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县域医共体以抗感染临床药师为主体的抗菌药物使用管理模式

应用及评价
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邓晓琴 ，赵 池 ，李召红，阎鸿焰，沈东芳，谭何浪，姜明仲，邓南骏（重庆市忠县人民医院药剂科，重庆 忠县
404300）

中图分类号 R95 文献标志码 A 文章编号 1001-0408（2024）01-0095-06
DOI 10.6039/j.issn.1001-0408.2024.01.17

摘 要 目的 为提升乡镇医疗机构抗菌药物合理使用水平提供参考。方法 通过县域前置审方中心以抗感染临床药师为主体的
团队查找乡镇医疗机构抗菌药物使用中存在的主要问题、进行问题反馈、针对问题组织相关培训、完善前置审方软件的自定义规
则、实施自动拦截及药师在线审方等措施，构建以抗感染临床药师为主体的县域医共体抗菌药物使用管理模式。收集该县域医共
体 15 家乡镇医疗机构 2022 年 1－6 月（该模式实施前）和 2023 年 1－6 月（该模式实施后）的抗菌药物使用数据，并进行比较。
结果 与该模式实施前相比，各乡镇医疗机构门诊患者抗菌药物使用率由实施前的24.97%下降至19.39%，门诊患者抗菌药物注射
剂使用率由66.10%下降至46.80%，门诊患者抗菌药物静脉滴注使用率由52.33%下降至40.35%，门诊患者抗菌药物联合使用率由
12.70%下降至8.19%，门诊抗菌药物处方点评合理率由55.28%提升至73.93%。实施后，各诊断抗菌药物处方占比与实施前基本
一致；按药品解剖学、治疗学及化学分类法分类，少数抗菌药物的用药频度（DDDs）及占比较实施前有所改变，其中林可霉素、庆大
霉素等药物的DDDs下降明显；按照AWaRe分级目录分类，各分类抗菌药物DDDs占比与实施前基本一致。结论 基于县域医共
体前置审方中心构建以抗感染临床药师为主体的抗菌药物使用管理模式可有效提升乡镇医疗机构抗菌药物的合理使用水平。
关键词 县域医共体；抗菌药物；乡镇医疗机构；临床药师；合理用药

Application and evaluation of management mode for the use of antimicrobial drugs in county-level medical
communities led by anti-infective clinical pharmacists
DENG Xiaoqin，ZHAO Chi，LI Zhaohong，YAN Hongyan，SHEN Dongfang，TAN Helang，JIANG Mingzhong，
DENG Nanjun（Dept. of Pharmacy， Zhongxian People’s Hospital of Chongqing， Chongqing Zhongxian 404300，
China）

ABSTRACT OBJECTIVE To provide reference for improving the rational use of antimicrobial drugs in primary township
medical institutions. METHODS Based on the county prescription pre-review center， a team led by anti-infective clinical
pharmacists constructed the management mode for the use of antimicrobial drugs in county-level medical communities with clinical
pharmacists as the main team by finding out the main problems in the use of antimicrobial drugs in primary township medical
institutions， providing feedback on the problems， organizing relevant training for the problems， improving the customization rules
of the prescription pre-review software， implementing the automatic interception and pharmacist online prescription review and
other measures. Data on the use of antimicrobial drugs were collected and compared in the 15 primary township medical institutions
between January-June in 2022 （before the implementation of the mode） and January-June in 2023 （after the implementation of the
mode）. RESULTS Compared with before the implementation of the mode， the utilization rate of antimicrobial drugs in outpatients
of primary township medical institutions decreased from 24.97% before the implementation of the mode to 19.39% after the
implementation of the mode； the utilization rate of antimicrobial injection in outpatients decreased from 66.10% to 46.80%； the
utilization rate of intravenous drip of antimicrobial drugs in outpatients decreased from 52.33% to 40.35%； the rates of combined
use of antimicrobial drugs in outpatients decreased from 12.70% to 8.19%； the reasonable rate of antimicrobial prescribing in
outpatients increased from 55.28% to 73.93%. After the implementation of the mode， the proportion of antimicrobial prescriptions
for each diagnosis was basically the same as before； the
Δ 基金项目 重庆市科卫联合医学科研项目（No.2022MSXM126） defined daily dose system （DDDs） and proportion of a few
＊第一作者 副主任药师。研究方向：药事管理、临床药学。电话：
antimicrobial drugs changed compared with before according
023-54246806。E-mail：740159837@qq.com
# 通信作者 主任药师。研究方向：药事管理、临床药学。电话： to the anatomical therapeutic chemical classification of drugs，
023-54246806。E-mail：445090372@qq.com among which DDDs of lincomycin， gentamicin and other

中国药房 2024年第35卷第1期 China Pharmacy 2024 Vol. 35 No. 1 · 95 ·