多科室就诊患者处方中药物相互作用监测与评价

【作者】 覃韦苇； 应寅清； 孙黎敏； 张千； 王斌； 焦正； 钟明康；

【机构】 复旦大学附属华山医院；

【摘要】 目的:药物相互作用(Drug-Drug Interactions,DDIs)以及DDIs相关的药物不良反应随着用药数量的增加而增加。目前的处方审核软件一般只监测、审核某一科室开出的药品,对于不同科室开出的药品之间的DDIs缺乏有效的协调审核。门诊多科室就诊患者的用药安全存在风险。本研究旨在评估门诊多科室就诊患者处方中DDIs的发生率、来源与严重程度,并比较三种主流的药物信息数据库对DDIs的监测与评价,为该类患者的DDIs审核提供参考。方法:收集本院1周内到多个门诊科室就诊的所有患者的处方。回顾性处方分析,将DDIs分为两种类型,将来自同一个科室的药品组合形成的DDIs定义为科室内DDIs,将来自不同科室的药品组合形成的DDIs定义为科室间的DDIs。用Mcdex数据库、Micromedex数据库以及MIMS数据库分别鉴别、评价DDIs的严重程度。结果:(1)发生率:在收集的2117位患者的4632张处方中,Mcdex、Micromedex以及MIMS数据库分别鉴别出2130个,283个和1068个DDIs。三个数据库评价的DDIs的总体发生率分别为每百人100.1个、每百人13.4个和每百人50.4个。(2)来源:以Micromedex数据库评价结果分析,科室内DDIs发生率为每百人6.2个;科室间DDIs发生率为每百人7.1个,二者无统计学差异(6.2%vs.7.1%,P>0.05)。(3)严重程度:Mcdex、Micromedex以及MIMS数据库分别鉴别出1605个谨慎或禁忌的DDIs,124个Major或Contraindicated的DDIs,或126个谨慎或严重DDIs;三个数据库评价为谨慎(或Major)及以上等级的DDIs的比率分别为75.3%、43.8%和11.8%。除去重复发生的DDIs,31个DDIs被两个以上数据库评价为谨慎或禁忌的DDIs。讨论:(1)多科室就诊患者中DDIs的发生率较高,科室内DDIs和科室间DDIs各占一半。科室间DDIs不能忽视。(2)不同的药物信息数据库对DDIs的评价可能不同,临床应用时应综合参考不同数据库的评价。添加可以识别科室间DDIs的预警软件,且药师参与该类患者的用药安全管理是十分必要的。更多还原

【Abstract】 Objective:Drug-Drug Interactions(DDIs) affects patient’s medication safety.Patients visiting multiple clinics are at a potential risk of DDIs due to the increased number of mediations they are taking and the shortage of medication reconciliation between different clinics.The purpose of the study was to assess the incidence,source and severity of DDIs among outpatients who visited multiple clinics by using three leading drug interaction compendia.Methods:This was a one week,retrospective,observational study conducted at a medical center in China.We coded DDIs as "inner clinic DDI" if the two medications involved prescribed from the same clinic or as " intra clinics DDI"if the two medications involved prescribed from two different clinics.Mcdex,Micromedex and MIMS drug interaction databases were used to identify DDIs and to assess the severity of DDIs respectively.Results:(1) Incidence We collected 4632 medication prescriptions of 2117 patients who visited at least two clinics during study period.Mcdex,Micromedex and MIMS identified the numbers of 2130,283 and 1068 DDIs,respectively.The incidences of DDIs identified by the three compendia were 100.1 DDIs/100 patients,13.4 DDIs/100 patients and 50.4 DDIs/100 patients respectively.(2) Source Micromedex identified 7.1 intra clinics DDIs/100 patients and 6.2 inner clinics DDIs/100 patients,respectively(6.2% vs.7.1%,p>0.05).(3) Severity Numbers of 1605(75.3%),124(43.8%) or 126(11.8%) DDIs were identified as major or contradicted by Mcdex,Micromedex and MIMS,respectively.After removing duplicates,a number of 31 DDIs were identified as major or contradicted by at least two DDI compendia.Conclusion:(1)The intra clinics DDIs should not be ignored as it accounted for half the incidence of DDIs among outpatients visiting multiple clinicians.(2) There was a lack of consistency in the inclusion and grading of drug interactions across the three drug compendia.Healthcare providers should reconcile the discrepancies to get appropriate evaluation of DDIs.Computer based DDIs software should be introduced to help to detect intra-clinics DDIs during order entry or pharmacist’s efforts should be added to help reconcile the intra clinics DDIs during dispensing.更多还原