基本药物制度实施前后基层医院门诊处方抗菌药使用率的Meta分析

发布时间：2018-10-18 14:14

【摘要】：目的:系统评价基本药物制度的实施对基层医院抗菌药合理使用的影响程度。方法:检索CNKI、万方和维普中文期刊数据库,收集基本药物制度实施后抗菌药使用情况的文献,确定纳入文献,运用Rev Man 5.3和Stata 12.0软件对纳入文献数据进行Meta分析。结果:对43篇纳入文献数据进行Meta分析,基层医院基本药物制度实施后,门诊处方抗菌药使用率下降,与实施前比较,风险差具有统计学意义[RD=-0.03,95%CI(-0.04,-0.03),P0.000 01],但抗菌药使用率仍然偏高(46.16%)。漏斗图的对称性良好,Egger’s检验结果显示发表偏倚无显著性差异(P=0.571);但文献研究结果间存在高度异质性(I2=94%,P0.000 01);按不同医院和地区进行亚组分析,结果显示,文献研究者的研究方法、地区基本药物制度实施措施的差异性促进了研究之间高异质性的形成。结论:在建立统一的调查研究质量评价标准来降低研究间的异质性;建立与基本药物制度配套的措施来切实降低基层医院门诊处方抗菌药使用率。
[Abstract]:Objective: to evaluate the influence of the implementation of essential drugs system on the rational use of antimicrobial drugs in primary hospitals. Methods: the Chinese periodical databases of CNKI, Wanfang and Weipu were searched, and the literatures on the use of antimicrobial drugs after the implementation of the basic drug system were collected and included. The data were analyzed by Meta using the software of Rev Man 5.3 and Stata 12.0. Results: Meta analysis showed that the utilization rate of antibiotics in outpatient prescriptions decreased after the implementation of essential drugs system in primary hospitals. The risk difference was statistically significant [RD=-0.03,95%CI (-0.04- 0.03), P0.00001], but the utilization rate of antimicrobial drugs was still high (46.16%). The symmetry of funnel graph was good, and the results of Egger's test showed no significant difference in publication bias (P0. 571), but there was a high heterogeneity among the results of literature research (I _ 2 / 9444 / P _ (0.00001). The differences in the implementation of regional essential drug systems promote the formation of high heterogeneity among studies. Conclusion: it is necessary to establish a unified quality evaluation standard to reduce the heterogeneity of the study and to establish the corresponding measures to reduce the utilization rate of antibacterials in outpatient prescriptions of grass-roots hospitals.
【作者单位】：华中科技大学附属同济医院药学部;华中科技大学同济医学院药学院;
【分类号】：R951

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