| OBJECTIVE In order to understand the use status of key monitored drugs in county hospitals in Wuhu,analyze the situation and causes of unreasonable drug use orders,objectively evaluate the management effect,and improve the level of rational drug use through continuous rectification,providing reference for the improvement and promotion of relevant policies.METHODS 1.Literature research method: In the database collection of literature by searching for "monitored drugs" "adjuvant" "health charged fees" "county-level hospitals" "the rational use of drugs" "pharmaceutical care" "adverse reactions such as" keyword to retrieve related articles,in recent years for the national key monitoring drug regulatory laws and regulations and policy documents was summarized and analyzed,Understand the control status of key monitored drugs and the impact of medical insurance cost control on their use,find problems and put forward improved methods.2.Retrospective analysis methods:(1)The drug use of key monitored drugs in 8county-level hospitals in Wuhu area during 2018-2020 was retrospectively investigated,and the related data of key monitored drugs during 2018-2020 were collected from Hospital Information System(HIS)and processed with EXCEL software.The Frequency of drug use(DDDs),Daily drug costs(DDC)and sequencing ratio(B/A ratio)of key monitored drugs in 3 years were statistically analyzed.(2)8 hospitals were monitored in 2018-2020 statistical drug purchase,consume the total amount,total amount of the prescription number,monitored drugs into the top 30 sales amount,the top ten key monitoring drug sales amount,computing key monitoring of drug purchase amount,key monitoring of drug income ratio,prescription drug cost proportion.Meanwhile,the change of drug proportion and per capita drug cost in 8medical institutions was analyzed.(3)The official website of National Adverse drug Reactions(ADRs)was used to make statistics on the reports of key monitoring ADRs from 2018 to 2020.(4)The medical records of key monitored drugs were collected from HIS system of the hospital,and the proportion of irrational drug use of key monitored drugs in 2019 and2020 was compared,and the situation of drug use beyond the limits of medical insurance was analyzed.Pareto diagram and fishbone diagram were used to analyze the main types of irrational drug use and the existing reasons,based on which improvement measures were formulated and rectified.(5)To investigate the staffing situation of clinical pharmacists in 8 medical institutions,and whether the number of clinical pharmacists can meet the requirements of second-grade hospitals.3.Questionnaire survey method:based on literature query results,actual use of key monitored drugs,expert evaluation and preliminary survey,a questionnaire questionnaire was formed to investigate medical staff’s attitude towards the current use of key monitored drugs and put forward constructive suggestions.RESULT 1.According to the control,the usage of key monitored drugs showed a general downward trend from 2018 to 2021,and the total DDDs of key monitored drugs were 719234.29,558802.30 and 495040.42,respectively,with decreasing percentages of 22.31% and 11.41%.DDDs in the top four of the best to make the capsule respectively,clopidogrel bisulfate tablet,atorvastatin calcium tablet and injection in panxi tora azole sodium,basic for oral preparations,and given priority to with chronic disease treatment,ranking the adr mentioned three drugs for injection,injection with thrombus and Dan red injection,this has to do with health control fee to reduce auxiliary clinical application has a lot to do with the use of,The use of other varieties fluctuated,but not by much.The DDC of human serum albumin,Danhong injection and Desocine injection in the top 3 in the order of DDC was more than 400 yuan,and the DDC of human serum albumin was always in the first place,and the unit price of these drugs was also relatively high.The DDC of Bailing capsule and pantoprazole sodium injection ranked the bottom,and the DDC value of Bailing capsule was the lowest,which was 3.1 yuan.2.The procurement sum and sales sum of key monitored drugs in each hospital showed a downward trend from 2018 to 2020.The key monitored drugs procurement sum decreased from 42.827,100 million yuan to 34.132,700 yuan in 2019 and 22.543,700 yuan in 2020,decreasing by 20.3% and 33.95% respectively.The consumption sum decreased by 31.31% and 43.77% from 33.6871 million yuan to 23.1399 million yuan in 2019 and 13.0111 million yuan in 2020.The proportion of purchase sum of key monitored drugs decreased from 11.54% to 9.09% and 7.52%,21.17% and 17.3%,respectively;the proportion of sales sum decreased from 9.54% to 7.28% and 5.74%,23.66% and 21.14%,The proportion of prescriptions of key monitored drugs decreased from 24.44% to 22.08%,showing a downward trend,among which the proportion of prescriptions in HOSPITAL D and hospital F was the lowest.The proportion of drugs decreased from 27.32% to 24.68%,the per capita drug cost decreased from 1467.38 yuan to 1197 yuan,and the per capita cost of key monitored drugs decreased from358.13 yuan to 266.12 yuan..It shows that the control has achieved effect,effectively saving the medical insurance fund,reducing the burden of patients’ medical expenses,and achieving better control effect.The top six drugs in the key monitoring list of 8hospitals showed no change in consumption sum from 2018 to 2020.The drugs were mainly classified as cardiovascular and cerebrovascular drugs,proton pump inhibitors,antibacterial drugs and biological products with high unit price,human serum albumin,which basically met the drug use characteristics of county-level hospitals.But proton pump inhibitors,antibiotics and biologics need to be further regulated.3.The reported rate of adr of key monitored drugs decreased from 16.74% to 9.49%from 2018 to 2020,and the difference was statistically significant,which was related to the decrease of the use of key monitored drugs.4.In special reviews of key monitoring drugs from 2019 to 2020,8 drugs were reviewed and 1770 medical records were reviewed,among which 720 were reviewed in 2019,181(25.14%)were unreasonable,and 89(8.48%)were unreasonable in 2020,1050 were unreasonable,and the irrational rate showed a downward trend.The utilization rate of drug use beyond the limits of medical insurance decreased from 51.84% to 15.96%,Both of them had statistical significance(P <0.05).Clinical pharmacists use Pareto diagram and fishbone diagram to analyze the specific reasons for irrational use of key monitored drugs,and then formulate corrective measures.5.Besides G court,the other seven medical institutions of clinical pharmacists are less than 3 people,shows that drugs after zero addition into the cost of hospital pharmacy department department,simply ignored the pharmacy department leadership on ideology,under the condition of increasing in pharmacy,a serious shortage of clinical pharmacists,cannot satisfy the public demand for pharmaceutical care,the value of pharmacists are also not very good.6.A total of 160 questionnaires were sent out,and 149 were recovered,with a recovery rate of 93.13%.Most of them were male in gender,with the highest proportion of 31-40 years old,with a high degree of junior college and bachelor degree,with the most junior titles,and clinical medicine and pharmacy personnel.Medical staff are generally not familiar with the policies related to key monitoring,but are familiar with the key monitoring varieties used in their department.More than half of the medical staff believe that the abuse of key monitoring drugs will increase the medical burden of patients correspondingly,which is consistent with the reports in literature reading.Key control way for prescription records comments on drugs,health care and warning,basically don’t charge phenomenon,health department of quality control frequency in the majority with each quarter,nearly 100% of the medical staff thought controls will enhance medical quality,promote the rational use of drugs,if the monitored drugs limited procurement can affect the doctor’s diagnosis and treatment of clinical It is mainly manifested in the small scope of drug selection and the inability to realize individual drug use for patients.The survey results provide direction for further improvement.CONCLUSION Medicare charged fees under the background of wuhu eight key monitoring drug control effective medical institutions at the county level,2018-2020,key control drug purchase amount,sales amount,key monitoring of drug purchase amount,amount of monitored drugs,medicine proportion,per capita monitored drugs,prescription of a downward trend,At the same time,the incidence of adverse drug reactions is gradually decreased,which promotes drug safety and effectively saves medical insurance funds and medical resources.Eight county medical institutions refer to medical institutions and a number of comments on mode,with expert consensus,relevant guidelines,health-care limit medication rules for evidence-based learning basis,through the comments on the rectification,super health limit utilization,the declining incidence of irrational drug use,focus on monitoring the use of the drug gradually tend to be more reasonable,but there are still unreasonable situation,Unreasonable types mainly include indications beyond medical insurance limits and treatment courses,which are mainly reflected in insufficient indications and long treatment courses of proton pump inhibitors,human serum albumin and flurbiprofen ester injection.Special comments on drugs should be strengthened in the future.The number of clinical pharmacists in 8 county-level hospitals was insufficient to meet the increasing public demand for pharmaceutical care.The control of key monitored drugs is a continuous practical action,which requires long-term supervision,effective implementation and continuous improvement. |
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