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DRG视角下临床药师参与肿瘤中心药事精细化管理的实践与思考
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| 篇名： | DRG视角下临床药师参与肿瘤中心药事精细化管理的实践与思考 |
| TITLE： | Practice and exploration of clinical pharmacists participating in refined pharmaceutical management of oncology center from the perspective of DRG |
| 摘要： | 目的探讨临床药师基于疾病诊断相关分组（DRG）参与肿瘤中心住院患者药事精细化管理的成效。方法以陆军军医大学大坪医院肿瘤中心进入DRG病组且住院时间不超过60d的出院患者为对象，分析临床药师参与药事精细化管理干预前（2019年1－12月）、干预后第1年（2020年1－12月）、干预后第2年（2021年1－12月）患者的DRG指标和住院相关指标的变化情况；根据DRG入组情况和疾病诊疗方式选取肿瘤中心重点DRG病组，分析其干预前后的住院相关指标和干预后的合理用药情况。结果与干预前比较，干预后第1、2年，DRG病组数增至157、184种，病例组合指数显著升高（P＜0.05），费用消耗指数、时间消耗指数、平均住院日、次均住院费用均显著降低或缩短（P＜0.05），次均药费均显著升高（P＜0.05），无低风险死亡和严重药品不良反应发生。在4种重点DRG病组中，RE19、RU29病组干预后第1、2年的平均住院日和RU14病组干预后第1年的平均住院日，RE19病组干预后第1、2年的次均住院费用和RU14、RV19、RU29病组干预后第2年的次均住院费用，以及RU14病组干预后第2年的次均药费均显著低于干预前（P＜0.05），RE19、RU29病组干预后第1、2年的次均药费均显著高于干预前（P＜0.05）；干预后次均药费显著增加的DRG病组存在药品联用不适宜、用法用量不适宜、超说明书用药等不合理用药情况。结论在DRG背景下，临床药师参与药事精细化管理后，肿瘤中心整体诊疗服务能力提升，诊疗效率有所提高，且无低风险死亡及严重药品不良反应病例，促进了医疗机构合理用药。 |
| ABSTRACT： | OBJECTIVE To investigate the effectiveness of clinical pharmacists’ participation in the refined pharmaceutical management for inpatients of oncology center based on diagnosis related groups （DRG）. METHODS Patients who entered DRG and stayed in hospital for less than 60 days in oncology center of Daping Hospital， Army Medical University were selected as the research objects to analyze the changes of DRG indicators and related hospitalization indicators before the intervention of clinical pharmacists’ participation in the refined pharmaceutical management （Jan.-Dec. 2019）， the first year after the intervention （Jan.- Dec. 2020）， and the second year after the intervention （Jan.-Dec. 2021）； the key DRG groups were selected from the oncology center according to DRG enrollment and disease diagnosis and treatment methods， and related hospitalization indicators before and after the intervention and rational drug use after intervention were analyzed. RESULTS Compared with before intervention， in the first and second years after the intervention， the number of DRG groups increased to 157 and 184， and the case mix index increased significantly （P＜0.05）， while costconsumption index， time consumption index， average hospital stay and average hospitalization expense per time were decreased or shortened significantly （P＜0.05）； drug cost per time was increased significantly （P＜0.05）， and there were no low- risk deaths and severe adverse drug reactions. Among the 4 key DRG groups， the average hospital stay in RE19 disease group and RU29 disease group in the first and second year after intervention and those of RU14 disease group in the first year after intervention were significantly lower than before （P＜0.05）； the average hospitalization expense per time of RE19 disease group in the first and second year after intervention and those of RU14 disease group， RV19 disease group and RU29 disease group in the second year after intervention were significantly lower than before （P＜0.05）； drug cost per time of RU14 disease group in the second year after intervention was significantly lower than before， while those of RE19 disease group and RU29 disease group in the first and second year after intervention were significantly higher than before （P＜0.05）. There was some irrational drug use in the DRG disease groups with a significant increase in the drug cost per time after the intervention， such as inappropriate selection of drugs， inappropriate usage and dosage， off-label drug use， etc. CONCLUSIONS In the context of DRG， after the clinical pharmacists participated in the refined pharmaceutical management， the overall diagnosis and treatment service capacity of oncology center are improved， the efficiency of diagnosis and treatment are improved， and there are no low-risk deaths and severe adverse drug reactions， which promote the management of rational drug use in medical institutions. |
| 期刊： | 2022年第33卷第22期 |
| 作者： | 伍渊麟，鲜秋婉，李晨，陈世耕，侯敏，罗晓枫，刘耀 |
| AUTHORS： | WU Yuanlin，XIAN Qiuwan，LI Chen，CHEN Shigeng，HOU Min，LUO Xiaofeng，LIU Yao |
| 关键字： | 疾病诊断相关分组；临床药师；药事精细化管理；肿瘤中心；成效 |
| KEYWORDS： | diagnosis related groups； clinical pharmacist； refined pharmaceutical management； oncology center； effectiveness |
| 阅读数： | 267 次 |
| 本月下载数： | 16 次 |
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