质子泵抑制剂管理委员会的多方面干预对门诊和急诊科酸抑制剂处方模式的影响。

Impact of proton pump inhibitor management committee's multifaceted interventions on acid suppressant prescribing patterns in outpatient and emergency departments.

机构信息

Department of Pharmacy, the Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, China.

School of Pharmacy, Southwest Medical University, No.1 Xianglin Street, Longmatan District, Luzhou, 646000, China.

出版信息

BMC Health Serv Res. 2022 Mar 29;22(1):417. doi: 10.1186/s12913-022-07820-x.

DOI:10.1186/s12913-022-07820-x

PMID:35351121

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8966235/

Abstract

BACKGROUND

A nationwide campaign for rational proton pump inhibitor (PPI) use launched in 2015 had a positive impact for hospitalized patients PPI use. But there were few studies focusing on the rational use of PPIs in outpatients. In 2018, the PPI management committee conducted a year-long intervention on the appropriate use of PPIs in outpatient and emergency departments, including clinical pharmacist interventions and stewardship interventions. The purpose of this study was to examine the impact of the PPI management committee's multifaceted interventions by comparing the real-world acid suppressant prescribing patterns for outpatients before (2017) and after intervention (2019) at a Chinese tertiary teaching hospital.

METHODS

Prescriptions containing any acid suppressant in outpatient and emergency departments in baseline (2017) and postintervention (2019) periods were extracted from the hospital information system and the prescription automatic screening system. Acid suppressant prescribing patterns were evaluated based on primary diagnoses and patient demographics. The prescribed acid suppressants stratified using age groups (< 7, 7-17, 18-45, 46-65, 66-85 and > 85 years) were also examined.

RESULT

The utilization rate of acid suppressant in 2017 and 2019 was 2.5% (41,165/1,619,366) and 2.2% (49,550/2,236,471), respectively (P < 0.0001). 60,135 acid suppressant prescriptions were obtained in 2017 and 73,275 in 2019. The rate of acid suppressant prescriptions for the approved indications significantly increased from 62.6% (2017) to 65.4% (2019) (P < 0.0001). Prescriptions diagnosed as abnormal symptoms, signs and clinical manifestations, decreased in 2019 (13.0% vs. 16.5%, P < 0.0001). The most frequently prescribed PPIs differed between 2017 and 2019 (rabeprazole 2017 vs. esomeprazole 2019). Omeprazole was the most common PPI and cimetidine was the most common HRA prescribed to patients aged < 18 years in 2017 and 2019. A total of CNY11.83 million was spent on acid suppressants in 2019, accounting for about 48.7% of total medication cost, increased by 11.3% from 2017 (37.4%).

CONCLUSION

The proportion of acid suppressant prescriptions for approved indications was enhanced after the PPI management committee's multifaceted interventions, but there were still some problems in the selection of acid suppressants.

摘要

背景

2015 年发起了一项全国性的质子泵抑制剂（PPI）合理使用运动，该运动对住院患者的 PPI 使用产生了积极影响。但是，很少有研究关注门诊患者中 PPI 的合理使用。2018 年，PPI 管理委员会对门诊和急诊科 PPI 的合理使用进行了为期一年的干预，包括临床药师干预和管理干预。本研究旨在通过比较中国一家三级教学医院 2017 年（基线期）和 2019 年（干预后）门诊酸抑制剂处方模式，评估 PPI 管理委员会多方面干预的效果。

方法

从医院信息系统和处方自动筛选系统中提取基线期（2017 年）和干预后（2019 年）门诊和急诊科含任何酸抑制剂的处方。根据主要诊断和患者人口统计学特征评估酸抑制剂的处方模式。还检查了按年龄组（<7、7-17、18-45、46-65、66-85 和>85 岁）分层的处方酸抑制剂。

结果

2017 年和 2019 年酸抑制剂的使用率分别为 2.5%（41165/1619366）和 2.2%（49550/2236471）（P<0.0001）。2017 年获得 60135 份酸抑制剂处方，2019 年获得 73275 份。批准适应症的酸抑制剂处方率从 2017 年的 62.6%显著增加到 2019 年的 65.4%（P<0.0001）。诊断为异常症状、体征和临床表现的处方在 2019 年减少（13.0%比 16.5%，P<0.0001）。2017 年和 2019 年最常开的 PPI 不同（雷贝拉唑 2017 年比埃索美拉唑 2019 年）。奥美拉唑是 2017 年和 2019 年<18 岁患者最常开的 PPI，西咪替丁是最常开的 H2RA。2019 年用于酸抑制剂的费用为 1.183 亿元人民币，占总用药费用的约 48.7%，比 2017 年（37.4%）增长了 11.3%。