Analysis on the current situation of drug use beyond the drug specification in China

Source: Chinese medical information guide 2015-6-18: the use of drugs beyond the drug specification is common in medical institutions at home and abroad, but the degree of use is different Research shows that about 21% of commonly used drug prescriptions belong to the use of drugs beyond the specification, and only 27% of them have evidence-based medical evidence to support the effectiveness and safety of their use At present, there is a lack of unified research data on the management status of hyperdrug instructions in medical institutions in China Based on this, the author conducted a research on the literature and medical institutions of hyperdrug instructions The relevant data are as follows The types of drugs involved in the hyperdrug instructions of medical institutions in China were searched by CNKI with "hyperdrug instructions" and "drug unregistered usage" as abstract search terms The time node was December 30, 2014 Results 112 literatures reported the specific types and proportion of hyperdrug instructions of medical institutions in China Among the 112 articles, the most frequently reported Chinese patent medicine is super specification (14 articles, 12.5%), followed by digestive and metabolic system drugs and respiratory system drugs (12 articles, 10.7%), followed by anti infective drugs (11 articles, 9.8%), nervous system drugs (11 articles, 9.8%) and vitamins, trace elements and nutrition drugs (8 articles, 7.1%) According to the ranking of the average proportion of hyperdrug instructions, in China's medical institutions, the proportion of hyperdrug instructions used in blood and hematopoiesis system is the highest (55.0%), and the types of drugs involved are intravenous injection of human immunoglobulin and albumin, followed by respiratory system drugs (41.0%) The main reasons for the use of hyperdose were as follows: antitumor drugs, immunomodulators (36.3%), antiallergic drugs (34.6%) and nervous system drugs (33.8%) Based on this, the author conducted a six-month survey on the management status of hyperdrug instructions in more than 600 different medical institutions in China, including 323 tertiary hospitals and 301 secondary hospitals The preliminary results are as follows: (1) 59.6% of the survey Medical institutions are allowed to use super drug instructions in hospitals, among which the third level hospitals are allowed to use more than the second level hospitals, accounting for 68.0% and 42.7% respectively (2) 63.4% of the respondents accepted the use of drugs beyond the drug instructions in the hospital, of which 71.3% were accepted by the third level hospital and 47.9% by the second level hospital (3) 54.7% of the investigated hospitals have formulated the management system for the use of drugs beyond the drug specification The ratio of the third level hospitals and the second level hospitals is 60.4% and 30.3% respectively (4) 54.4% of the investigated hospitals have formulated the management process of drug use beyond the drug specification, of which 65.2% are in the third level hospitals and 26.0% are in the second level hospitals In the management process, most of the hospitals include the following measures: doctors provide evidence-based basis for the use of super drug instructions, medical department or medical department records, patients sign informed consent, approval and discussion by the pharmaceutical management committee, and review by clinical pharmacists (5) Only 19.7% of the investigated hospitals have formulated the drug catalogue of the hyperdrug instructions based on evidence, which includes ambroxol injection atomization, progesterone injection in the treatment of urinary calculi, azithromycin injection in children and sildenafil (Viagra) For pulmonary hypertension, sulfasalazine for mandatory spondylitis, medroxyprogesterone acetate tablets for appetite enhancement, montmorillonite powder for external treatment of ulcers, etc (6) Only 25.7% of the survey hospitals require special personnel or designated departments to track the drug use effect beyond the drug instructions, and the proportion of tertiary hospitals is significantly higher than that of secondary hospitals (about 10.0%) (7) 81.3% of the survey hospitals did not limit the right of specific doctors to prescribe drugs beyond the instructions, among which 76.4% of the third level hospitals and 86.5% of the second level hospitals (8) 91.6% of the investigated hospitals have formulated the hospital formulary, but 85.6% of the over specification drugs have not been listed in the hospital formulary, of which 83.1% are not listed in the third level hospital and 88.5% are not listed in the second level hospital (9) 99.1% of the survey hospitals conducted medical order audit for over specification drugs, of which more than 50.0% of the hospitals conducted full audit for over specification drugs, and nearly 50.0% of the hospitals conducted occasional audit or regular audit (10) 9.1% of the survey hospitals have medical disputes related to the use of drugs beyond the instructions, among which the incidence of tertiary hospitals is 18.0%, and that of secondary hospitals is 1.0%.