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目的:验证WHO倡导的监测-培训-计划(MTP)模式对我国医疗机构不合理用药的干预效果。方法:以卫生部用药指导原则及WHO或国家级治疗指南为标准,开展培训、改变用药习惯、经过3轮以上MTP干预。收集2006年7月～2007年7月干预前后珠海市6所二级以上医院门诊上感及住院清洁手术预防性抗菌药及注射剂使用数据,分析用药合理性。结果:MTP干预使呼吸内科及儿科门诊上感患者的抗菌药使用率、注射剂使用率、抗菌注射剂使用率、抗菌药平均费用均大幅降低;3种清洁手术中,预防性抗菌药国家级指南遵从率干预后明显升高,用药合理性与卫生经济效益显著提高。结论:抗菌药与注射剂的过度使用是当今全球性严重影响医疗安全的问题,处方点评、临床路径、治疗监护以及MTP干预都是纠正大处方/用药过度的有效方法。欲以较低成本达到尽量扩大基本医疗覆盖面的目的,可采用MTP对策,其对处方者和患者充分循证说理的和谐方式,证明是实施合理用药的重要策略,有必要加以推广应用。
Objective: To verify the effect of monitoring-training-planning (MTP) mode advocated by WHO on irrational use of medicines in medical institutions in China. Methods: Based on the guidelines of the Ministry of Health and the guidelines of WHO or national treatment guidelines, training was conducted to change the medication habits and after 3 or more MTP interventions. The data on the use of prophylactic antimicrobial agents and injections in six outpatient clinics and hospitalized clean surgeries in Zhuhai from July 2006 to July 2007 before and after intervention were collected to analyze the rationality of medication. Results: The results showed that the use of MTP in anti-bacterial medicine, injections, antimicrobial injections and the average cost of antimicrobial drugs were greatly reduced in respiratory medicine and pediatric outpatients. Among the three types of clean operation, the national guidelines for preventive antimicrobials were followed After the intervention rate was significantly increased, the rational use of medicines and health economic benefits significantly increased. CONCLUSIONS: Overuse of antimicrobial agents and injections is a global problem that seriously affects medical safety today. Prescribing reviews, clinical pathways, treatment monitoring, and MTP intervention are all effective ways to correct large overdosage / overdosage. In order to achieve the goal of maximizing the coverage of basic medical services at a lower cost, MTP can be adopted, and its harmonious way of fully evidence-based justification for both prescribers and patients proves to be an important strategy for rational drug use and it is necessary to promote it.