Journal of School of Public Health and Institute of Public Health Research
مجله دانشکده بهداشت و انستیتو تحقیقات بهداشتی
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تحلیل نسخ داروخانه های دانشگاه علوم پزشکی تهران درسطح مراقبت های بهداشتی اولیه
(PHC)، براساس شاخص هایWHO در تجویز دارو: مطالعه مقطعی (1402-1395)
Analysis of Prescriptions in Pharmacies of Tehran University of Medical Sciences at the Primary Health Care (PHC) Level, Based on WHO Drug Prescribing Indicators: A Cross-Sectional Study 2016-2023
بهداشت عمومی
Public Health
پژوهشي
Research
<span style="font-size:11pt"><span style="line-height:normal"><span style="tab-stops:right 48.45pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span calibri="" style="font-family:"><b><span b="" lang="FA" lotus="" style="font-family:">زمینه و هدف</span></b> <span dir="LTR" new="" roman="" style="font-family:" times="">:</span><span b="" lotus="" style="font-family:"> منطقی کردن مصرف دارو از اولویت های سیاست های دارویی می</span> <span b="" lang="FA" lotus="" style="font-family:">باشد. سازمان جهانی بهداشت </span><span dir="LTR" new="" roman="" style="font-family:" times="">(WHO)</span><span b="" lang="FA" lotus="" style="font-family:"> برای ارزیابی نسخ، بررسی شاخص های تجویز دارو را توصیه می کند. اصلاح الگوهای تجویز دارو باعث نزدیک شدن به شاخص های </span><span dir="LTR" new="" roman="" style="font-family:" times="">WHO</span><span b="" lang="FA" lotus="" style="font-family:"> و در نتیجه مصرف منطقی دارو می گردد. </span></span></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="line-height:normal"><span style="tab-stops:right 48.45pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span calibri="" style="font-family:"><b><span b="" lang="FA" lotus="" style="font-family:">روش کار: </span></b><span lang="FA" style="background:white"><span b="" lotus="" style="font-family:">در این مطالعه </span></span><span lang="FA" style="background:white"><span b="" lotus="" style="font-family:">ده نسخه به صورت تصادفی از هر داروخانه در هرماه انتخاب و شاخص های</span></span> <span dir="LTR" style="background:white"><span new="" roman="" style="font-family:" times="">WHO</span></span><span lang="FA" style="background:white"><span b="" lotus="" style="font-family:"> شامل میانگین اقلام،</span></span><span lang="FA" style="background:white"><span b="" lotus="" style="font-family:"> درصد نسخ دارای حداقل (یک قلم آنتی بیوتیک</span></span><span lang="FA" style="background:white"><span b="" lotus="" style="font-family:">،</span></span><span lang="FA" style="background:white"><span b="" lotus="" style="font-family:"> یک قلم تزریقی و یک قلم کورتیکوستروئید تزریقی)</span></span> <span lang="FA" style="background:white"><span b="" lotus="" style="font-family:">در </span></span><span lang="FA" style="background:white"><span b="" lotus="" style="font-family:">نسخ محاسبه گردید.</span></span><span b="" lang="FA" lotus="" style="font-family:"> حجم نمونه نسخ مورد بررسی در 8 سال پیاپی به تفکیک هر شبکه/ مرکز، در شهرری 4800، اسلامشهر 14520 و مرکز بهداشت جنوب تهران 5880 نسخه بود. </span></span></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="line-height:normal"><span style="tab-stops:list 20.85pt left 45.8pt 91.6pt 137.4pt 183.2pt 229.0pt 274.8pt 320.6pt 366.4pt 412.2pt 458.0pt 503.8pt 549.6pt 595.4pt 641.2pt 687.0pt 732.8pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span calibri="" style="font-family:"><b><span b="" lang="FA" lotus="" style="font-family:"><span style="color:black">نتایج</span></span></b><span b="" lang="FA" lotus="" style="font-family:"><span style="color:black">:</span></span><b> </b><span b="" lang="FA" lotus="" style="font-family:">در این مطالعه روند میانگین اقلام از کمترین مقدار</span><span b="" lang="FA" lotus="" style="font-family:">2/5</span><span b="" lang="FA" lotus="" style="font-family:"> تا بالاترین عدد 3/99 در نوسان بوده است و با میانگین پیشنهادی</span><span dir="LTR" style="background:white"><span new="" roman="" style="font-family:" times="">WHO</span></span><span lang="FA" style="background:white"><span b="" lotus="" style="font-family:"> یعنی</span></span><span b="" lang="FA" lotus="" style="font-family:"> 1/7 تفاوت زیادی دارد.</span></span></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="line-height:normal"><span style="tab-stops:list 20.85pt left 45.8pt 91.6pt 137.4pt 183.2pt 229.0pt 274.8pt 320.6pt 366.4pt 412.2pt 458.0pt 503.8pt 549.6pt 595.4pt 641.2pt 687.0pt 732.8pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span calibri="" style="font-family:"><span b="" lang="FA" lotus="" style="font-family:">روند تغییرات </span><span b="" lang="FA" lotus="" style="font-family:"><span style="color:black">درصد نسخ دارای حداقل یک قلم آنتی بیوتیک </span></span><span b="" lang="FA" lotus="" style="font-family:">از کمترین مقدار، 33/36% تا <span style="background:white">بالاترین مقدار یعنی</span> 63/93% در نوسان بوده است</span> <span b="" lang="FA" lotus="" style="font-family:">و با میانگین پیشنهادی</span><span dir="LTR" new="" roman="" style="font-family:" times="">WHO</span><span b="" lang="FA" lotus="" style="font-family:"> یعنی 20/3% تفاوت زیادی دارد.</span><span dir="LTR" style="font-family:"Times New Roman",serif"></span></span></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="background:white"><span style="line-height:normal"><span style="tab-stops:list 20.85pt left 45.8pt 91.6pt 137.4pt 183.2pt 229.0pt 274.8pt 320.6pt 366.4pt 412.2pt 458.0pt 503.8pt 549.6pt 595.4pt 641.2pt 687.0pt 732.8pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span calibri="" style="font-family:"><span b="" lang="FA" lotus="" style="font-family:">روند تغییرات </span><span b="" lang="FA" lotus="" style="font-family:"><span style="color:black">درصد نسخ دارای حداقل یک قلم تزریقی </span></span><span b="" lang="FA" lotus="" style="font-family:">از کمترین مقدار یعنی </span><span b="" lang="FA" lotus="" style="font-family:">23/7</span><span b="" lang="FA" lotus="" style="font-family:">% تا بالاترین مقدار 44/9% در نوسان بوده است</span> <span b="" lang="FA" lotus="" style="font-family:">و با میانگین پیشنهادی</span><span dir="LTR" new="" roman="" style="font-family:" times="">WHO</span><span b="" lang="FA" lotus="" style="font-family:"> یعنی 18/75% تفاوت زیادی دارد.</span><span dir="LTR" style="font-family:"Times New Roman",serif"></span></span></span></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="line-height:normal"><span style="direction:rtl"><span style="unicode-bidi:embed"><span calibri="" style="font-family:"><span b="" lang="FA" lotus="" style="font-family:">روند تغییرات </span><span b="" lang="FA" lotus="" style="font-family:"><span style="color:black">درصد نسخ دارای حداقل یک قلم کورتیکوستروئید تزریقی</span></span><span b="" lang="FA" lotus="" style="font-family:"> از کمترین مقدار یعنی 10/8% تا بالاترین مقدار یعنی 25/75% در نوسان بوده است.</span></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="line-height:normal"><span style="direction:rtl"><span style="unicode-bidi:embed"><span calibri="" style="font-family:"><b><span b="" lang="FA" lotus="" style="font-family:"><span style="color:black">نتیجه گیری</span></span></b><span b="" lang="FA" lotus="" style="font-family:">: منطقی کردن مصرف دارو باید جزو اولویتهای سیاستهای دارویی قرار گیرد. استفاده از الگوی نسخه نویسی اصولی بر اساس شاخص های </span><span dir="LTR" new="" roman="" style="font-family:" times="">WHO </span><span b="" lang="FA" lotus="" style="font-family:">، می تواند معیار مناسبی برای ارزیابی نسخ پزشکان در سطح مراقبت های بهداشتی اولیه </span><span b="" lang="FA" lotus="" style="font-family:">(</span><span dir="LTR" new="" roman="" style="font-family:" times="">PHC</span><span b="" lang="FA" lotus="" style="font-family:">)</span><span b="" lang="FA" lotus="" style="font-family:"> قرار گیرد.</span></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="line-height:normal"><span style="unicode-bidi:embed"><span calibri="" style="font-family:"><b><span new="" roman="" style="font-family:" times="">Background and Aim</span></b><span new="" roman="" style="font-family:" times="">: </span><span new="" roman="" style="font-family:" times="">Rationalizing drug use is a priority in drug policy-making. The World Health Organization (WHO) recommends the evaluation of prescriptions using drug prescribing indicators. Improving prescribing patterns leads to closer alignment with WHO indicators and, consequently, promotes rational drug use.</span></span></span></span></span><br>
<span style="font-size:11pt"><span style="line-height:normal"><span style="unicode-bidi:embed"><span calibri="" style="font-family:"><b><span new="" roman="" style="font-family:" times="">Materials and Methods</span></b><span dir="RTL" lang="FA" new="" roman="" style="font-family:" times="">:</span> <span new="" roman="" style="font-family:" times="">In this study, ten prescriptions were randomly selected from each pharmacy on a monthly basis. WHO prescribing indicators, including the average number of drug items per prescription and the percentage of prescriptions containing at least one antibiotic, one injectable drug, and one injectable corticosteroid, were calculated. The sample size of the prescriptions evaluated over eight consecutive years, stratified by network/center, was 4,800 in Shahr-e Rey, 14,520 in Eslamshahr, and 5,880 in the South Tehran Health Center.</span></span></span></span></span><br>
<span style="font-size:11pt"><span style="line-height:normal"><span style="unicode-bidi:embed"><span calibri="" style="font-family:"><b><span lang="EN" new="" roman="" style="font-family:" times=""><span style="color:#1f1f1f">Results</span></span></b><span lang="EN" new="" roman="" style="font-family:" times=""><span style="color:#1f1f1f">: </span></span><span new="" roman="" style="font-family:" times="">The average number of drug items per prescription ranged from a minimum of 2.5 to a maximum of 3.99, showing a considerable difference from the WHO-recommended average of 1.7. The percentage of prescriptions containing at least one antibiotic fluctuated from 33.36% to 63.93%, which was substantially higher than the WHO-recommended average of 20.3%.<br>
Additionally, the percentage of prescriptions containing at least one injectable drug ranged from 23.7% to 44.9%, differing markedly from the WHO-recommended average of 18.75%.</span></span></span></span></span><br>
<span style="font-size:11pt"><span style="line-height:normal"><span style="unicode-bidi:embed"><span calibri="" style="font-family:"><b><span new="" roman="" style="font-family:" times="">Conclusions</span></b><span new="" roman="" style="font-family:" times="">:</span> <span new="" roman="" style="font-family:" times="">Rationalizing drug use should be prioritized in drug policies. Adopting a principled prescription-writing model based on WHO indicators can serve as an appropriate criterion for evaluating physicians’ prescriptions at the primary health care (PHC) level.</span></span></span></span></span><br>
شاخص تجویز داروی سازمان بهداشت جهانی, مراقبت های بهداشتی اولیه
World Health Organization Drug Prescribing Indicators, Primary Health Care
173
184
http://sjsph.tums.ac.ir/browse.php?a_code=A-10-1-282&slc_lang=other&sid=1
Afsaneh
Mosleh
افسانه
مصلح
amosleh08@gmail.com