我们的研究表明，用于改变医生抗生素处方的三层模型得到了成功实施。
