| 摘要: |
| 目的：调查儿科哮喘药物配备和临床应用现状，探讨我国基本药物目录（National Essential Medicine List，NEML）和医保目录（National Drug Reimbursement List，NDRL）内药物应用于儿科人群的合理性。方法：本研究于2020年8-9月对来自全国46家医疗机构的245名临床药师进行问卷调查，收集基本信息、哮喘药物使用情况、哮喘药物评价情况、哮喘相关药学服务等资料，采用描述性方法进行统计分析。结果：46家医疗机构共配置抗炎平喘药物67种，最常配置及使用的药物分别为吸入用布地奈德混悬液、盐酸肾上腺素注射液、醋酸泼尼松片、孟鲁司特咀嚼片和注射甲泼尼龙琥珀酸钠。其中，10种常用药物存在超说明书用药、剂型不适宜等临床用药问题。在药物评价方面，基于儿童用药特殊性，超过5%儿科药师建议氨茶碱（片剂）和茶碱（缓释片）从NEML删除。超过5%儿科药师建议班布特罗（口服常释剂型）、倍氯米松（吸入剂）、氨茶碱（口服常释剂型）从NDRL中的甲类调整为乙类或删除。此外，超过30%儿科药师建议7种药物调整为医保甲类，分别为孟鲁司特（咀嚼片）、孟鲁司特（颗粒剂）、沙美特罗替卡松（吸入剂）、布地奈德（吸入剂）、布地奈德福莫特罗（吸入剂）、孟鲁司特（口服常释剂型）和丙卡特罗（口服液体剂）。在药学服务方面，超95%调查对象所在医疗机构已开展哮喘相关用药指导，但仅54.01%哮喘相关用药指导主要人员为儿科药师。结论：本研究从一线药师角度对NEML和NDRL在儿科人群应用的合理性进行评价，为下一步建立我国儿童基本药物目录提供参考。同时，儿科药师还应加强处方前置审核、减少超说明书用药，大力开展药学服务，从而提高哮喘用药知识知晓度，降低患儿哮喘发作率。 |
| 关键词: 儿童用药 支气管哮喘 药品评价 药学服务 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2022.09.003 |
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| 基金项目:国家重大新药创制专项,编号2017ZX09304029;北京医药卫生经济研究会委托项目“儿童药品临床综合评价指南开发及哮喘用
药临床综合评价试点研究”。 |
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| Current Status and Clinical Evaluation of Asthma Medication in Children: Based on Survey Results of 46 Medical Institutions |
| Yu Yuncui, Hu Lihua, Huang Huijie, Jia Lulu, Cao Wang, Xiang Li, Wang Xiaoling |
| (National Children’s Medical Center, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China) |
| Abstract: |
| Objective: To investigate the current status of pediatric asthma drug allocation and medication, and to explore the application rationality of drugs in pediatrics from National Essential Medicine List (NEML) and National Drug Reimbursement List (NDRL). Methods: A questionnaire survey was performed on 245 clinical pharmacists from 46 medical institutions in China from Aug. to Sept. 2020, basic information, asthma medication, asthma drug evaluation, asthma-related pharmaceutical care and other data were collected. Descriptive methods were used for statistical analysis. Results: A total of 67 kinds of anti-inflammatory and anti-asthmatitic drugs were prepared in 46 medical institutions. The most commonly prepared and used drugs were inhaled budesonide suspension, epinephrine hydrochloride injection, prednisone acetate tablets, montelukast chewable tablets and methylprednisolone sodium succinate injection. Among them, 10 commonly used drugs had off-label use, improper dosage forms and other clinical medication problems. In terms of drug evaluation, more than 5% of pediatric pharmacists recommended that aminophylline (tablets) and theophylline (sustained-release tablets) should be removed from NEML based on the particularity of pediatric medication. More than 5% of pediatric pharmacists recommended that bambuterol (oral regular release), beclomethasone (inhalant) and aminophylline (oral regular release) should be changed from class A to class B or removed from NDRL. Meanwhile, more than 30% of pediatric pharmacists suggested that the following 7 kinds of drugs should be adjusted to class A, such as montelukast (chewable tablets), montelukast (granules), salmeterol and ticasone (inhalant), budesonide (inhalant), budesonide formoterol (inhalant), montelukast (oral regular release) and procataterol (oral liquid). In terms of pharmaceutical care, more than 95% of the medical institutions where the respondents worked had provided guidance on asthma medication, yet only 54.01% of the asthma medication instructor were pharmacists. Conclusion: This study evaluates the application rationality of drugs in pediatrics from NEML and NDRL from the perspective of front-line pharmacists, and provides reference for the establishment of essential medicine list for children in China. Meanwhile, pediatric pharmacists should also strengthen prescription pre-review, reduce off-label drug use, and vigorously develop pharmaceutical care, so as to improve the awareness of asthma medication knowledge and reduce the incidence of asthma in children. |
| Key words: medication for children bronchial asthma drug evaluation pharmaceutical care |
