倾向评分匹配法在门诊糖皮质激素处方合理性评价中的应用

摘要

目的：探讨倾向评价匹配法在门诊糖皮质激素处方合理性评价中的应用。方法：利用等概率整群抽样法，抽取我院（北部院区）2015年门诊使用糖皮质激素类药物的处方1271张。根据药品说明书、《糖皮质激素类药物临床应用指导原则》和临床指南等，对处方中糖皮质激素使用合理性进行判断，将不合理处方纳入不合理处方组，采用倾向评分匹配法，在合理处方中选取与不合理处方在性别、年龄、医保方面完全一致（P＝1）的相同数量的处方纳入合理处方组。比较两组在疾病系统、药物剂型、给药途径、药物用量方面的差异。结果：1271张处方中，用药合理的处方1168张（91.90％），不合理处方103张（8.10％），经倾向评分匹配后，两组各纳入103张处方相对于合理处方组，不合理处方组在药物剂型（P＝0.962）、给药途径（P＝0.246）和DDDs（P＝0.307）方面差异无统计学意义，但在疾病系统方面不合理组中有56张（54.4％）处方的诊断疾病超出指导原则，而合理用药组中仅1张处方（1.0％）超出指导原则，两组比较差异有统计学意义（P＜0.001）。不合理处方分析中，99张（96.1％）处方为适应证不合理，4张（3.9％）处方为给药途径不合理。结论：采用倾向评分匹配法开展处方点评，有助于发现影响处方合理性的因素，药师在审核处方时发现所患疾病超出指导原则时应慎重，重点判断其使用合理性。%OBJECTIVE:To explore the application of propensity score matching in the rationality evaluation of outpatients glucocorticoid prescriptions. METHODS:1 271 outpatient prescriptions including glucocorticoid drugs in 2015 were selecteds by equal probability cluster sampling from nerth district of our hospital. According to drug package inserts,Guiding Principles for Clin-ical Application of Glucocorticoid Drugs and clinical guidelines,the rationality of glucocorticoid used in prescriptions were judged irrational ones were included in irrational prescriptions (IP) group. Rational prescriptions (RP) group included the same number which were selected from rational prescriptions by propensity score matching (PSM) and were in line with irrational ones in re-spects of gender,age and medical insuranc (P=1). The differences between 2 groups were compared in respects of disease sys-tem,dosage form,route of administration and drug dosage. RESULTS:There were 1 168 rational prescriptions(91.90%)and 103 irrational ones(8.10%)in 1 271 prescriptions. After PSM,2 groups of ochincluded 103 prescriptions,there was no statistical dif-ference between RP group and IP group in terms of dosage form(P=0.962),route of administration(P=0.246)and DDDs(P=0.307). For disease system,disease diagnose of 56 prescriptions(54.4%)in IP groups went beyond guideline principle,while one prescription(1.0%)in RP group,with statistical significance(P<0.001). Among irrational prescription analysis,99 prescriptions (96.1%) were irrational indication,and 4 prescriptions (3.9%) were irrational route of administration. CONCLUSIONS:PSM is helpful to find out the factors inducing irrational prescription,pharmacists should be careful and focus on rationality judgement when they find that disease system is berond guiding principle.