药物使用回顾性审查,处方错误和临床结果
Sean Hennessy1, Warren B Bilker, Lan Zhou
1Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia 19104-6021, USA. shenness@cceb.med.upenn.edu
JAMA
|September 18, 2003
概括
追溯药物利用评估 (DUR) 没有减少处方错误或改善患者的治疗结果. 政策制定者应该重新考虑这项必要的审查过程的授权.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 药物经济学 药物经济学
- 临床药房 临床药房
背景情况:
- 药物使用回顾性审查 (DUR) 是国家医疗补助计划的强制性要求,在私营部门也很常见.
- 目前的证据并未证明,追溯DUR可以改善临床结果或减少处方错误 (例外).
研究的目的:
- 评估后期DUR对处方错误率的影响.
- 评估后期DUR对处方错误的患者临床结果的影响.
主要方法:
- 一项纵向生态研究分析了例外率,控制了干预前的趋势和时间.
- 一项队列研究检查了例外患者的住院情况,控制了六个医疗补助计划中的混因素.
主要成果:
- 追溯DUR实施并没有降低异常率;观察到异常率有所增加 (0.064每1000处方/月).
- 追溯DUR对所有原因或特定原因住院的住院没有显著影响.
- 医生警报仅在研究州的1-25%的例外情况中被使用.
结论:
- 药物使用回顾性审查表明,对处方错误率或临床结果没有可衡量的影响.
- 鉴于缺乏经过证明的有效性和潜在的危害,政策制定者应该考虑取消对追溯DUR的立法授权.
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