中国儿童超说明书用药管理现状及认知度的横断面调查

发布时间：2018-10-22 07:59

【摘要】：目的调查中国儿童超说明书用药的管理现状及医务人员的认知度,为规范儿童超说明书用药提供依据。方法以横断面研究设计,在中国大陆每个省至少选择一家具备儿科资质的医疗单位;调查人群:儿科医生、药师、护士和医务科行政人员;由儿科临床专家、药学专家、流行病学专家和药事管理专家组成的工作小组自制《中国儿童超说明书用药调查表》,包括基本信息维度6个条目,所在医院超说明书用药的现状及管理维度11个条目,超说明书用药及其管理的认知和《中国儿科超说明书用药专家共识》知晓情况维度33个条目,行网络问卷调查。结果全国31省436家医院参与调查,其中儿童专科医院36家,妇幼保健院50家,综合性医院350家;一级医院20家,二级医院185家,三级医院231家。收集到有效问卷2116份,其中医生621名、药师755名、护士531名和医务科行政人员209名;初级职称712名、中级职称894名、高级职称510名。63.8%的医生有开具超说明书用药处方经历,职称越高,超说明书用药的现象越多;18.8%的医生经常超说明书用药,职称越高经常超说明书用药发生概率越大;19.4%的医生超说明书用药时都没有得到药师或护士提醒。药师发现过医生超说明书用药的情况是普遍存在的,不论药师职称的高与低(87.1%~98.3%),不论医院级别(82.1%~94.2%),6.9%~8.8%的护士面对医生超说明书用药拒绝执行医嘱。60.6%的被调查医院针对超说明书用药有统一制度流程,其中三级医院的比例高于一、二级医院,儿童专科医院的比例高于综合医院和妇幼保健院。70%的被调查者认为超说明书用药并不违法,但是80%以上的被调查者肯定超说明书用药存在风险。在医生、药师、护士和医务科行政人员中,2016年中华医学会儿科学分会临床药理学组提出的《中国儿科超说明书用药专家共识》知晓率分别为51.2%、56.8%、35.8%和45.4%。结论中国大陆儿童超说明书用药现象普遍存在,急需统一有效的管理模式,需要制定出适合中国大陆的超说明书用药流程,加强医务人员培训,推进儿童规范化超说明书用药。
[Abstract]:Objective to investigate the management status and medical staff's cognition of children's super-instruction drugs in China, and to provide the basis for standardizing children's super-instruction drugs. Methods A cross-sectional study was designed to select at least one paediatric qualified medical unit in each province in mainland China. The survey included pediatricians, pharmacists, nurses and medical administrators. A working group composed of epidemiologists and pharmaceutical management experts made up the questionnaire of Chinese Children's Super-instructions for Drug use, which included 6 items of basic information dimension, 11 items of current situation and management dimension of superprescriptions in the hospital where they were located. There were 33 items in the knowledge dimension of drug use and its management and the consensus of Chinese Pediatrics experts. A questionnaire survey was conducted on the internet. Results 436 hospitals in 31 provinces participated in the investigation, of which 36 were specialized hospitals for children, 50 for maternal and child health care, 350 for general hospitals, 20 for first class hospitals, 185 for second class hospitals and 231 for third level hospitals. 2116 valid questionnaires were collected, including 621 doctors, 755 pharmacists, 531 nurses and 209 medical administrative staff, 712 junior titles, 894 intermediate titles and 510,510senior titles. The higher the professional title, the more the phenomenon of drug use, 18.8% of doctors often overuse the instructions, the higher the professional title, the greater the probability of over-prescribing, and 19.4% of doctors do not get a reminder from pharmacists or nurses when they use drugs in excess of instructions. Pharmacists have found that doctors' overuse of drugs is common. Regardless of whether the title of pharmacist is high or low (87.1% or 98.3%), regardless of hospital grade (82.1% or 94.2%), 6.9% and 8.8% of nurses refuse to carry out doctors' orders in the face of doctors' overprescriptions. 60.6% of the hospitals surveyed have a unified system for over-prescribing drugs, among which the proportion of third-level hospitals is higher than one. The proportion of second-level hospitals and specialized hospitals for children was higher than that in general hospitals and maternal and child health hospitals. 70% of the respondents thought that the over-instruction medication was not illegal, but more than 80% of the respondents believed that there was a risk of over-prescribing drugs. Among doctors, pharmacists, nurses and administrative staff of medical department, the awareness rate of "expert consensus of Chinese Pediatrics Hyperspecification" put forward by Clinical Pharmacology Group of Chinese Academy of Pediatrics in 2016 was 51.2% and 45.4%, respectively. Conclusion the phenomenon of supermanual drug use in children in mainland China is very common, and it is urgent to establish a unified and effective management model. It is necessary to establish a procedure suitable for the mainland of China, to strengthen the training of medical personnel, and to promote the standardization of drug use in children.
【作者单位】： 复旦大学附属儿科医院呼吸科;重庆医科大学附属儿童医院;
【分类号】：R985
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本文编号：2286573