摘要
目的通过运用多元干预策略,改善基层各界合理应用抗菌药物的意识,提高基层医师的合理用药水平,避免盲目使用抗菌药物,保障基层医院的医疗质量和患者的健康。方法根据国家卫生行政部门多年来持续发布的对抗菌药物合理使用的管理要求,借鉴某些管理成效好的医院的经验和做法,结合我国基层乡镇卫生院普遍存在的实际问题,设计多元干预策略方案,选择较偏远的某县下面的某家具有代表性的乡镇卫生院进行试点,验证实施多元干预策略的可行性。之后,根据试点结果,完善研究方案,进而选择条件相似的2个县的所有乡镇卫生院,随机分为数量相同的干预组和对照组,采用平行、整群随机对照、开放试验来充分论证多元干预策略方案的效果。结果多元干预策略明显提升了基层各界对抗菌药物合理应用的意识,基层医师在治疗急性呼吸道感染时滥用抗菌药物的现象得到了好转,合理应用水平明显提高,处方抗菌药物使用率显著降低(从70%以上降到30%以下),治疗效果和医疗质量得到保障。结论多元干预方案中的各项具体策略措施(行政引导、技术指导、组织和制度建设、科普宣传、信息化支持,以及微信平台建设和应用等)对基层医院的管理者、医师、药师、患者及家属等的影响各有侧重,整体运用可达到理想成效,对改善基层医院普遍存在的不合理使用抗菌药物的状况、保障基层的医疗质量和患者的健康具有重要现实意义。
AIM To improve the awareness of rational use of antibacterial drugs in grass-roots units,improve the rational use of antibacterial drugs by grass-roots doctors,avoid blind use of antibacterial drugs in the treatment of common diseases such as acute respiratory infection,and ensure the medical quality of grass-roots hospitals and the health of people by using multiple intervention strategies.METHODS According to the management requirements for the rational use of antibacterial drugs continuously issued by the National Health Administrative Department for many years,the project team designed a multi-intervention strategy scheme by drawing lessons from the experience and practices of some hospitals with good management results and combining with the practical problems commonly existing in grassroots township hospitals in China.Subsequently,a representative township hospital under a remote county was selected as a pilot to verify the feasibility of implementing multiple intervention strategies.Finally,according to the pilot results,the research scheme was improved,and then all township hospitals in 2 counties with similar conditions were selected and randomly divided into the same number of intervention groups and control groups.Parallel,cluster randomized controlled and open trials were used to fully demonstrate the effect of multiple intervention strategies.RESULTS The awareness of rational use of antibacterial drugs at the grass-roots level were obviously enhanced by using multiple intervention strategies;the abuse of antibacterial drugs by grass-roots doctors in treating patients with acute respiratory infection was fundamentally improved,the level of rational application was significantly improved,the utilization rate of prescription antibacterial drugs was significantly reduced(from over 70%to below 30%),and the treatment effect and medical quality were guaranteed.CONCLUSION The specific strategies and measures(administrative guidance,technical guidance,organization and system construction,popular science propa
作者
郑锦坤
卓超
魏晓林
郭伟
陈锋
陈志旭
ZHENG Jinkun;ZHUO Chao;WEI Xiaolin;GUO Wei;CHEN Feng;CHEN Zhixu(Department of Pharmacy,Yuebei People’s Hospital,Shaoguan 512026,China;Guangzhou Institute of Respiratory Health,The First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Dalla Lana School of Public Health,University of Toronto,Toronto M5T3M7,Canada)
出处
《中国临床药学杂志》
CAS
2022年第11期813-817,共5页
Chinese Journal of Clinical Pharmacy
基金
中国初级卫生保健基金会的资助(编号2019-030)
韶关市2021年科技计划资助项目(编号:韶科[2021]91号,210805154531792)
关键词
多元干预策略
基层医院
抗菌药物
合理应用
multiple intervention strategy
primary hospital
antibacterial drug
rational application
