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前瞻性处方审核系统促进手术患者镇痛药安全使用、改善临床结局并节省医疗费用：来自南京鼓楼医院的经验。

Prospective Prescription Review System Promotes Safe Use of Analgesics, Improves Clinical Outcomes, and Saves Medical Costs in Surgical Patients: Insights from Nanjing Drum Tower Hospital.

机构信息

Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.

State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Taipa, Macau.

出版信息

Adv Ther. 2022 Jan;39(1):441-454. doi: 10.1007/s12325-021-01935-z. Epub 2021 Nov 13.

DOI:10.1007/s12325-021-01935-z

PMID:34773208

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8799563/

Abstract

INTRODUCTION

The rate of awareness of prospective prescription review for inpatient prescriptions remains low, and no study has evaluated prospective prescription review systems among hospitalized patients. In this study we evaluate the effect of a prospective prescription review system on the use of analgesics, clinical outcomes, and medical costs in hospitalized patients who underwent surgery.

METHODS

A single-center, real-world study was conducted retrospectively at Drum Tower Hospital, Nanjing, China. Patient data were extracted from the medical records, before (June 2016-May 2017) and after (June 2018-May 2019) prescription review system implementation. The primary outcome was proportion of prescriptions of analgesics with potential risks. The secondary outcomes included prescription of opioids or non-opioids, usage of medications to manage analgesics-related adverse events, clinical outcomes, and medical costs. Propensity score matching was used to balance the cohort of patients before and after implementation of the prescription review system.

RESULTS

A total of 28,150 inpatients were included for study analysis. After implementation of the prescription review system, the proportion of prescriptions of analgesics with potential risk was significantly reduced (6.3% vs 26.1%, P < 0.05). A significant decrease was observed in the proportion of patients prescribed opioids (24.3% vs 27.5%, P < 0.001) and tramadol (4.7% vs 12.1%, P < 0.001). There was a significant decrease in prescription of antiemetics (21.8% vs 34.1%, P < 0.001) and cathartics (38.4% vs 50.6%, P < 0.001) which were used in the management of opioid-related adverse events. There was a decreased length of stay in hospital [median (Q1, Q3) 10 (6, 17) vs 11 (7, 18), P < 0.01)] with similar readmission rates within 30 days post discharge (1.0% vs 0.8%, P = 0.099).

CONCLUSIONS

The introduction of the prescription review system was associated with safer prescribing, including a reduction in prescriptions of analgesics with potential risk and necessity of medication to manage analgesics-related adverse events, which resulted in better clinical outcomes and cost saving.

摘要

简介

患者对住院处方的前瞻性处方审核意识仍然较低，尚无研究评估住院患者的前瞻性处方审核系统。在这项研究中，我们评估了前瞻性处方审核系统对接受手术的住院患者使用镇痛药、临床结局和医疗费用的影响。

方法

这是一项在中国南京鼓楼医院进行的单中心真实世界研究。从病历中提取患者数据，在实施处方审核系统之前（2016 年 6 月至 2017 年 5 月）和之后（2018 年 6 月至 2019 年 5 月）。主要结局是潜在风险的镇痛药处方比例。次要结局包括阿片类药物或非阿片类药物的处方、管理镇痛药相关不良事件的药物使用、临床结局和医疗费用。使用倾向评分匹配来平衡实施处方审核系统前后的患者队列。

结果

共纳入 28150 例住院患者进行研究分析。实施处方审核系统后，潜在风险的镇痛药处方比例显著降低（6.3%比 26.1%，P<0.05）。阿片类药物（24.3%比 27.5%，P<0.001）和曲马多（4.7%比 12.1%，P<0.001）的处方比例也显著下降。止吐药（21.8%比 34.1%，P<0.001）和泻药（38.4%比 50.6%，P<0.001）的处方比例也显著下降，这些药物用于管理阿片类药物相关不良事件。住院时间缩短[中位数（Q1，Q3）10（6，17）比 11（7，18），P<0.01]，出院后 30 天内再入院率相似（1.0%比 0.8%，P=0.099）。