Prescription Comment And Intervention Of Chinese Patent Medicine In Outpatient Department Of A Primary Health Center

Objective:Through sampling and reviewing the prescriptions of Chinese patent medicines for outpatients in primary health centers of a county-level city,the irrational drug use and the main reasons for the existence were analyzed,and targeted intervention measures were proposed to analyze the intervention effect and improve the level of rational use of Chinese patent medicines in primary health centers in order to promote the safe,effective and economic medication of patients.Methods:Stratified random sampling method was used to select the prescriptions of Chinese patent medicines in the outpatient department of the health center.The prescriptions of Chinese patent medicines in March 2021 were exported in the form of Excel through the pharmacy outpatient system,300 prescriptions were selected every month as the object of review,and a total of 1800 prescriptions were selected by the same method until August 2021,that is,before the intervention.According to the basis for the review of Chinese patent medicine prescriptions,the selected prescriptions were reviewed.From the type of irrational prescription,department,physician,the same drug and other distribution,analyze the main reasons for the existence of irrational drug use,targeted to take some intervention measures.From March to August 2022,the prescriptions of Chinese patent medicines in the outpatient department were selected as the extraction objects,and the extraction method was the same as that before the intervention,a total of 1800 prescriptions,that is,after the intervention.The selected prescriptions were reviewed and analyzed and summarized.Excel2007 was used for data calculation.SPSS 26.0 software was used for statistical analysis of relevant data.X2 test was used for enumeration data.Rank sum test P<0.05 was considered statistically significant.Whether irrational prescriptions were improved after intervention and the effect of intervention measures were analyzed.Results:Before intervention:In terms of irrational drug use types,the proportion of irregular prescriptions was high,accounting for 60.28%,and irregular prescriptions were mainly manifested in:no clinical diagnosis or incomplete clinical diagnosis and outpatient prescription for more than 7 days;the proportion of inappropriate medication was 33.18%,mainly manifested in:inappropriate selection of drugs,inappropriate combination of drugs and repeated administration;the proportion of abnormal prescriptions was 6.54%,mainly manifested in:medication without indications.In departments,irrational drug use was mainly concentrated in surgery and internal medicine,accounting for 49.07%and 23.83%,respectively.In terms of physicians,irrational drug use was mainly concentrated in physicians A,D and C,accounting for 36.92%,14.95%and 10.75%,respectively.In terms of drugs,the top three irrational prescription drugs in different departments were mainly distributed in Qingkailing Granules,Lianhua Qingwen Granules,Ganmao Qingre Capsules and Kangfuyan Capsules.Combined with the actual situation,rules and regulations of the health center and other factors,take intervention measures in optimizing the allocation of review personnel,further clarifying the content of review,improving the outpatient information system,physicians,pharmacists and other aspects.After intervention,it was found that the qualified rate of intervention prescription in this health center increased from 88.11%to 92.22%.In terms of irrational prescription types,the proportion of irregular prescriptions decreased from 7.17%to 4.39%,inappropriate medication decreased from 3.94%to 3.28%,and abnormal prescriptions decreased from 0.78%to 0.11%.All three improved,with irregular prescribing improving more significantly.In terms of departments,all outpatient departments were improved,the unqualified rate of surgery decreased from 5.83%to 4.89%,internal medicine decreased from 2.83%to 1.33%,gynecology decreased from 1.44%to 0.33%,traditional Chinese medicine decreased from 1.78%to 1.22%,and internal medicine and gynecology improved significantly.In terms of physicians,the unqualified rate of prescriptions of all physicians showed an overall downward trend,and the unqualified rate of prescriptions of some physicians was 0%,such as ugly physicians,physicians,physicians,physicians,physicians,physicians,physicians,and non-physicians,but some physicians still had serious irrational drug use,such as physicians A,physicians B,and physicians C.In terms of drugs,the unqualified rate of the same drugs in the same department was improved,and the unqualified rate of the same drugs in surgery decreased from 1.89%to 1.00%,in internal medicine decreased from 0.72%to 0.17%,in traditional Chinese medicine decreased from 0.78%to 0.28%,and in gynecology decreased from 0.95%to 0.11%.Surgical and gynecological improvement was significant.Conclusion:After half a year of implementation verification,for the intervention of physicians,such as regularly organizing medical staff to carry out training and testing on the knowledge related to rational drug use;for the intervention of pharmacists,such as opening medication consultation windows to provide high-quality pharmaceutical care;strengthening prescription review and strictly blocking irrational prescription loopholes;strengthening the training on the knowledge related to prescription review;sorting out the classification catalogue of Chinese patent medicine drugs;unified classification and placement of traditional Chinese and western medicine in pharmacies,manually replacing prescription review and pre-operation and other intervention measures are still good.Due to various factors,improving the clinical diagnosis of TCM and printing electronic medical orders have not been successfully opened,and the effect of medical science popularization is poor.Before and after the intervention,the number of outpatient Chinese patent medicine prescriptions increased from 7740 to 8885,showing an increasing trend,the number of irrational prescriptions showed a decreasing trend,and the qualified rate gradually increased.However,the phenomenon of irrational drug use still exists,and prescription review is a process of continuous accumulation and long-term slow progress.With the intervention of rectification measures,the types and specific problems of irrational prescriptions may change continuously,so this requires pharmacists to timely summarize the prescription comments and analyze the crux of irrational drug use,and then targeted practical intervention measures.