19 254例门诊病例质子泵抑制剂更换的处方分析研究

Study on Prescription Analysis of Proton Pump Inhibitors Switch of 19 254 Outpatients

关键词:  质子泵抑制剂  处方分析  胃酸相关性疾病

Key words:  proton pump inhibitors  prescription analysis  gastric acid-related disease

摘要:

目的 比较治疗胃酸相关性疾病期间更换与未更换质子泵抑制剂(proton pump inhibitor, PPI)患者的临床特征和处方差异，为后续临床PPI用药的选择和优化提供依据。方法 建立门诊PPI处方数据库，纳入标准：被开具≥2张成人PPI处方的患者。非换药组指患者只使用了1种PPI且规格、剂量未变化；换药组指治疗中更换过PPI包括不同通用名称、同种通用名不同规格或剂量改变的药物。比较2组间患者数占比、疗程、处方张数、诊断结果、剂量强度和PPI的使用强度指标。结果 PPI处方分析显示换药组的例数占21.90%，高于非换药组。在65~79岁年龄段中，换药组与非换药组使用者例数比为1.22(826/678)。换药组的胃食管反流患者占13.14%，高于非换药组(8.28%)。换药组的平均处方数张高于非换药组(3.88±2.61 vs 2.81±1.88，P<0.05)，处方≥4张的例数比例换药组是非换药组的近三倍。换药组的平均疗程[(47.13±42.39) d]长于非换药组(P<0.05)。换药组的使用频度、每日费用及药物利用指标高于非换药组。结论 换药组的PPI使用者占比大，年处方数多，疗程长，使用强度大，医师和药师应优化PPI临床使用并加强用药安全教育，减少因更换药物带来的弊处，提高PPI临床用药价值。

Abstract:

OBJECTIVE To provide a reference for selecting and optimizing subsequent clinical proton pump inhibitor (PPI) medication by comparing the clinical characteristics and prescription differences of outpatients with and without the PPI switch in the treatment of gastric acid-related diseases.METHODS Outpatient PPI prescriptions database was established.Inclusion criteria were:patients prescribed with more than two adult PPI prescriptions.The non-switch drug group was defined as the patients who used only one PPI,and the specifications and dosage did not change.The switch drug group was defined as patients who switched the PPI with different generic names or specifications and dosage of the same generic name.The patient proportion,duration,number of prescriptions,diagnostic result,dose intensity and the utilization of PPI between the two groups were compared.RESULTS The PPI prescription analysis result showed the proportion of switch drug group accounted for 21.90%,which was higher than that in the non-switch drug group.In the 65-79 age group,the ratio of users in the switch drug group to the non-switch drug group was 1.22(826/678).The patient proportion of gastroesophageal reflux disease in the switch drug group was 13.14%,which was higher than that in the non-switch drug group (8.28%).The average number of prescriptions in the switch drug group was higher than that in the non-switch drug group (3.88±2.61 vs 2.81±1.88,P<0.05),the proportion of users with ≥ 4 prescriptions in the switch drug group was nearly three times than that of the non-switch drug group.The average duration of treatment in the switch drug group was (47.13±42.39) d,which was longer than that in the non-switch drug group (P<0.05).The frequency of use,defined daily cost and drug utilization index of PPI in the switch drug group were higher than in the non-switch drug group.CONCLUSION PPI users in the switch drug group have more proportion,more prescriptions per year,longer duration,and higher intensity.Clinical doctors and pharmacists should optimize the clinical use of PPI and strengthen the education of drug safety,reduce the disadvantages of drug switching and improve the clinical value of PPI.