| Objective: 1.To improve the service capability of the clinical medical education through the retrospective analysis on the drug use of coronary heart disease in 8 hospitals which belong to different level in the same area.2.To provide reference for the health departments to make decisions through investigating the rationality of proton pump inhibitors and traditional chinese medicine injections that are used in coronary heart disease patients in accordance with the opinions which are able to control the unreasonable increase in medical cost and deepen the reform of the medical and health system by the State Health and Family Planning Commission and so on.3.To explore the methods of medical cost reducing and investigate the necessity and feasibility of medical cost control.Methods: The patients with coronary heart disease as the first diagnosis were got through the medical insurance system in eight hospitals which belong to different level in Mianyang from 2014 to 2016,then excluding the death and the one which are in hospital less than two days.The total number of cases is divided by the quotient integer part of 200 as the interval,the details of disease and drug use of the 200 patients were got at last.The drugs that were used in the patients were classified according to the pharmacological effects,and the sex,age,hospitalization date,cost,and so on of them were also obtained.Then the data were processed and counted by EXCEL 2007 ACCESS 2007 and SPSS 19.0.The rationality of drug use and the pharmaceutical cost composition in these patients were analyzed and evaluated by the domestic and foreign guidelines,expert consensus and high quality evidence-based literature of coronary heart disease.Results: 55.8% of all were the male patients,The average age of them was 73.0±10.6 years,Average age of the females was 74.9±9.5 years.The average hospitalization time were 13.2-days and the average hospitalization cost were 12052.2 yuan.The average proportion cost of drugs was 35.2%,and the amount of drugs for coronary heart disease accounted for 72.4% of the total drug cost.80.9% of the patients had took lipid-lowering agents,46.9% had took angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists,76.1% had took the anti-platelet drugs.The numbers of patients using anti-platelet drugs had took proton pump inhibitors accounted for 66.2% of all.The amount of chemical drugs extracted from traditional chinese medicine and traditional chinese medicine to improve circulation accounts for 37.8% of the total cost of coronary heart disease treatment and 27.3% of the total medicine cost.The number of the species of drugs without indication accounts for 17.6% of all,and it was frequently used with other drugs that are identical.The phenomenon that of several chinese patent medicine injection rotational use are quite common,and there are 14 drugs that can improve myocardial energy and metabolism,6 of which are off-label drug use,Angiotensin converting enzyme inhibitor was used 220 times,The angiotensin receptor blocker was used 530 times,but the number of isosorbide mononitrate by oral are 4 times that of by injection,Xuezhikang and fenofibrate was used alone in one patient and two patients were treated with propranolol and 15 patients with nifedipine.Dipyridamole were also used in 2 patients.42 patients were taking clopidogrel combined with omeprazole.Conclusions: The coronary heart disease was more often among the men than women.Meanwhile,it found that,men diagnosed as the coronary heart disease trended to be younger than women.In the study,the average length of stay was longer than that from the literature.There were unreasonable prescription in the therapy of the coronary heart disease in the 8 hospitals.The application of the statins,the renin-angiotensin-aldosterone system inhibitor,the antiplatelet agent and other drugs that was important in the therapeutic regimen was insufficient,which means more patients diagnosed as the coronary heart disease should be treated by the drugs above.The application of the adjuvant drug was unresonable detected from the included hospitals: there was application without indication by the comments on the proton pump inhibitors,drugs to improve cardiac energy and metabolism,and the chinese patent medicine.Meanwhile,The chinese patent medicine was also abused and misused.Alprostadil,a kind of vascular dilation drug,occupied unrational part of the cost.Those drugs above should be supervised potently by the government.When it was referred to the select of the different kinds of the drug,some problem was detected there with.In the therapy of the coronary heart disease,the angiotensin converting anzyme inhibitor should be a kind of the first line treatment.The oral dosage forms of the isosorbide mononitrate should be prior to the injection.However,it turned out to be not.In addition,there was monotherapy of Fenofibrate,Nifedipine tablets(not controlled release),dipyridamole,propranolol and so on,which was unreasonable.The negative drug-drug reaction may exist in the combination of the drug,such as the combination of clopidogrel and omeprazole.And the poor persistent training of the doctors,the result of the frontier research and the latest commend for the treatment had not be applied for the patients extensively.The clinical pharmacists should take advantage of their own professional knowledge to participate in the training and the supervising of the rational drug use,in the formulation of regimes of the drug therapy for the clinical pathway,in the checking of the prescription,in the evaluation of the medical cost and the drug price negotiations according to pharmacoeconomics.The clinical pharmacists should also play an important role to regulate the expenditure of medical insurance,to the supervise the use of target drugs,to promote the rational drug use,to reduce the proportion of the cost which was occupied by the drug,thus to reduce the burden of patients and resolve the problem of “expensive medical treatment”. |
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