摘要
目的 利用真实世界数据,从药物有效性、安全性和经济性角度出发,利用社会网络分析研究医师用药习惯,为按疾病诊断相关分组(DRG)付费下合理用药提供思路。方法 选取2021年1月1日—6月30日某三级甲等综合医院出院患者信息,基于DN-DRG分组器,获取甲状腺大手术组(KD19)所有合并用药,绘制整体网络关系图,根据凝聚子群网络的树形图开展用药方案优化。结果 共纳入80种常用药物,通过对1 681例甲状腺大手术患者的合并用药进行关系网络划分,得到4个主要用药子群,进一步对药物中心度和连接度高的核心子群3进行用药优化,主要包括地塞米松、托烷司琼、泮托拉唑钠、体外培育牛黄、帕洛诺司琼等药物,结合处方点评等方法,发现存在的不合理用药问题包括围术期预防应用左氧氟沙星和超说明书使用中药制剂,同时提示从药物经济性角度应进一步扩大重点监控药品管控范围。结论社会网络分析工具可协助临床药师在医疗机构按DRG付费开展精细化药事管理工作。
Objective To explore the medication habits based on the method of social network analysis,and to research the medication regimens from the perspectives of drug effectiveness,safety and economy,which provide a reference for rational drug use under the payment of DRG. Methods Based on the DN-DRG grouping, the combination of drug use in patients included the major thyroid surgery group(KD19) were extracted using the hospital information system from January to June 2021. A systemic social network analysis was performed for the combination of drug use,and further subgroup network extracted via tree diagram for the optimization medication regimens. Results A total of 80 commonly used drugs and 1 681 patients undergoing the major thyroid surgery were included for the network analysis, and then four major drug subgroups were obtained by extracting subgroup analysis. Subgroup 3 with the highest drug centrality and connectivity was optimized, including dexamethasone,tropisetron, pantoprazole, cultured bezoar in vitro, palonosetron and so on. Combined with the comment of prescription,the possible problems of irrational drug use included the preventive use of levofloxacin in perioperative period and the off-label use of traditional Chinese medicines. Meanwhile,it was suggested to further expand the scope of adjuvant medicines from the perspective of pharmacoeconomic. Conclusion The method of social network analysis can be used to perform the delicacy pharmacy management based on DRG payment for clinical pharmacist.
作者
魏安华
戴小喆
董登姣
唐忻
李娟
Wei Anhua;Dai Xiaozhe;Dong Dengjiao(Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei,430030,China;不详)
出处
《中国医院管理》
北大核心
2023年第1期79-83,共5页
Chinese Hospital Management
基金
国家自然科学基金青年科学基金项目(81803841)。
