| 张楠,夏文斌,杨慧鹃,闫阔,陆红柳,崔宏力,徐执扬,周杰红.DRGs付费背景下临床药师参与临床路径合理用药管理模式探讨[J].中国药事,2022,36(2):194-202 |
| DRGs付费背景下临床药师参与临床路径合理用药管理模式探讨 |
| Study on the Management Mode of Rational Drug Use with Clinical Pharmacists' Participation in Clinical Pathway Under the Background of DRGs Payment |
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| DOI：10.16153/j.1002-7777.2022.02.012 |
| 中文关键词: DRGs付费 临床药师 临床路径 合理用药 干预 |
| 英文关键词: DRGs payment clinical pharmacists clinical pathway rational drug use intervention |
| 基金项目:北京市科技计划首都临床特色应用研究(编号 Z181100001718125) |
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| 中文摘要: |
| 目的：探索建立DRGs付费背景下临床药师参与临床路径合理用药管理模式。方法：以阑尾切除术(不伴合并症)、阑尾切除术(伴合并症)、上肢长骨手术(不伴合并症)、上肢长骨手术(伴合并症)4个病种为试点，临床药师对各病种药费超标原因及用药不合理问题进行分析，为临床制定DRGs标准用药清单和管理计划，建立临床路径与用药合理性评判标准，通过信息化方式实施综合干预。结果： 与干预前(2020年 3-4 月)相比，干预后(2021年 1-2 月)上述4个病种的实际例均药费与DRGs标杆药费差值、药品使用金额占比、不合理用药问题发生率均显著下降，且均具有显著性差异(P ＜0.05)，以上4个病种抗菌药物使用强度分别由44.85、57.67、26.62、31.67降至37.12、43.62、20.22、15.80。结论： DRGs付费背景下临床药师参与临床路径合理用药管理模式对于降低医院阑尾切除术及上肢长骨手术住院病例实际药费及药品使用金额占比，以及在减少不合理用药问题的发生方面具有一定的积极作用。 |
| 英文摘要: |
| Objective: To explore the establishment of the management mode of rational drug use with clinical pharmacists participating in clinical pathway under the background of DRGs payment. Methods: Four diseases, including appendectomy (without complications), appendectomy (with complications), upper limb long bone surgery (without complications) and upper limb long bone surgery (with complications) were included as the pilot project. Clinical pharmacists analyzed the causes of excessive drug costs and the problems of irrational drug use for various diseases, developed DRGs standard medication list and management plan, established clinical pathway and rational evaluation standard of drug use and implemented comprehensive intervention through information technology. Results: Compared with those before the intervention (March to April, 2020 ), after the intervention (from January to February, 2021), the average drug costs of the actual case and DRGs benchmark drug cost, the proportion of drug use amount and the incidence of irrational drug use were markedly decreased with significant differences (P ＜0.05). The use intensity of antibiotics in the above four diseases had decreased from 44.85, 57.67, 26.62, and 31.67 to 37.12, 43.62, 20.22 and 15.80, respectively. Conclusion: Under the background of DRGs payment, the participation of clinical pharmacists in the management of rational drug use in clinical pathway plays a positive role in reducing the actual drug costs and the proportion of drug use amount of inpatients with appendectomy and upper limb long bone surgery as well as reducing the occurrence of irrational drug uses. |
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