Twycross R G, Bergl S, John S, Lewis K
University of Oxford, UK.
Palliat Med. 1994;8(2):137-43. doi: 10.1177/026921639400800207.
A computerized system for monitoring drug use which makes use of the British National Formulary (BNF) drug categories and a departmental formulary (DF) has been developed. Data entry takes less than one week of secretarial time per annum. Details of drug use in 385 patients three weeks after referral to a National Health Service palliative care unit over five years form the basis of this report. The median number of drugs per patient was five, with a maximum of 11; 97% of the drugs were from the DF. Analgesics were the commonest category of drugs used. The 10 most commonly used drugs included three analgesics (morphine, co-proxamol, flurbiprofen), two laxatives (co-danthrusate, lactulose), dexamethasone, metoclopramide, ranitidine, temazepam and amitriptyline/dothiepin. Seventeen per cent of patients received two preparations from the same second level BNF category (analgesics excluded). The concurrence was questionable in about half of these, and mostly related to the use of laxatives or to hypnotics and anxiolytics. Several unexpected inclusions in the top 10 drugs illustrate the need for quantification rather than pontification about drug use in palliative care. Examination of duplicate prescribing provides a forum for examining ways of simplifying drug regimens.
已开发出一种利用英国国家处方集（BNF）药物类别和科室处方集（DF）来监测药物使用情况的计算机化系统。每年的数据录入工作秘书用时不到一周。本报告以五年间转诊至国民健康服务姑息治疗病房三周后的385名患者的用药细节为基础。每位患者使用药物的中位数为5种，最多为11种；97%的药物来自DF。镇痛药是最常用的药物类别。最常用的10种药物包括三种镇痛药（吗啡、复方丙氧氨酚、氟比洛芬）、两种泻药（复方丹蒽醌、乳果糖）、地塞米松、甲氧氯普胺、雷尼替丁、替马西泮以及阿米替林/多塞平。17%的患者使用了同一第二级BNF类别中的两种制剂（不包括镇痛药）。其中约一半情况的同时使用存在疑问，且大多与泻药或催眠药及抗焦虑药的使用有关。十大常用药物中的几例意外入选情况表明，在姑息治疗中对药物使用需要进行量化而非主观判断。对重复开药的检查为探讨简化药物治疗方案的方法提供了一个平台。
