【摘要】 目的:阐述证据质量评价方法在临床药学实践工作中的应用,促进临床合理用药。方法:介绍我院(怀化市第一人民医院)临床药师以循证医学为基础制订的药物使用的证据质量评价标准化流程[以GRADE(Grades of Recommendations Assessment,Development and Evaluation)系统为主],并通过医嘱点评、新药申请和用药咨询三项临床药学实践案例描述该流程的使用方法。结果与结论:我院制订的证据质量评价标准化流程为首先查找权威指南及参考书、药品说明书和相关研究文献等,当查找后在无高级别证据的情况下应用GRADE系统对现有证据进行评分、定级等来量化其质量,以及时、准确地给出用药建议。在3个实践案例中,使用GRADE系统评分结果分别为≤-3分、=-2分、≤-3分,证据级别分别为D级(极低级证据)、C级(低级证据)、D级,推荐强度分别为无推荐、弱推荐、强烈反对推荐。临床药师在工作中利用上述标准化的证据质量评价方法可为临床提供合理的用药建议。更多还原

【Abstract】 OBJECTIVE: To illustrate the application of evidence quality evaluation methods in the practice of clinical pharmacy and then promote clinical rational use of drugs. METHODS:The standardized process of evidence quality evaluation formulated by clinical pharmacists of our hospital(Huaihua First People’s Hospital)on the basis of evidence-based medicine was introduced [mainly including evidence quality grading and recommended density system of GRADE(Grades of Recommendations Assessment,Development and Evaluation)]. The application of the process was described through 3 projects of clinical pharmacy practice as medical order review,new drug purchase and drug consultation. RESULTS & CONCLUSIONS:The process of evidence quality evaluation in our hospital was as follows:Firstly,find preferentially authoritative guides and references,drug package inserts and related studies,etc. Then,use the GRADE system to quantify the quality of existing evidence when no high-level evidences were found. Lastly,medication advices could be given timely and accurately. The scores of 3 cases according to GRADE system were≤-3 points,=-2 points,≤-3 points,respectively. Corresponding evidence levels were successively D level(very low level evidence), C level(low level evidence) and D level. Further, recommended strengths were no recommendation,weak recommendation and strong recommendation against drug treatment programs. Clinical pharmacists make use of the above-mentioned standardized quality evaluation methods in clinical work,so as to provide reasonable medication recommendations for clinical practice.更多还原