【摘要】：目的調(diào)查中國(guó)兒童超說(shuō)明書(shū)用藥的管理現(xiàn)狀及醫(yī)務(wù)人員的認(rèn)知度,為規(guī)范兒童超說(shuō)明書(shū)用藥提供依據(jù)。方法以橫斷面研究設(shè)計(jì),在中國(guó)大陸每個(gè)省至少選擇一家具備兒科資質(zhì)的醫(yī)療單位;調(diào)查人群:兒科醫(yī)生、藥師、護(hù)士和醫(yī)務(wù)科行政人員;由兒科臨床專(zhuān)家、藥學(xué)專(zhuān)家、流行病學(xué)專(zhuān)家和藥事管理專(zhuān)家組成的工作小組自制《中國(guó)兒童超說(shuō)明書(shū)用藥調(diào)查表》,包括基本信息維度6個(gè)條目,所在醫(yī)院超說(shuō)明書(shū)用藥的現(xiàn)狀及管理維度11個(gè)條目,超說(shuō)明書(shū)用藥及其管理的認(rèn)知和《中國(guó)兒科超說(shuō)明書(shū)用藥專(zhuān)家共識(shí)》知曉情況維度33個(gè)條目,行網(wǎng)絡(luò)問(wèn)卷調(diào)查。結(jié)果全國(guó)31省436家醫(yī)院參與調(diào)查,其中兒童專(zhuān)科醫(yī)院36家,婦幼保健院50家,綜合性醫(yī)院350家;一級(jí)醫(yī)院20家,二級(jí)醫(yī)院185家,三級(jí)醫(yī)院231家。收集到有效問(wèn)卷2116份,其中醫(yī)生621名、藥師755名、護(hù)士531名和醫(yī)務(wù)科行政人員209名;初級(jí)職稱(chēng)712名、中級(jí)職稱(chēng)894名、高級(jí)職稱(chēng)510名。63.8%的醫(yī)生有開(kāi)具超說(shuō)明書(shū)用藥處方經(jīng)歷,職稱(chēng)越高,超說(shuō)明書(shū)用藥的現(xiàn)象越多;18.8%的醫(yī)生經(jīng)常超說(shuō)明書(shū)用藥,職稱(chēng)越高經(jīng)常超說(shuō)明書(shū)用藥發(fā)生概率越大;19.4%的醫(yī)生超說(shuō)明書(shū)用藥時(shí)都沒(méi)有得到藥師或護(hù)士提醒。藥師發(fā)現(xiàn)過(guò)醫(yī)生超說(shuō)明書(shū)用藥的情況是普遍存在的,不論藥師職稱(chēng)的高與低(87.1%~98.3%),不論醫(yī)院級(jí)別(82.1%~94.2%),6.9%~8.8%的護(hù)士面對(duì)醫(yī)生超說(shuō)明書(shū)用藥拒絕執(zhí)行醫(yī)囑。60.6%的被調(diào)查醫(yī)院針對(duì)超說(shuō)明書(shū)用藥有統(tǒng)一制度流程,其中三級(jí)醫(yī)院的比例高于一、二級(jí)醫(yī)院,兒童專(zhuān)科醫(yī)院的比例高于綜合醫(yī)院和婦幼保健院。70%的被調(diào)查者認(rèn)為超說(shuō)明書(shū)用藥并不違法,但是80%以上的被調(diào)查者肯定超說(shuō)明書(shū)用藥存在風(fēng)險(xiǎn)。在醫(yī)生、藥師、護(hù)士和醫(yī)務(wù)科行政人員中,2016年中華醫(yī)學(xué)會(huì)兒科學(xué)分會(huì)臨床藥理學(xué)組提出的《中國(guó)兒科超說(shuō)明書(shū)用藥專(zhuān)家共識(shí)》知曉率分別為51.2%、56.8%、35.8%和45.4%。結(jié)論中國(guó)大陸兒童超說(shuō)明書(shū)用藥現(xiàn)象普遍存在,急需統(tǒng)一有效的管理模式,需要制定出適合中國(guó)大陸的超說(shuō)明書(shū)用藥流程,加強(qiáng)醫(yī)務(wù)人員培訓(xùn),推進(jìn)兒童規(guī)范化超說(shuō)明書(shū)用藥。
[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.
【作者單位】： 復(fù)旦大學(xué)附屬兒科醫(yī)院呼吸科;重慶醫(yī)科大學(xué)附屬兒童醫(yī)院;
【分類(lèi)號(hào)】：R985
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本文編號(hào)：2286573