Six Medical Institutions In Deyang District Were Involved In Chronic Hepatitis B From 2013 To 2017 Analysis Of Antiviral Drug Application In Inpatients

Objective:1.Through retrospective study on the antiviral drug application of chronic hepatitis B inpatients in six medical institutions of different levels in deyang area,to understand the current situation of antiviral drug therapy for chronic hepatitis B in this area;2.By reviewing chronic hepatitis B prevention guidelines,expert consensus,and high-quality evidence-based research literature,to formulate the evaluation criteria for the rational application of chronic hepatitis B treatment antiviral drugs,and to evaluate the rationality of the treatment and medication of chronic hepatitis b inpatients in six medical institutions,so as to provide a reference for the rational clinical medication and carry out training and education on rational drug use.Methods:Through the inpatient medical record management system of six medical institutions,we extracted the first diagnosis of chronic hepatitis B disease in five years from January 1,2013 to December 31,2017,excluding drug-induced liver disease,alcoholic liver disease,autoimmune liver disease and other viral liver diseases not caused by hepatitis b virus.Referring to the calculation formula n=P(1-p)/(e2/Z2+P(1-p)/N)of random sample size,the confidence degree is set as P<0.01,the proportion estimation is set as 0.5,and the percentage of precision value is set as 0.03 and 0.04,respectively.The required sample size is calculated between 988 and 1692,and integer 1200 was taken as the target sample size for sampling analysis.After exclusion of death and hospitalization for less than 2 days,the patients were sorted by admission time.The total number of qualified cases in each medical institution was divided by the quotient of 100 and rounded to an integer as the interval.6 cases were successively extracted,and 1200 cases were finally included as the research object.Classification of therapeutic drugs by pharmacological action,and the data of sample detail data wereextract and sort by EXCEL 2007、ACCESS 2007 and IBM SPSS 23.0 software.Finally,specific data such as patient gender,age,average hospital stay,amount of hospitalization,amount of drugs,drug classification,drug details and drug combination were obtained.According to the standard of rational drug use evaluation,the application of drugs was analyzed and evaluated.Results:The study showed that 73.5%of the patients were male,the mean age of male patients was 51.3±10.4 years,and that of female patients was 57.8±9.7 years.The average length of stay was 17.1 days,the average hospitalization cost was 12,141.8 yuan,the average proportion of drugs was 38.3%,the amount of drugs for coronary heart disease accounted for 71.1%of the total drug cost.In terms of drug utilization review(DUR),a total of 914 patients were treated with antiviral therapy,and the top three utilization frequencies were entecavir,adefovir dipivoxil and lamivudine.Among them,the defined daily dose system(DDDs)of entecavir is the largest,and the drug utilization index(DUI)of the interferon is all less than 1,while the DUI of the nucleoside(acid)is all equal to 1;In terms of drug utilization evaluation,the serological conversion rate of HBeAg is 22.3%、the negative conversion rate of HBV DNA was 40.2%、the ALT recurrence rate was 56.1%、、the HBsAg conversion rate was 1.2%;the incidence of adverse reactions,such as flu-like symptoms,gastrointestinal reactions,allergic reactions,mental disorders,renal impairment,osteoporosis,and bone marrow suppression was 2.8%,2.2%,1.9%,0.9%,0.5%,0.3%,and 0.10%,respectively;Rational use of antiviral drug:①among the 1200 patients,278(23.2%)did not strictly grasp the initiation signs of antiviral therapy,antiviral therapy is given at wil;②230 cases(44.6%)of HBeAg positive or negative patients were unreasonable in the selection of antiviral drugs,and 94 cases(47.0%)of hepatitis B cirrhosis patients were unreasonable in the selection of antiviral drugs when the disease progressed to the compensatory stage or decompensated stage.Genetic testing was performed in 164 patients with virological breakthrough,and 69 patients(42.1%)did not correctly implement the drug resistance rescue plan.;③ Antiviral therapy in special populations,there were 56 cases(42.4%)of patients with HBV-related liver disease who were unreasonable in drug selection.In special populations,there were 56 patients(42.4%)with hbv-related liver disease、28 patients(27.2%)were of special age or physiological stage、9 patients(26.5%)were combined with other diseases and 7 patients(20.0%)with ALT≤2×ULN,the selection of antiviral drugs was unreasonable antiviral drugs;④In terms of follow-up of antiviral treatment,734 patients(79.2%)treated with antiviral drugs were followed up.The follow-up rate was higher in tertiary hospitals than secondary hospitals,and higher in general hospitals than in specialized hospitalsand mainly conducted by telephone.Conclusions:The incidence of chronic hepatitis B is higher in men than in women,the age of onset was earlier in males than in females,the average length of stay was higher than the general report.Six medical institutions in the drug treatment of chronic hepatitis B are unreasonable.in terms of antiviral treatment,we cannot strictly grasp the indications of treatment and start the application of antiviral drugs at will.In terms of drug selection,HBV DNA level、degree of liver inflammation、medication history、contraindications and whether for special groups are not taken into consideration.Antiviral drugs are randomly selected,discontinued or replaced.Some patients with drug resistance,no genetic testing was conducted,no measures were taken in accordance with the drug resistance rescue plan,and drugs were selected by experience.In terms of hepatoprotection therapy,multiple hepatoprotection drugs are used in combination,without combining the indications of hepatoprotection therapy and the characteristics of patients with liver damage,and a number of varieties exceed the normal dosage,leading to excessive treatment.These unreasonable conditions,on the one hand,are related to the low level of economic conditions and medical care in deyang area,on the other hand,doctors do not pay enough attention to the treatment of chronic hepatitis B and participate in the relevant training on rational drug use wasless,which leads to the untimely and incomplete spread of drug use norms and new progress in treatment.Through this study,we have a better understanding of the current clinical problems in the drug treatment of chronic hepatitis.Clinical pharmacists can make use of their professional advantages to participate in the education and training,guidance and supervision,clinical path anddoctor’s order review。Assist clinicians to make the best medication plan to avoid unreasonable use and abuse of drugs.