Evaluation Of Clinical Practice Guidelines Of Chinese And Western Medicine For Acute Bronchitis Based On Clinical Inspection Methods

Purpose1.Comprehensive evaluation of the methods and recommendations for the development of acute bronchitis guidelines at home and abroad,screening out high-quality clinical practice guidelines,providing a basis for future development of similar guidelines,and evaluation of normative clinical diagnosis and treatment behaviors of Chinese and Western medicine for acute bronchitis Provide standards and references.2.Investigate the prescription behavior of Chinese medicine and antibiotics for acute bronchitis in a top three Chinese medicine hospital in Shenyang City.Provide support for regulating and evaluating the prescription behavior of acute bronchitis,it also provides clues and evidence for the study of whether Chinese medicine can reduce or replace the hot spot of antibiotic use in acute bronchitis.3.Follow the internationally accepted clinical audit evaluation paradigm,explore how the guidelines are applied in clinical practice,how effective,the underlying causes of the influencing factors,and recommendations for the next revision of the guidelines,etc.,for the compliance and clinical practice in the acute bronchitis guidelines.Application evaluation provides reference,and can also provide important basis for clinical practice decision-making,medical insurance policy formulation,and drug clinical application.Method1.The AGREE II evaluation scale system was used to evaluate the quality of the guidelines for acute bronchitis at home and abroad,and to screen and compare the recommendations for drug,non-pharmaceutical,preventive and TCM interventions.2.Transfer the original electronic prescription data of the first diagnosis of "acute bronchitis" in a respiratory department outpatient department and emergency department from January 1,2015 to December 31,2016 in a hospital in Shenyang,and analyze the epidemiology of patient prescription.Characteristics and treatment season and solar terms,blood routine and lung CT test results,related cost characteristics,characteristics of traditional Chinese medicine and antibiotic prescription drugs,referral status and medication characteristics,and factors affecting the use of antibiotics.3.Follow the high-quality clinical guidelines and clinical examination procedures for acute bronchitis in Chinese and Western medicine,a retrospective review of clinical prescriptions for acute bronchitis for 6 months was conducted at a top three Chinese medicine hospital in Shenyang.Taking the high-quality guidelines of traditional Chinese medicine and western medicine as the standard,the main investigations of the prescriptions of traditional Chinese medicines,symptomatic western medicines and antibiotics for acute bronchitis.Results1.There are 13 guidelines for the evaluation of acute bronchitis at home and abroad.Including SIGN(England 2006),AFP(Australia 2008),NICE(England 2008),CCHMC(America 2010),SATS(South Africa 2010),AAP(America 2014),CJP(China 2014),CACM(China 2015),FMSD(Finland 2015),NICE(England 2015),ACP / CDC(America 2016),JAID / JSC(Japan 2016),PREDICT(Australia 2018).One of them is recommended for use at level A,10 is recommended for grade B but modified,and 2 is for grade C.Of the 13 guides included,only 3 were published between 2006 and 2009,and the remaining guides were published in 2010 or later;10 guides are based on evidence-based evidence and methodologies;and 6 guides are organized by the United Kingdom and the United States.Development,followed by China(n = 2),Australia(n = 2)and other countries(Japan,South Africa and Finland);10 guidelines were developed by the Medical Association,followed by government agencies and hospitals;The highest scores in the AGREE II evaluation tools are clear(71.1%),followed by scope and purpose(70.9%),participants(54.7%),rigor(50.2%),applicability(43.8%),and lowest scores.It is editorial independence(40.6%).In summary of the Western medicine guidelines for drug treatment,non-drug treatment,prevention recommendations and their level of evidence and recommended intensity,the guidelines can be agreed on most points of view: bronchodilators are not recommended(6/8);Application of hormones(7/7);antibiotics are not recommended for routine use(9/9);routine use of antiviral drugs(4/4)is not recommended;montelukast(3/3)is not recommended;chest therapy is not recommended(7/7);oxygen inhalation if necessary(6/7);prophylactic treatment with palivizumab(4/4);attention to hand washing(4/4);avoiding exposure to tobacco and pollution(3/3))Wait.However,there are some differences in the clearance of respiratory secretions and the use of atomized hypertonic saline.The TCM guidelines point to the use of various methods such as decoction,proprietary Chinese medicine,acupuncture and acupoint application.2.A prescription for acute bronchitis in a top three hospital of Shenyang City was included in 14101 prescriptions for acute bronchitis,including 4,761 and 9,340 prescriptions for male and female patients.The winter solstice,winter,and heavy snow were the three most prescribed solar terms for patients;The most routine inspections accounted for 48.62%;the per capita cost was 449.76 yuan,of which medicines accounted for 79.19% of the total expenses;the prescription rate of traditional Chinese medicine alone was 80.84%,and the prescription rate of western medicine alone was 3.04%,combined with the use of Chinese and Western medicines.The prescription rate was 16.12%;only the proprietary Chinese medicine group(9554)accounted for the most,accounting for 68.13% of the total number of prescriptions(14,101);prescription Chinese medicine in the compound Puqi tablets(9058),Yangyinqing The lung drink mixture(5895 sheets)ranked the top two,the dosage form was mainly tablet;the prescription rate of antibiotics was 12.55%,and the second generation cephalosporin was used.The use rate of cefaclor sustained release tablets was 53.39%.Of the 134 prescriptions for the initial use of Chinese and Western medicine,72 patients in the follow-up clinic chose to discontinue antibiotics.Among the 943 prescriptions for the initial diagnosis of traditional Chinese medicine,851 patients in the follow-up visit continued to use traditional Chinese medicine treatment;male,0-20 age group,autumn prescription,no blood test,no chest X-ray examination,no serological test of Mycoplasma pneumoniae More patients have prescribed antibiotics.3.By comparing the "A Guide to the Treatment of Acute Trachea-Bronchitis(2015 Edition)" and the Western Medicine Guidelines,there are 21 syndrome types in the clinical audit of acute bronchitis,and there are 12643 syndromes in accordance with the guidelines.Accounted for 89.7%.Among them,the guide contains the syndrome of phlegm and blood stasis(10,468),accounting for 77.9%;the syndrome of qi and yin deficiency(2,094),accounting for 15.6%.The prescription of Chinese medicine is only 76.12%,and the prescription of traditional Chinese medicine decoction is 3.88%,and the prescription of Chinese medicine and syndrome differentiation is 8.92%.There are 18 kinds of prescriptions used in the prescription of patients with fever and stagnation of lung syndrome,the total frequency of use is 22,550 times;the compound Puqi tablets(7,468 times),accounting for 33.1%;the nourishing Yinqingfei drink mixture(4083 times),accounting for 18.1%;Jin Chong capsule(3299 times),accounting for 14.6%.The recommended treatment for patients with phlegm and blood stasis syndrome is: clearing away heat and removing phlegm,relieving lung and relieving cough,and the Chinese medicines that are in full compliance with the treatment account for 20.2% of the total,and some of them meet 76.8%.The prescription of Qiyin deficiency syndrome is 68.43%,and the prescription of traditional Chinese medicine decoction is 7.55%.The prescription of Chinese medicine and syndrome differentiation is 11.17%.In the prescription of patients with Qi and Yin deficiency syndrome,10 kinds of Chinese patent medicines were used,the total frequency of use was 1634 times;compound Puqi tablets(1086 times),accounting for 66.5%;and andrographolide dispersible tablets(187 times),The proportion is 11.4%.The recommended treatment for patients with Qi and Yin deficiency syndrome is: Yiqi Yangyin,Runfei and Cough,and the treatment of some Chinese medicines that meet the requirements of the guidelines only account for 7% of the total,while the heat-clearing steroids account for the total.91%.The symptomatic western medicines and antibiotics used in clinical acute bronchitis are all related drugs that are not recommended in the guidelines.Conclusion1.Through the evaluation of the quality of the development of acute bronchitis guidelines at home and abroad and comprehensively summarized the consensus and disagreement of the recommended recommendations for drug therapy,non-drug therapy,prevention and Chinese medicine treatment,the clinical results of high quality acute bronchitis were screened out.The guidelines provide standards and guidelines for clinical audit research,and provide rational and standardized treatment advice for clinicians,facilitating the formation of optimal clinical practice.2.The prescription rate of acute bronchitis antibiotics,the total prescription rate of traditional Chinese medicines and the prescription rate of traditional Chinese medicines are obviously better than those reported in domestic and foreign literatures,which can provide some clues as to whether Chinese medicine can reduce or replace the hotspot problem of antibiotic use in acute bronchitis.And basis.3.Through the evidence-based examination of the clinical practice guideline of acute bronchitis and real-world prescription behavior,the clinical audit evaluation method was introduced into the field of traditional Chinese medicine and its clinical application was comprehensively evaluated,which is the applicability of clinical practice guide in the field of traditional Chinese medicine.It provides reference for application evaluation,and provides an important basis for improving the clinical diagnosis and treatment level of TCM and clinical practice decision-making,medical insurance policy formulation,drug clinical application and other hot issues of medical reform.