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目的:系统评价基本药物制度的实施对基层医院抗菌药合理使用的影响程度。方法:检索CNKI、万方和维普中文期刊数据库,收集基本药物制度实施后抗菌药使用情况的文献,确定纳入文献,运用Rev Man 5.3和Stata 12.0软件对纳入文献数据进行Meta分析。结果:对43篇纳入文献数据进行Meta分析,基层医院基本药物制度实施后,门诊处方抗菌药使用率下降,与实施前比较,风险差具有统计学意义[RD=-0.03,95%CI(-0.04,-0.03),P<0.000 01],但抗菌药使用率仍然偏高(46.16%)。漏斗图的对称性良好,Egger’s检验结果显示发表偏倚无显著性差异(P=0.571);但文献研究结果间存在高度异质性(I2=94%,P<0.000 01);按不同医院和地区进行亚组分析,结果显示,文献研究者的研究方法、地区基本药物制度实施措施的差异性促进了研究之间高异质性的形成。结论:在建立统一的调查研究质量评价标准来降低研究间的异质性;建立与基本药物制度配套的措施来切实降低基层医院门诊处方抗菌药使用率。
Objective: To systematically evaluate the impact of the implementation of the basic drug system on the rational use of antibacterials in primary hospitals. Methods: The databases of CNKI, Wanfang and VIP Chinese Periodicals were searched, and the literature on the use of antimicrobials after the implementation of the basic drug system was collected. The data were confirmed and incorporated into the literature. Meta-analysis was performed on the included data using RevMan 5.3 and Stata 12.0 software. Results: Meta-analysis was performed on 43 included literatures. After the implementation of the basic drug system in primary hospitals, the utilization rate of prescription antibacterials in outpatients decreased. Compared with before implementation, the difference in risk was statistically significant (RD = -0.03, 95% CI (- 0.04, -0.03), P <0.000 01], but antibacterials usage was still high (46.16%). The symmetry of the funnel diagram was good, and the Egger’s test showed no significant difference in publication bias (P = 0.571). However, there was a high degree of heterogeneity in the literature (I2 = 94%, P <0.000 01) The subgroup analysis showed that the differences between the research methods of the literature researchers and the implementation measures of the regional essential medicines system promoted the formation of highly heterogeneous studies. Conclusion: The establishment of a unified quality evaluation standards for investigation and research to reduce the heterogeneity between the research; establish and supporting the basic drug system measures to effectively reduce the use of prescription antibacterials in outpatient hospitals.