昆明医科大学第一附属医院临床路径药学评价体系的建立与应用

摘要

目的:探索昆明医科大学第一附属医院(以下简称"我院")临床路径药学评价体系的建立与应用.方法:利用德尔菲法,在文献研究的基础上,从药物使用的安全、有效、合理和经济等4个方面拟定临床路径合理用药评价体系,向全国30位专家进行2次问卷调查,并对结果进行分析,最终建立我院临床路径合理用药评价体系,并根据该体系对我院带状疱疹的临床路径用药进行评价.结果:两轮问卷调查后,专家积极系数为100％,权威系数分别为0.805和0.830,一级指标的协调系数分别为0.537和0.476(P＜0.01),二级指标的协调系数分别为0.334和0.311(P＜0.01),最终建立了包含4个一级指标和14个二级指标的临床路径药学评价体系.应用该体系对我院带状疱疹的临床路径用药进行评价,结果显示,实施临床路径的受试组患者给药剂量、间隔与疗程、给药途径、抗菌药物均次使用种数、抗菌药物使用时间、抗菌药物使用率、平均住院时间、治疗总费用、平均药品费用和基本药物费用所占比例均明显低于未实施临床路径的对照组患者,差异均有统计学差异(P＜0.05).结论:我院临床路径药学评价体系的可靠性较高,该体系基本得到专家的认可,可以作为评价临床路径用药的有效工具.%OBJECTIVE: To investigate the establishment and application of clinical pathway pharmacy evaluation system in the First Affiliated Hospital of Kunming Medical University (hereinafter referred to as "our hospital"). METHODS: Based on the literature research, Delphi's method was used to draw up the rational drug evaluation system of clinical pathway from the aspects of safety, effectiveness, rationality and economy of drug use. Two questionnaires were made to 30 experts nationwide and the results were analyzed, and ultimately the clinical pathway rational drug evaluation system of our hospital was establish. According to the system, the clinical route of medication for bullous zoster in our hospital was evaluated. RESULTS: After two rounds of questionnaires, the expert's positive coefficient was 100％, the authority coefficient was 0.805 and 0.830 respectively. The coordination coefficients of the first-level indicators were 0.537 and 0.476 respectively (P＜0.01). The coordination coefficients of the second-level indicators were respectively 0.334 and 0.311 (P＜0.01). Finally, the drug evaluation system of clinical pathways including 4 first-level indicators and 14 second-level indicators was established. The system was used to evaluate the clinical pathway of blisters, the results showed that the dose, interval and course of treatment, route of administration, categories of antibiotics, application time of antibiotics, application rate of antibiotics, average length of stay, total treatment cost, proportion of average drug cost and essential drug cost in patients in the trial group with implementation the clinical pathway were significantly significantly lower than that of the control group without clinical pathway, and the differences were statistically significant (P＜0.05). CONCLUSIONS: The reliability of the clinical pathway pharmacy evaluation system in our hospital is relatively high, which is basically recognized by experts and can be used as an effective tool for the evaluation of clinical pathway drug use.