Status Analysis and Improvement Strategies of Outpatient Prescriptions in Community Health Centers in China

doi:10.12114/j.issn.1007-9572.2019.00.091

Abstract

Abstract: Background　Outpatient prescribing is a major part of community health services.Irrational drug use can increase the occurrence of adverse drug reactions and aggravate the waste of health resources.Objective　To investigate the causes of irrational drug use in community health centers（CHCs） in China and put forward improvement strategies accordingly on the basis of systematically reviewing the survey articles regarding outpatient prescriptions in domestic CHCs published in the past decade.Methods　We searched the databases of PubMed，CNKI，Wanfang Data Knowledge Service Platform，and VIP for articles evaluating the rationality of outpatient prescriptions in CHCs in China published from June 30，2008 to June 30，2018.We summarized the outpatient prescribing in domestic CHCs，and put forward solutions to irrational drug use in CHCs based on related documents issued by the national government recently.Results　A total of 456 articles either in Chinese or English were searched，and 20 of them were included finally after reviewing the full contents.Analysis showed that the average percentage of irrational outpatient prescriptions in CHCs in China was 6.86%（9 079/132 350）．Problems of irrational drug use included inappropriate drugs for clinical diagnosis of conditions，incorrect dose and usage，inappropriate dosage forms and administration routes，repeated administration，possible drug interactions and incompatibilities，inappropriate selection of drugs，inaccurate or no prescription notes，and prescription writing issues.Conclusion　In general，a variety of problems related to outpatient prescribing are found in domestic CHCs，which are associated with legislative supervision，development of CHCs，community physicians and outpatients.To increase the rational use of drugs in CHCs，it is suggested that prescriptions quality assessment system should be developed and improved by relevant departments，medication trainings for community physicians should be strengthened，and e-prescribing system should be optimized.

Key words: Community health services, Community health centers, Prescriptions, Rational drug use, Status, Strategy

摘要： 背景　门诊处方是社区卫生服务的一项主要内容，不合理用药会增加药物不良反应事件的发生，加剧医疗卫生资源的浪费问题。目的　通过系统回顾近10年来公开发表的我国社区卫生服务中心门诊处方的调查研究文献，从整体上了解我国社区卫生服务中心在用药合理性方面存在的不足，分析其原因并提出相应的改进策略。方法　检索2008-06-30（含）至2018-06-30（含），收录于PubMed数据库、中国知网、万方数据知识服务平台、维普网中，关于我国社区卫生服务中心门诊处方合理性评价的文献，总结我国社区卫生服务中心的门诊用药情况，结合近年来国家出台的相关文件提出社区不合理用药问题的解决思路。结果　检索各文献数据库共命中中英文文献456篇，获取全文逐一浏览内容后确定目标文献共20篇。归纳相关文献内容，统计出我国社区卫生服务中心门诊处方平均不合格率为6.86%（9 079/132 350），存在的问题包括处方用药与临床诊断不符、剂量和用法不正确、选用剂型和给药途径不合理、重复给药、存在潜在的药物相互作用和配伍禁忌、选药用药不适宜、处方备注缺少或错误、其他处方书写问题。结论　我国社区卫生服务中心在门诊用药方面普遍存在较多问题，原因与立法监管、医疗机构、社区医生及患者有关。建议有关部门通过建立和完善处方点评制度、强化对社区医生的用药培训以及改进电子处方系统等途径提高社区卫生服务中心的用药合理性。

关键词: 社区卫生服务, 社区卫生中心, 处方, 合理用药, 现状, 策略

XU Zhijie,MAO Runyue,PAN Jianjiang, et al. Status Analysis and Improvement Strategies of Outpatient Prescriptions in Community Health Centers in China[J]. Chinese General Practice, 2019, 22(10): 1147-1152. DOI: 10.12114/j.issn.1007-9572.2019.00.091.
徐志杰,毛润越,潘健将等. 我国社区卫生服务中心门诊处方的现状分析和改进策略[J]. 中国全科医学, 2019, 22(10): 1147-1152. DOI: 10.12114/j.issn.1007-9572.2019.00.091.

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