陕西省医疗机构抗菌药物管理体系建设及其影响因素

Constructions of antibiotic stewardship programs among hospitals in Shaanxi Province and influencing factors

  • 摘要:
    目的  旨在明确陕西省医疗机构抗菌药物管理体系的建设情况、管理策略现状及阻碍因素。
    方法  于2022年10-11月采用问卷星设计的在线问卷调查方法, 参照《2015年抗菌药物临床应用指导原则》、美国医院抗菌药物管理计划核心要素评价清单(Checklist for Core Elements of Hospital Antibiotic Stewardship Programs), 通过微信通信软件邀请医疗机构抗菌药物管理小组成员或抗感染临床药师填写问卷。
    结果  58家医疗机构参与本次调研, 所有医疗机构基本符合我国抗菌药物管理的要求, 但较美国核心要素清单的要求仍有差距。医院抗菌药物临床应用管理项目工作小组专业人员构成以抗感染临床药师和感染科医生为主, 抗菌药物处方点评制度完善且落实到位。在优化抗菌药物使用干预策略方面, 实施抗菌药物处方前置审核的医院占37.93%;开展的抗菌药物管理项目主要有手术预防给药(86.21%)、社区获得性肺炎(72.41%)。阻碍抗菌药物科学管理的因素主要包括:缺乏感染专家和感染团队(62.07%)、医院管理资金投入不足(67.24%)、医生拒绝改变处方习惯(53.45%)、缺乏领导层对抗菌药物管理的支持(55.17%)、抗菌药物管理工作优先级别低(48.28%)。
    结论  陕西省抗菌药物管理体系较为完善, 普遍重视抗菌药物管理工作, 但多停留在行政层面, 未来研究和策略制定应考虑如何克服阻碍因素, 提升抗菌药物科学化管理水平。

     

    Abstract:
    OBJECTIVE  The aim was to clarify the construction of antibiotic stewardship programs, the status of management strategies and barriers in medical institutions of Shaanxi Province.
    METHODS  Referring to the Clinical Application of Antibacterial Drugs Guiding Principles (2015) and the American Checklist for Core Elements of Hospital Antibiotic Stewardship Programs, an online survey designed by Wenjuanxing was used from Oct. to Nov. in 2022, and were send to personnels of antibiotic management and clinical pharmacist by the APP WeChat.
    RESULTS  Totally 58 hospitals involved in the survey, all of which basically meet the requirements of antibacterial drug management in China; but there were still gaps with the requirements of the U. S. Checklist for Core Elements. The antibiotic stewardship programs team was mainly composed of clinical pharmacists and physician in infectious department, and the antimicrobial prescription review system were comprehensive and fully implemented. In terms of intervention strategies to optimize the use of antibiotics, 37.93% of the hospitals implemented the pre-review for antibiotics prescription; the common interventions included preoperative prophylactic antibiotic use (86.21%) and community-acquired pneumonia (72.41%). The main impeding factors for antimicrobial managements were lack of specialists and teams in infection (62.07%), insufficient financial investment (67.24%), doctors′ refusal to change their prescribing habits (53.45%), lack of supports from leadership (55.17%), and low priority of antimicrobial drug management (48.28%).
    CONCLUSIONS  The AMS system in Shaanxi Province is relatively complete and paid attention generally, but mostly by the administrative personnel. Future research and strategy development should consider how to overcome the barriers and improve scientific antimicrobial drug management.

     

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