Objective To collect and analyze the data of emergency medicine supply for both Wenchuan and Lushan earthquakes victims in the West China Hospital, so as to provide evidence for scientifically and efficiently carrying out the logistical support for emergency rescue medicines supply, and improving the coping capacity for those similar public health emergencies. Methods Both medicine constituent ratios and DDDs were taken as evaluation indexes, and the data were input by Excel software. Then the following items were analyzed: the use and cost of emergency medicine for victims admitted in the hospital from one day to one month after earthquake, as well as, the acceptance, allocation and use of the donation medicines for both Wenchuan and Lusan earthquakes. Results During the first month after Lushan earthquake, the victims used 26 categories of medicines involving 455 drug specifications in the West China Hospital. The dosage and DDDs of therapeutic medicines were higher than those of ancillary medicines. The donation medicines for Lushan earthquake accepted by the hospital were in 8 categories involving 16 drug specifications, and they were all used to rescue the victims in the hospital. Based on the hospital emergency medicine supply system oriented by the information of victim’s medicine use, the drug specification and total drug cost of the donation medicines for Lushan earthquake decreased by 90.91% and 89.73%, respectively, indicating a more accurate and efficient system compared with those for Wenchuan earthquake. Conclusion The implementation of the hospital emergency medicine supply system oriented by the information of victim’s medicine use is helpful to improve the time efficiency and pertinence of earthquake medical rescue.
Objective To imitate and calculate the ways, input amount and feasibility of governmental compensation to municipal public hospitals in Shenyang city after abolishing drug retail mark-up policy under existing conditions, so as to provide regional demonstration for the decision-making and smooth implementation of public hospital reform. Methods The relevant information of 18 municipal public general hospitals or specialized hospitals during 2008-2010, such as annual basic numeration tables, summary and detailed statements of income and expenditure were collected, and the average data of both national and provincial hospitals in the same or similar level during 2009-2011 were retrieved from China Health Statistics Yearbook. The Questionnaire of Compensation to Medical Institutions was self-designed, distributed and reclaimed in order to get the data of respective hospitals during 2008-2010. Then the following 4 compensation ways were calculated: governmental input compensation, price compensation of medical service, pharmaceutical affairs compensation for price difference, and integrated way of the former 3 compensations; and the feasibility of compensation after health system reform was analyzed. Results a) If the drug retail mark-up policy was abolished in municipal hospitals, the total loss of hospitals would increase from RMB 200 million yuan in 2008 to approximately RMB 330 million yuan in 2010. b) The balance of payments and patient’s cost of Shenyang municipal public hospitals were basically similar to those of both national and provincial hospitals in the same level. c) As for the year of 2010, the new governmental compensation after implementation of new health system reform was at least RMB 438 million yuan, accounted for about 1.8 % of general budget expenditure in Shenyang municipal level. d) The results of the imitation and calculation of 3 price adjustment schemes of medical service showed that, only the third could completely compensate the abolition of drug retail mark-up. e) As to the pharmaceutical service charge based on compensation for pharmaceutical administration, it was RMB 115.6921 million yuan in Shenyang municipal public hospitals in 2010, and it could compensate 58.6% of the drug price difference. f) Compared with the former 3 compensation ways, the integrated compensation way could make public hospitals have general balance of payments which were RMB 115 million yuan, 172 million yuan and 268 million yuan, respectively. Conclusion a) After the abolition of the hospital expense covered by drug revenue, it is reasonable and feasible in increasing governmental compensation according to the annual depreciation cost of permanent assets, adjustment of medical service price, and increase income of pharmaceutical service. b) The second integrated scheme of comprehensive compensation schemes can make most hospitals have some favorable balance; the slightly increasing charge of medical care is affordable by patients and medical insurance departments, so it is operable. c) The successful and sustainable implementation of public hospitals compensation policy depends on the reform of both structure and mode of payment in medical insurance system.
Objective To analyze the costs of emergency medication in the West China Hospital within one month after Lushan earthquake based on actual medication of the victims’ disease spectrum. Methods We collected emergency medication data as evaluation index in the West China Hospital within one month after Lushan earthquake, including daily cost, cumulative percentage of pharmacology category, average cost per day/person, average cost per day/person when DUI=1, difference between average cost per day /person, and average cost per day/person when DUI=1, etc. Then, we input data using Excel software for statistically analyzing the costs of emergency medication within one month after the earthquake. Results During one month after the earthquake, the costs changed consistently with the number of victims, which implied the change of costs was rational. Injuries were classified into 6 categories and 12 kinds according to ICD-10. The costs of medication accounted for 71% of the total costs. Six kinds of illness accounted for 21%. Medication for injuries was classified into 3 categories and 18 kinds; average cost per day was 186.87 yuan and average cost per person was 1 702.70 yuan. Medication for illness was classified into 5 categories and 28 kinds; average cost per day was 38.96 yuan and average cost per person was 185.13 yuan. The mean value of average cost per day/person of injection was 14.52/5.08 times more than that of non-injection. Meanwhile, the mean value of average cost per day/person of imported medication was 7.10/5.28 times more than that of domestic medication. Conclusion The factors that impact the medication costs include: a) disease burden and traumatic conditions of the sick and wound; b) administration pathway (injection vs. non-injection); c) imported or domestic medication; and d) the rationality of taking DUI as evaluation index. When DUIgt;1, injection through the vein and imported medication take a larger share which increase the costs of medication. Emergency rescue package should mainly prepare for the injury. In order to ensure the timely, safe and effective medication, injection should be given priority to. We also should take into consideration crash-resistance/anti-quake package, reasonable dosage, convenience-to-use of drugs as well as the needs of the illness.
Objective To investigate the information of label use of high-alert drugs for children of high risk population, in the Military General Hospital of Beijing PLA. Methods We selected high-alert drugs used in this hospital as objectives. The package inserts of these drugs were investigated and medication parts for children were analyzed. Results 201 drugs regarded as high-alert drugs were included, of which only 78 drugs have accurate detailed description of medication for children, accounting for 38.8% of the total of investigated high-alert drugs. Conclusion Children, as high-risk population, needs more attention concerning the use of high-alert drugs. However, risks in the use of high-alert drugs increased due to the lack of the information of label use of high-alert drugs. To ensure the safety of drug use in children, the information of drug use for children in the package inserts should be urgently supplemented.
Objective To introduce the evidence-based evaluation on off-label uses at home and abroad, so as to investigate a systematic method of evidence-based evaluation on off-label uses. Methods In combination with the domestic and international research literature, a systematic method of evidence-based evaluation on off-label uses was discussed from the following three aspects: sources of evidence, levels of evidence, and recommendation strength. Results Sources of evidence included Clinical Pharmacology, DRUGDEX? System, NCCN Drugs amp; Biologics Compendium and handsearched literature. Levels of evidence and recommendation strength could refer to the 2009 grade system of Oxford Centre for Evidence-Based Medicine, and the strength of recommendations and scientific support of DRUGDEX? System. Conclusion A systematic method of evidence-based evaluation on off-label uses is initially established.
Objective To analyze chemical drugs included in the National Essential Medicines List (EML) of China, to provide reference on how to improve the selection criteria and strengthen management and supply of essential medicines. Methods Dosage form, specification and manufacturers of 201 kinds of chemical drugs included in the EML were retrieved through SFDA website, data collection and analysis were conducted using Excel software. Results Domestic chemical drugs in EML involved 24 kinds of dosage forms, 644 kinds of specifications, 37 854 kinds of drugs for sales, and 2 908 manufacturers. Imported chemical drugs in EML involved 12 kinds of dosage forms, 43 kinds of specifications, 113 kinds of drugs for sales, and 53 manufacturers. Included drugs were primarily normal dosage forms while chemical drugs had many different specifications. Medicines duplication in production was serious and the distribution in market was unbalanced. The sole and exclusive dosage form variety lacked of effective evidence. Selection mechanism and reevaluation needed to be developed. Conclusion It is suggested to include drug specification in EML, and refer to spectrum of diseases for detailed selection mechanism of essential drugs, reevaluation of the listed drugs and formulate strict drug bidding rules so as to optimize EML.
Medical ethics must be considered for protecting the fights and interests of patients in clinical trials. Now the fights of the subjects are more and more emphasised, but there are some problems. It is evidence-based medicine (EBM) and emphasis of evidence that need the high-quality clinical trials, yet it violates the principle of ethics in some degree. It will be helpful for the administrators to supervise the clinical trials on drugs well from the point of ethical views.
【摘要】 目的 分析宜宾市第二人民医院2009年门、急诊麻醉药品的使用情况，促进麻醉药品使用的合理化和规范化。 方法 对2009年门急诊1 420张麻醉药品处方进行统计，统计处方总数，麻醉药品临床使用分布情况，根据药品分类分别统计麻醉药品的用药总量，各种麻醉药品的处方所占的比例，实际用药总天数等。对非癌症处方以用药频率及药物利用指数（DUI）为指标，癌症处方以用药天数及平均日用药量为指标进行进行统计、分析、评价。 结果 门急诊的麻醉药品有8种，盐酸吗啡缓释片的总用量居首位，盐酸哌替啶针在急诊处方中出现频率较高，芬太尼透皮贴剂的用药频度较小，药物利用指数均≤1。 结论 宜宾市第二人民医院的急诊麻醉药品使用基本合理。A total of 1 420 pieces of narcotic drugs prescriptions for the outpatient in our hospital in 2009 were extracted. The total number of prescriptions, the distribution of the clinical use of narcotic drugs, the total amount of narcotic drugs according to different types, the proportion of each kind of narcotic drug prescription and the actual number of medication durations were counted and analyzed. Defined daily dose (DDD) and drug use index (DUI) of the non-cancer drugs prescription; meanwhile, the number of drug-using days and average daily amount of cancer drug prescription were statistically analyzed. Results There were eight kinds of narcotic drugs for the outpatients. The most total amount of narcotic drugs was morphine hydrochloride sustained release tablets; the medication frequency of pethidine injection in the emergency prescription was high and the medication frequency of transdermal fentanyl was low. The narcotic drugs utilization index was lower than one. Conclusion The use of narcotic drugs in our hospital is rational.
目的:了解我院药品不良反应(ADR)发生的特点。方法:对我院2006年1月至2009年8月收集到的67例ADR报告进行回顾性统计分析。结果:我院报告ADR例数最多的部门为新生儿,有51例(7612%);0~28 d年龄段患儿ADR发生率较高(5223%),且男性高于女性;静脉给药方式是导致ADR的主要因素(9701%);ADR发生率最高的为抗感染药(8056%),其中绝大多数是由头孢菌素类和青霉素类引发;临床表现以皮肤及其附件损害最为常见(8841%)。结论:儿童用药更应该加强ADR的监测,提高ADR报告的质量,合理、规范使用药物,尤其是抗菌药物,以减少或避免ADR的发生。