| Objective:To investigate the current situation and developing trend of drug utilization of glucocorticoids in the hospital for successive3years, evaluate the rationality of the use of glucocorticoids and analyze the factors of influencing the irrational drug use,analyze the drug safety through investigation of adverse reactions of glucocorticoids, in order to offer the scientific evidence for safe, effective and economical use of drugs and promote the rational use of drugs.Methods:1. Glucocorticoids used in the hospital during the period2010-2012were statistically analysed in respect to expenses, defined daily doses and the daily costs.2. A random sampling of1560cases histories, which were treated with systemic glucocorticoids at least one time in the hospital during Jan.～Dec. in2011, were retrospectively analyzed. The aim was to investigate the current state and evaluate the rationality of use of glucocorticoids and analyze the factors of influencing the irrational drug use in the hospital. 3. The adverse reactions in the patients who continued to take systemic glucocorticoids after discharge from hospital mentioned above were recorded by telephone. The aim was to investigate preventive drugs and monitoring indicators periodically.Results:1. During the period2010to2012in the hospitalization, sales sum and DDDs of glucocorticoids revealed an increasing tendency.The kinds of drugs and DDDc remained basically stable.DDDs of the drugs ranking in the first5places were dexamethasone sodium phosphate injection, prednisone acetate tablets, dexamethasone acetate tablets, methylprednisolone sodium succinate for injection (40mg), methylprednisolone tablets.2.1247cases were selected from the1560cases which were chosen randomly. For all diseases, surgical diseases comprised26.30%(328/1247), medical oncology comprised51.72%(645/1247) medical disease other than cancer comprised21.97%(274/1247)3.1247cases were selected and evaluated the appropriate use of glucocorticoids. It was showed that16.63%(206/1239) had appropriately used glucocorticoids in all cases,16.05%(52/324) in surgical diseases,16.90%(109/645) in medical oncology,16.67%(45/270) in medical disease other than cancer.4. The unreasonable uses of glucocorticoids included inappropriate duration (5.45%), inappropriate doses (6.09%) and no indication for drug utilization (2.57%)5. The risk factors of unreasonable use of glucocorticoids were analyzed through multi-variate unconditional logistic regression. It was showed that admission condition and if pulse therapy were positive correlate with improper indication, which meant the serious admission condition and pulse therapy related with higher rate of inappropriate use.6.176cases were followed by telephone. The incidence of ADRs in patients treated with glucocorticoids was18.75%(33/176) after discharge from hospital. The adverse reactions were cushing’s syndrome, abnormal glucose tolerance, inducing infection, cataracts, osteoporosis, osteonecrosis, etc.7. Measures for prevention of ADRs of glucocorticoids were included monitoring bone mineral density (2.27%) and fundus examination (3.98%) periodically.Conclusion:1. The statistics from year2010to2012had reflected the stable trend of clinical application of glucocorticoids. Dexamethasone and prednisone were the first line drugs because of their low price and definite therapeutic effect.There was an appropriate constitute of drug use in the hospital.2. It was showed that the serious patients related with higher rate of inappropriate use.3. There exists general phenomenon of irrational using about glucocorticoids. It is suggested that the health facilities need strengthen the supervision and administration of glucocorticoids, attach importance to clinical pharmacy, prescribe behaviors of drug using in order to decrease ADRs and promote the rational use of glucocorticoids. |
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