多策略方法对卡塔尔一所教学医院抑酸药物使用的影响。

Impact of multi-approach strategy on acid suppressive medication use in a teaching hospital in Qatar.

机构信息

Department of Clinical Pharmacy, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.

出版信息

Int J Clin Pharm. 2011 Oct;33(5):763-71. doi: 10.1007/s11096-011-9531-0. Epub 2011 Jul 2.

DOI:10.1007/s11096-011-9531-0

PMID:21725628

Abstract

OBJECTIVE

To evaluate the impact of a multi-approach strategy to improve the appropriate usage of acid suppressive medication (ASM) in medical inpatients and compare it with the baseline data from 2007.

SETTING

Five general medicine wards in a 600-bed teaching hospital in Doha, Qatar.

METHOD

A prospective evaluation of the usage of ASM 1 year after a multi-approach strategy. This consisted of four main interventions: audit and feedback method (including awareness lectures to all medical and pharmacy staff), implementation of a usage guideline for medical inpatients, circulating a logarithmic chart on the proper usage of ASM for medical inpatients from admission through to discharge and participation of clinical pharmacists in the multidisciplinary rounds. All medical patients admitted from May through June 2009 were evaluated. Data about the usage of ASM were collected upon and during admission, at discharge and at the next follow-up visit. Justified indications for its usage were based on the approved product information and on evidence-based literature recommendations. Data were compared with the findings of the baseline clinical audit done 2 years earlier.

MAIN OUTCOME MEASURE

The usage of ASM in justified and non-justified indications upon and during admission, at discharge and at the next follow up visit.

RESULTS

A total of 414 patients were admitted during the study period, 208 patients (50%) received ASM compared to 53% in 2007 (206 patients out of 389). Seventy-four patients (36%) were using ASM upon admission compared to 48 patients (23%) in the 2007 clinical audit. Inappropriate ASM use decreased with 51% during admission (66 to 32%, P < 0.0001), 62% at discharge (34 to 13%, P < 0.0001) and 67% at the next follow up visit (15 to 5%, P = 0.0008).

CONCLUSION

Despite the higher number of patients receiving ASM upon admission, the multi-approach strategy used in our institution resulted in a significant improvement in the appropriate usage of ASM in medical inpatients.

摘要

目的

评估多途径策略对改善住院患者酸抑制药物（ASM）合理使用的影响，并与 2007 年的基线数据进行比较。

地点

卡塔尔多哈一家 600 床位教学医院的 5 个普通内科病房。

方法

在多途径策略实施 1 年后，对 ASM 的使用情况进行前瞻性评估。这包括四项主要干预措施：审核和反馈方法（包括向所有医疗和药剂师人员开展意识讲座）、为住院患者制定 ASM 使用指南、为住院患者从入院到出院期间的 ASM 合理使用情况发布对数图表、以及临床药师参与多学科查房。评估 2009 年 5 月至 6 月期间入院的所有内科患者。入院时、入院期间、出院时和下次随访时收集有关 ASM 使用的数据。其合理使用的适应证依据已批准的产品信息和循证文献推荐确定。将数据与 2 年前进行的基线临床审核结果进行比较。

主要观察指标

合理和不合理适应证下入院时、入院期间、出院时和下次随访时 ASM 的使用情况。

结果

研究期间共收治 414 例患者，其中 208 例（50%）接受了 ASM 治疗，而 2007 年的 389 例患者中有 206 例（53%）接受了 ASM 治疗。入院时，74 例（36%）患者正在使用 ASM，而 2007 年临床审核中，48 例（23%）患者正在使用 ASM。入院期间，不适当的 ASM 使用率下降了 51%（66 例降至 32%，P<0.0001），出院时下降了 62%（34 例降至 13%，P<0.0001），下次随访时下降了 67%（15 例降至 5%，P=0.0008）。