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中国防痨杂志 ›› 2012, Vol. 34 ›› Issue (12): 808-812.

• 论著 • 上一篇    下一篇

抗结核药品合理化使用核查方法的探讨

万利亚 周林 成诗明 王倪 马艳   

  1. 100710 北京，中国防痨协会（万利亚）；中国疾病预防控制中心结核病预防控制中心（周林、成诗明、王倪）；北京市结核病胸部肿瘤研究所临床中心办公室（马艳）
  • 收稿日期:2012-10-20 出版日期:2012-12-10 发布日期:2013-03-09
  • 通信作者: 万利亚 E-mail:wanly@chinatb.org
  • 基金资助:

    中国全球基金结核病项目实施性研究(08-009)

Study on the usage verification for rational use of anti-TB drugs

WAN Li-ya，ZHOU Lin，CHENG Shi-ming，WANG Ni，MA Yan   

  1. Chinese Antituberculosis Association, Beijing 100710, China
  • Received:2012-10-20 Online:2012-12-10 Published:2013-03-09
  • Contact: WAN Li-ya E-mail:wanly@chinatb.org

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摘要： 目的  探讨药品使用核查的方法，间接评价药品使用的合理性。 方法  采取典型调查的方法，选择河南省（县1、县2）、重庆市（县3、县4）和吉林省（县5、县6），共6个县作为调查现场，通过全国结核病防治季报表获得各结核病防治机构肺结核患者发现和治疗转归等信息，同时查阅各结核病防治机构药品出入库登记本和患者病历获得药品出入库数量、过期破损数量和断货天数等信息。根据指标定义计算缺货率、过期破损率、正确处方率和药品使用核查差异度（参考区间定为±25%）等指标。2007年1—12月，调查现场共发现新发涂阳肺结核患者2122例，复治涂阳肺结核患者202例，涂阴肺结核患者1596例。新发涂阳肺结核患者2个月末痰检未阴转率为6.03%（128/2122）；复治涂阳肺结核患者2个月末痰检未阴转率为7.92%（16/202）。 结果  调查现场缺货率为1.78%［234/（36×365）］，过期破损率为0.57%［2159/（125 544+250 440）］；按整群抽样调查的方法调查了1200例肺结核患者，均按照《中国结核病防治规划实施工作指南（2008年版）》的要求开出正确处方，正确处方率100%；HRZE板式组合药使用核查差异度为－41.93%［（84.378－119 760）/84.378］，最高为－12.1%［（13 140－14 730）/13 140］，最低为－86.36%［（10 673－19 890）/10 673］，其中县4、县5和县6差异度低于－25%；HR板式组合药使用核查差异度为－28.60%［（173 475－223 080）/173 475］，最高为－14.05%［（34 470－39 600）/34 470］，最低为－114.51%［（17 761－38 100）/17 761］，其中县5和县6差异度低于－25%；HRE板式组合药使用核查差异度为31.22%［（26 434－18 180）/26 434］，最高为90.91%［（3960－360）/3960］，最低为3.52%［（2985－2880）/2985）］，其中县1、县2和县5差异度高于25%。  结论  通过比较理论与实际消耗量差异的方法进行药品使用核查，可以粗略评价抗结核治疗中合理化用药的情况，建议每6个月或1年开展一次。

关键词: 结核, 肺/药物疗法, 抗结核药, 药物利用, 治疗结果

Abstract: Objective  To discuss the method of drug use verification to evaluate the rational use of drug indirectly.  Methods  The typical survey methods were adopted and six counties were selected from Henan, Chongqing and Jilin. The information of TB case detection and treatment outcome was collected from national control quarterly report. And the information related to in- and out- store, damage or expired, out of stock was collected from account book and medical record. Out of stock rate, damage/expired rate, correct prescription rate and drug use verification difference degree were calculated according to the definitions. Totally 2122 new smear positive TB, 202 retreatment smear positive TB, and 1596 smear negative TB were involved from 2007.1－12.  The smear negative conversion rates at the end of two months’ treatment was 6.03% (128/2122) for new smear positive cases and 7.92% (16/202) for retreatment smear positive cases. Results  Out of stock rate was 1.78% (234/(36×365)) and damage/expired rate was 0.57% (2159/(125 544+250 440)). 1200 TB cases, selected by cluster sampling method, were all given the correct prescriptions in accordance with “Guidelines for Implementing the National Tuberculosis Control Program in China”. The drug use verification difference degree of HRZE was －41.93%((84 378－119 760)/84 378), with the maximum－12.1% ((13 140－14 730)/13 140) and the minimum －86.36% ((10 673－19 890)/10 673)), there were 3 counties below －25%. The difference degree of HR was －28.60%((173 475－223 080)/173 475), with the maximum－14.05% ((34 470－39 600)/34 470) and the minimum －114.51%((17 761－38 100)/17 761)), there were 2 counties below －25%. The difference degree of HRE was 31.22% ((26 434－18 180)/26 434), with the maximum 90.91% ((3960－360)/3960) and the minimum 3.52% ((2985－2880)/2985)), there were 3 counties above 25%.  Conclusion  As it’s possible that evaluating the rational drug use roughly through comparing the difference between theoretical and actual consumptions, we suggest implement drug use verification every six months or one year.

Key words: Tuberculosis, pulmonary/drug therapy, Antitubercular agents, Drug utilization, Treatment outcome

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