抗肝炎病毒药物应用情况调研及库存优化管理

发布时间：2018-03-22 01:21

本文选题：肝炎病毒　切入点：干扰素　出处：《山东大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：为了规范医院药品的使用与管理,切合三甲医院评审的要求,完善药事管理工作,以我院主流药品抗肝炎病毒药物为主线,通过分析抗肝炎病毒药物使用与管理方面存在的问题,建立可行性的研究与解决方法,进一步探索适合我院实际情况的符合三甲医院评审要求的药品使用与管理模式。方法：通过对抗肝炎病毒药物药物的用法用量、适应症、耐药性、治疗指南的变化分析药物的合理应用。采用处方分析的方法对含有抗肝炎病毒药物的处方进行分析,研究使用抗肝炎病毒药物的情况,分析应用的合理性,调查抗肝炎病毒药物联合应用的种类、模式,评价联合用药对肝炎治疗效果的影响；采用药物利用评价的方法,分析我院2009年—2013年抗肝炎病毒药物的出库金额和种类分布,对抗肝炎病毒药物的使用进行统计,分析其规律性；采用库存管理的ABC分析法和动态库存分析法,分析抗肝炎病毒药物的库存金额、周转率、周转天数的变化,并进行动态库存监督。结果：药物说明书、指南是药物使用的依据。药物市场份额的变化与药物的疗效不良反应有关。20000张处方分析显示,有4336例接受抗病毒治疗的患者,包括342例慢性丙型肝炎,3019例慢性乙型肝炎；其中代偿性肝硬化850例,失代偿性肝硬化125例。81%的患者接受单药抗病毒治疗,19%的患者接受联合用药治疗。药物利用研究表明,抗肝炎病毒药物总体呈现增长趋势,核苷(酸)类药物占抗病毒药物总销售额的73%,成为抗病毒治疗的主流药物。干扰素类药物中,500万IU重组人干扰素α-2b和180万IU聚乙二醇干扰素α-2a占主导地位。从DDDs值来看,阿德福韦酯、拉米夫定的DDDs5年中一直居前。对药品库存进行优化管理后,在药品销售额变化无统计学差异的情况下(P0.05),优化后的药品库存金额、库存周转率、库存周转天数均与优化前相比有极显著性差异(P0.01)。通过对单品种药品的动态监测来看,药品阿德福韦酯片、恩替卡韦胶囊、恩替卡韦片的累积入库曲线与累积出库曲线之间的距离均比实施零库存之前短。结论：我院抗肝炎病毒药物应用基本合理,但尚需加强儿童患者用药研究、联合抗病毒治疗的研究以及患者耐药后的管理；药物的疗效、安全性、经济性是肝病抗病毒药物选择的影响因素；实施零库存之后,抗肝炎病毒药品库存大大降低,在提高周转率的同时降低了药品周转天数,减少了资金的占用。以上分析研究表明规范药品的使用与管理工作是当今医院提高核心竞争力的有力武器之一。规范医院药事管理工作,加强医院药品全过程的管理,建立长期的监管机制,是可行的和有必要的。
[Abstract]:Objective: in order to standardize the use and management of hospital drugs, meet the requirements of the third Class A hospital review, improve the drug management, take the mainstream drugs and anti-hepatitis virus drugs in our hospital as the main line. By analyzing the problems existing in the use and management of antiviral drugs and establishing feasible research and solutions, this paper further explores the drug use and management model suitable for the needs of the third Class A Hospitals in our hospital. Methods: the rational use of antiviral drugs was analyzed by using dosage, indication, drug resistance and treatment guidelines. Prescription analysis was used to analyze the prescriptions containing antiviral drugs. To study the use of anti-hepatitis virus drugs, to analyze the rationality of their application, to investigate the types and patterns of combined use of anti-hepatitis virus drugs, to evaluate the effect of combined use of drugs on the treatment of hepatitis, and to use the method of drug utilization evaluation. The amount and distribution of antiviral drugs in our hospital from 2009 to 2013 were analyzed, and the use of anti-hepatitis virus drugs was analyzed. Analyze the changes of stock amount, turnover rate and turnover days of antiviral drugs, and carry out dynamic inventory monitoring. Results: drug instructions, guidelines are the basis for drug use. Changes in drug market share are related to adverse drug efficacy. Analysis of 20, 000 prescriptions showed that 4336 patients received antiviral therapy. Including 342 cases of chronic hepatitis C and 3019 cases of chronic hepatitis B, 850 cases of compensatory cirrhosis and 125 cases of decompensated cirrhosis of liver were treated with single antiviral therapy. Anti-hepatitis virus drugs generally show an increasing trend. Nucleoside (acid) drugs account for 73% of the total sales of antiviral drugs, and have become the mainstream of antiviral therapy. Of the interferon drugs, 5 million IU recombinant human interferon 伪 -2b and 1.8 million IU polyethylene glycol interferon 伪 -2a are dominant. Adefovir ester, DDDs5 of lamivudine has been in the top position in the middle of the year. After optimizing the management of drug inventory, without statistical difference in the change of drug sales, the optimized amount of drug inventory, inventory turnover rate, The days of inventory turnover were significantly different from those before optimization (P 0.01). According to the dynamic monitoring of single drug varieties, Adefovir tablets, entecavir capsules, The distance between cumulative entry curve and cumulative exit curve of entecavir sheet is shorter than that before zero inventory. Conclusion: the use of antiviral drugs in our hospital is basically reasonable, but it is still necessary to strengthen the study of drug use in children patients, the study of combined antiviral therapy and the management of patients after drug resistance, the efficacy and safety of drugs, Economy is the influence factor of antiviral drug selection in liver disease. After zero stock is implemented, the antiviral drug stock is greatly reduced, which increases the turnover rate and reduces the number of days of drug turnover at the same time. The above analysis shows that standardizing the use and management of drugs is one of the powerful weapons to improve the core competitiveness of hospitals. The establishment of a long-term regulatory mechanism is feasible and necessary.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R95

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