本文選題：抗菌藥物 + 信息化　； 參考：《復(fù)旦大學(xué)》2012年碩士論文

【摘要】：1.研究目的 根據(jù)衛(wèi)生部對(duì)抗菌藥物使用規(guī)定的法規(guī)政策,針對(duì)傳統(tǒng)的抗菌藥管理的不足,采用信息化手段,在上海市某三甲醫(yī)院的HIS信息平臺(tái)上構(gòu)建抗菌藥物管理系統(tǒng),使得醫(yī)院抗菌藥物管理服務(wù)衛(wèi)生部標(biāo)準(zhǔn),同時(shí)使得臨床更加合理使用抗菌藥物。分析該醫(yī)院抗菌藥物使用情況,判斷綜合的信息化管理手段是否對(duì)醫(yī)院使用抗菌藥物情況產(chǎn)生影響�？偨Y(jié)醫(yī)院抗菌藥物管理系統(tǒng)的問題和獲得的經(jīng)驗(yàn),為后續(xù)抗菌藥物管理的進(jìn)一步改進(jìn)提供技術(shù)保障,增加項(xiàng)目實(shí)施的經(jīng)驗(yàn),總結(jié)相關(guān)知識(shí),并為項(xiàng)目的推廣提供依據(jù)。實(shí)施前后醫(yī)院住院使用抗菌藥物的情況對(duì)比：住院患者使用抗菌藥物費(fèi)用、住院患者使用抗菌藥物的百分率、抗菌藥物使用強(qiáng)度、住院用抗菌藥物患者病原學(xué)檢查百分比等指標(biāo)進(jìn)行對(duì)比分析,來了解此方法是否對(duì)醫(yī)院使用抗菌藥物產(chǎn)生影響。 2.研究內(nèi)容 2.1分析傳統(tǒng)抗菌藥物管理流程及存在的問題,實(shí)施構(gòu)建信息化抗菌藥物管理系統(tǒng)。 2.2研究指標(biāo)：包括抗菌藥物使用率、抗菌藥物強(qiáng)度、抗菌藥物送檢率以及抗菌藥物費(fèi)用。 2.3統(tǒng)計(jì)分析抗菌藥物系統(tǒng)使用前3個(gè)月和時(shí)候后3個(gè)月數(shù)據(jù)。 2.3.1抗菌藥物影響因素分析 2.3.2基礎(chǔ)情況比較 2.3.3分析指標(biāo)的比較 3.資料來源及方法 3.1文獻(xiàn)查閱 為了了解住院抗菌藥物信息化管理國內(nèi)外的研究情況,以及學(xué)習(xí)相關(guān)知識(shí)。課題組首先通過中國知網(wǎng)(CNKI)、萬方數(shù)據(jù)、維普等數(shù)據(jù)庫及互聯(lián)網(wǎng)搜索引擎(如百度、谷歌、必應(yīng)等)查閱相關(guān)文獻(xiàn),了解抗菌藥物、抗菌藥物相關(guān)政策、抗菌藥物的管理、效果評(píng)價(jià)等相關(guān)理論、研究現(xiàn)狀以及其他醫(yī)院試點(diǎn)情況,做好前期準(zhǔn)備工作,其次,通過衛(wèi)生部、各級(jí)衛(wèi)生局官方網(wǎng)站、衛(wèi)生信息網(wǎng)絡(luò)學(xué)術(shù)大會(huì),搜集門診自助服務(wù)相關(guān)材料,主要包括衛(wèi)生政策、實(shí)施推廣措施以及項(xiàng)目開展的相關(guān)材料。 3.2醫(yī)院信息化基本情況調(diào)查 醫(yī)院信息化經(jīng)過十多年的建設(shè)基本建立起貫穿全院的信息系統(tǒng)。從基本的財(cái)務(wù)核算系統(tǒng),到全部藥品管理和藥品配送系統(tǒng),再到覆蓋全部臨床科室的門診醫(yī)生站、住院醫(yī)生站、護(hù)士工作站、臨床檢驗(yàn)系統(tǒng)。都已經(jīng)在信息化完成,為抗菌藥物管理系統(tǒng)的構(gòu)建打下基礎(chǔ)。 3.3資料來源 上海某三甲醫(yī)院使用抗菌藥物管理系統(tǒng)前3個(gè)月和使用后3個(gè)月的病人疾病信息、抗菌藥物使用情況等數(shù)據(jù)。主要內(nèi)容包括：姓名、性別、年齡、疾病名稱等情況。比較指標(biāo)為：住院患者人均使用抗菌藥物品種數(shù)、住院患者人均使用抗菌藥物費(fèi)用、住院患者使用抗菌藥物的百分率、抗菌藥物使用強(qiáng)度、住院用抗菌藥物患者病原學(xué)檢查百分率。 4.研究結(jié)果 4.1通過對(duì)未使用抗菌藥物信息化管理系統(tǒng)簽流程的住院抗菌藥物管理情況分析,結(jié)合衛(wèi)生部有關(guān)抗菌藥物臨床應(yīng)用的文件精神,,構(gòu)建信息化的抗菌藥物管理系統(tǒng)。 4.2Logistic回歸顯示,構(gòu)建系統(tǒng)后使用抗菌藥物的概率是構(gòu)建系統(tǒng)前的0.73倍,即OR值為0.73(P0.0001),在年齡研究因素中,18～40歲使用抗菌藥物的概率最高,是1～6歲者的18.7倍,即OR值為18.7(P0.0001)。 4.3按是否構(gòu)建了抗菌藥物管理系統(tǒng)分組,即構(gòu)建前為A組,構(gòu)建后為B組。A組女性占總?cè)藬?shù)的50.36%,男性占49.64,；B組女性占50.01%,男性占49.99%；性別分別的組間差距無統(tǒng)計(jì)學(xué)意義(x2=0.3929,P=0.5308)。A組平均年齡為49.33±21.07歲,B組為49.56+21.10歲。年齡的組間差異無統(tǒng)計(jì)學(xué)意義(t=0.65,P=0.5163)。 4.4A組抗菌藥物使用率為62.99%,B組為51.40%,抗菌藥物使用率的組間差異具有統(tǒng)計(jì)學(xué)意義(x2=156.90,P0.0001)。為控制科室因素的影響,做CMH-x2檢驗(yàn),結(jié)果顯示,在去除了科室的影響后,抗菌藥物使用率的組間差異仍具有統(tǒng)計(jì)學(xué)意義(CMH-x2=1113-3170,P0.0001)。 4.5A組抗菌藥物使用強(qiáng)度為74.82,B組抗菌藥物使用強(qiáng)度為63.05。抗菌藥物使用強(qiáng)度的組間差異有統(tǒng)計(jì)學(xué)意義(P=0.0495)。 4.6A組抗菌藥物送檢率為62.68%,B組抗菌藥物送檢率為73.79%。為了控制科室因素的干擾,做CMH-x2檢驗(yàn),結(jié)果顯示控制了科室因素后,送檢率的組問差異有統(tǒng)計(jì)學(xué)意義(CMH-x2=9.47,P=0.0021)。 4.7A組抗菌藥物費(fèi)用約為2313萬元,B組抗菌藥物費(fèi)用約為2586萬元。抗菌藥物費(fèi)用的組間差異無統(tǒng)計(jì)學(xué)意義(t=-2.21,P=0.0915)。 5.研究結(jié)論 5.1未使用抗菌藥物管理系統(tǒng)前的抗菌藥物管理方法過于依靠道德和醫(yī)療水平。抗菌藥物管理效果難以達(dá)到衛(wèi)生部規(guī)定的要求,特別是抗菌藥物使用率,本次研究之前3個(gè)月統(tǒng)計(jì)顯示醫(yī)院的抗菌藥物使用率達(dá)到了62.99%未達(dá)到衛(wèi)生部的抗菌藥物使用率標(biāo)準(zhǔn)。 5.2基于分析傳統(tǒng)的抗菌藥物管理方法控制的難點(diǎn),結(jié)合衛(wèi)生部的法定法規(guī),我們完成了對(duì)抗菌藥物管理系統(tǒng)設(shè)計(jì)思路,通過1一個(gè)月的實(shí)施成功在上海某三甲醫(yī)院的信息平臺(tái)上構(gòu)建了抗菌藥物管理系統(tǒng),使得抗菌藥物管理從事后評(píng)價(jià)管理走向全程信息化管理。 5.3通過構(gòu)建抗菌藥物管理系統(tǒng)前后的數(shù)據(jù)對(duì)比,發(fā)現(xiàn)構(gòu)建后該院的抗菌藥物使用率降到了衛(wèi)生部規(guī)定值以下,抗菌藥物使用強(qiáng)度也得到了有效地降低,而送檢率得到了提高,有效改善抗菌藥物管理。 5.4雖然抗菌藥物管理系統(tǒng)取得了一定的效果,但是還有一些不足需要改進(jìn),如對(duì)抗菌藥物費(fèi)用的管理、特殊藥品的管理等。將系統(tǒng)改進(jìn)地更加完善就可以使得抗菌藥物的使用更加合理。
[Abstract]:1. purpose of research
According to the regulations and policies of the Ministry of health on the use of antibacterials, in view of the shortage of traditional antibiotics management, the anti-bacterial drug management system is constructed on the HIS information platform of a three a hospital in Shanghai, which makes the hospital antibacterial drug management service to the Ministry of health and makes the clinical use of antibacterial drugs more reasonable. Analysis of the use of antibiotics in the hospital to determine whether the comprehensive information management means have an impact on the use of antibiotics in the hospital. Summarize the problems and experience gained in the hospital antibacterial drug management system, provide technical support for further improvement of the follow-up antibacterial drug management, increase the experience of the project implementation, and summarize the related aspects. Knowledge, and to provide the basis for the promotion of the project. In the hospital before and after the use of antibiotics in hospital, the use of antibacterial drugs in hospitalized patients, the percentage of inpatient use of antibiotics, the intensity of antibiotic use, and the percentage of pathogens in hospitalized patients with antibiotics were compared and analyzed to understand this. Whether the method has an impact on the use of antibiotics in hospitals.
2. research content
2.1 analyze the management process and existing problems of traditional antibiotics, and implement the information management system.
2.2 Research Indicators: including the utilization rate of antibiotics, the intensity of antibiotics, the rate of antibiotics and the cost of antibiotics.
2.3 statistical analysis was made on the data in the first 3 months and 3 months after the use of antimicrobial drugs.
Analysis of the influencing factors of 2.3.1 antibacterial drugs
2.3.2 basic situation comparison
Comparison of 2.3.3 analysis index
3. sources and methods of information
3.1 literature review
In order to understand the domestic and foreign research on the information management of hospitalized antibacterial drugs, and the learning related knowledge. First of all, the group through the CNKI, Wanfang Data, VIP database and Internet search engines (such as Baidu, Google, Bing, etc.) to consult relevant literature to understand antibacterial drugs, antibacterials related policies, antibiotics management Theory, effect evaluation and other related theories, research status and other hospitals pilot conditions, preparatory work well, secondly, through the Ministry of health, the official website of the health bureau at all levels, the health information network academic conference, the collection of outpatient service related materials, including health policy, the implementation of promotion measures and related materials to carry out the project.
Survey on basic information of 3.2 hospital information
After more than 10 years of construction, hospital information has basically established the information system that runs through the whole hospital. From the basic financial accounting system, to the whole drug management and drug delivery system, to the outpatient doctor station covering all the clinical departments, the inpatient station, the nurse workstation and the clinical inspection system have all been completed in the information system and are antiseptic drugs. The construction of management system lays the foundation.
3.3 source of information
A three a hospital in Shanghai used the data of the disease information and the use of antibiotics for the first 3 months of the antibiotic management system and 3 months after use. The main contents include: name, sex, age and name of the disease. The comparison index is the number of anti bacteria drugs used in inpatients and the use of antibiotics per person in inpatients. The cost of substances, the percentage of antibiotics used in inpatients, the intensity of use of antibiotics, and the percentage of pathogens tested in hospitalized antimicrobial agents.
4. research results
4.1 through the analysis of the management of antibiotics in inpatients who have not used the information management system of antibacterial drugs, and combining the spirit of the Ministry of health on the clinical application of antibacterial drugs, the information management system of the antibacterials is constructed.
4.2Logistic regression showed that the probability of using antibacterial drugs after building the system was 0.73 times that of the system before building the system, that is, the OR value was 0.73 (P0.0001). Among the age research factors, the probability of using antibiotics at 18~40 years was the highest, which was 18.7 times that of the 1~6 year olds, that is, the OR value was 18.7 (P0.0001).
4.3 groups of antibacterials management system were constructed, that is, group A before construction, 50.36% of the total number of women in group.A in group B, 49.64 for men, 50.01% in group B and 49.99% for men, and there is no statistically significant difference between groups of sex respectively (x2=0.3929, P=0.5308).A group is 49.33 + 21.07 years, B group is 49.56+21.10 years old There was no significant difference in age between groups (t=0.65, P=0.5163).
The use rate of Antibacterials in group 4.4A was 62.99%, group B was 51.40%, and the differences in the use rate of antimicrobial agents were statistically significant (x2=156.90, P0.0001). In order to control the influence of the Department factors, the CMH-x2 test was done. The results showed that after the removal of the influence of the Department, the differences in the rate of use of antimicrobial agents were still statistically significant (CMH-x2=1113-3170, P 0.0001).
The intensity of antibacterial use in group 4.5A was 74.82, and the intensity of antimicrobial use in group B was 63.05., and the difference in the intensity of antimicrobial use between the two groups was statistically significant (P=0.0495).
The rate of Antibacterials in group 4.6A was 62.68%, and the rate of antibiotic delivery in group B was 73.79%. in order to control the interference of department factors and CMH-x2 test. The results showed that after the control of the Department factors, there was a statistically significant difference between the groups (CMH-x2=9.47, P=0.0021).
The cost of Antibacterials in group 4.7A was about 23 million 130 thousand yuan, and the cost of antibiotics in group B was about 25 million 860 thousand yuan. There was no statistical difference between the groups of antibacterials (t=-2.21, P=0.0915).
5. research conclusions
5.1 the antibacterials management methods before the use of the antibacterials management system depend too much on the moral and medical levels. The effect of antimicrobial drug management is difficult to meet the requirements of the Ministry of health, especially the use of antimicrobial agents. 3 months before this study, the statistics showed that the use of antibiotics in hospitals reached 62.99% to the Ministry of health. The standard of use rate of bacteria drugs.
5.2 based on the analysis of the difficulties in the control of traditional antibacterial drug management methods, combined with the legal regulations of the Ministry of health, we have completed the design idea of the antibacterials management system. Through the implementation of 1 months' implementation, the antibacterial drug management system has been constructed on the information platform of a three a hospital in Shanghai, so that the management of antimicrobial drugs is engaged in the post evaluation management. The whole process information management.
5.3 through the comparison of the data before and after the construction of the antibacterials management system, it is found that the utilization rate of antibacterial drugs in the hospital has dropped below the prescribed value of the Ministry of health, and the use of antibacterial drugs has also been effectively reduced, and the rate of delivery has been improved, and the antibacterial drug management is effectively improved.
5.4 although the antibacterials management system has achieved a certain effect, there are still some shortcomings that need to be improved, such as the management of the cost of antibacterial drugs, the management of special drugs, and so on. The improvement of the system will make the use of antibiotics more reasonable.

【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R197.3

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