Abstract: Background　The extended prescription service has been implemented since the extended prescription-related policy was specifically proposed during the comprehensive reform of community healthcare launched in Shanghai in 2015.However，there is a lack of study on the use of extended prescriptions in community-living chronic disease patients.Objective　To explore the use of extended prescriptions and influencing factors in community-living chronic disease patients，to provide a reference for optimizing this kind of services.Methods　A retrospective design was used.By use of cluster sampling，treatment data of chronic disease patients who had received extended prescriptions services from Zhujing Community Health Center of Jinshan District，Shanghai between 2017 and 2018 were extracted from the Health Information System of Jinshan District，Shanghai，and their general demographic information（sex，age，education level and marital status），disease history and medication （number of drug varieties） were obtained from the Residents' Health Records Management System.The use of extended prescriptions services and influencing factors（including problems） in these patients were analyzed.Results　There were 714 chronic disease patients who used extended prescriptions in Zhujing Community Health Center，accounting for 2.19% of the total patients（n=32 666） using prescription services during the two years，most of whom〔83.19%（594/714）〕 were 60 years old or older，and most of their visits were for treating common chronic diseases〔81.55%（707/867）〕，83.05% （593/714） of them had good adherence to extended prescriptions.The percentage of patients with good adherence to medication varied significantly by age，education level，marital status，type of disease，and medication（number of drug varieties） （P<0.05）.Of the total extended prescriptions，the problematic ones accounted for 12.50% （25/200），mainly included nonstandardized prescriptions〔without clinical diagnosis or with incomplete clinical diagnosis（10，5.00%），one treatment course longer than 30 days（6，3.00%），inappropriate drugs for symptoms（5，2.50%）〕 and inappropriate prescriptions〔inappropriate dosage（2，1.00%），inappropriate dosage form or route of administration（2，1.00%）〕．Conclusion　The prevalence of using extended prescriptions in this group is still relatively low.To improve this，it is suggested to strengthen the governmental support and guidance on extended prescription services.

Key words: Chronic disease, Extended prescription, Pharmacotherapy, Community health services, Development status, Cross-sectional studies

摘要： 背景　延伸处方是指上海市2015年专门在社区综合医改中推出的延伸处方政策，但目前对于延伸处方在社区慢病患者中的开展现状研究比较缺乏。目的　分析延伸处方在社区慢病患者中的开展现状，为优化延伸处方服务提供参考。方法　从上海市金山区卫生信息系统数据库中整群抽取2017—2018年在朱泾社区卫生服务中心就诊且使用延伸处方的慢病患者的数据，并通过《居民健康档案管理系统》掌握患者的基本信息（性别、年龄、文化程度、婚姻状况）、疾病史、用药情况（药品品种数），采用回顾性调查方法，分析延伸处方在社区慢病患者中的开展现状、影响因素和存在的问题。结果　2017—2018年朱泾社区卫生服务中心开具延伸处方的慢病患者共714例，占总开具处方（32 666例）的2.19%；其中60岁及以上老年慢病患者延伸处方开具率为83.19%（594/714）；疾病种类（例次）以常见慢性病为主（81.55%，707/867）；延伸处方执行依从性佳的慢病患者593例（83.05%）。不同性别慢病患者延伸处方执行依从性佳所占比例比较，差异无统计学意义（P>0.05）；不同年龄、文化程度、婚姻状况、疾病种类、用药情况（药品品种数）慢病患者延伸处方执行依从性佳所占比例比较，差异有统计学意义（P<0.05）。就诊于朱泾社区卫生服务中心的慢病患者延伸处方的不合格率为12.50%（25/200），主要问题为不规范处方和用药不适宜处方，不规范处方主要包括开具处方未写临床诊断或者诊断书写不全10例（5.00%）、延伸处方开具超过30 d用药时间6例（3.00%）、用药适宜证不适宜5例（2.50%）；用药不适宜处方主要包括药物的用法用量不适宜2例（1.00%）、药品剂型或给药途径不适宜2例（1.00%）。结论　社区慢病患者延伸处方开具率仍旧偏低，在社区慢病患者治疗管理中应进一步提高延伸处方的数量、执行依从性和处方开具质量。

关键词: 慢性病, 延伸处方, 药物治疗, 社区卫生服务, 开展现状, 横断面研究