蓝鱼o_0 发表于 2012-4-1 23:58

抗生素管理的成本效益分析

Cost-Effectiveness of Antimicrobial Stewardship

An active antimicrobial stewardship program at an academic medical center was found to be highly cost-effective.
The increasing prevalence of antimicrobial-resistant microorganisms and the rising costs of medical care have led many institutions to consider developing active antimicrobial stewardship programs (ASPs). Given the up-front personnel expenses required to initiate such programs, return on investment remains a concern.
An ASP was in place at the University of Maryland Medical Center for 7 years. It was centered on an antimicrobial monitoring team that included an infectious diseases–trained clinical pharmacist and a part-time infectious diseases physician. Investigators recently analyzed the effects of this program on antimicrobial utilization costs.
Between the year before ASP implementation (fiscal year 2001) and the final year of the program (FY 2008), the institutional antimicrobial utilization costs per 1000 patient days were reduced by 45.8% — from US$44,181 to $23,933. An institutional cost savings of $2,949,705 was seen during the first 3 years of the program, with savings achieved through decreased use of antifungal and antibacterial agents and switching from intravenous to oral delivery. Defined daily doses of antimicrobial agents were also reduced significantly between FY 2004 (the first period with available data) and FY 2008.
After the program was discontinued, antimicrobial utilization costs per 1000 patient days increased to $27,833 in FY 2009 and $31,653 in FY 2010. Institutional antimicrobial utilization costs rose by $1,000,000 in FY 2009 and by an additional $873,184 in FY 2010. No significant changes were seen in length of stay, readmissions, mortality, or drug-related group case mix index over the 10-year study period.
Comment: The potential benefits of antimicrobial stewardship are likely dependent on the personnel involved and the changing costs of antimicrobial agents, and they will be influenced by the advent of more-robust electronic medical record systems. Still, these findings offer a compelling justification for academic medical centers, in particular, to institute ASPs. The authors note that, on the basis of cost-effectiveness data, an ASP has now been reimplemented at their institution.
— Richard T. Ellison III, MD
Published in Journal Watch Infectious Diseases March 21, 2012

蓝鱼o_0 发表于 2012-4-2 00:02

研究提出了,抗生素管理ASP对于节省成本是有益的,但是随着活动的停止,会呈现反弹趋势。

因此非常强大的电子信息系统对此进行监控是非常重要和必要,可以持续的推进和改进ASP的效果。

神通广大 发表于 2012-4-2 08:45

如同蓝鱼老师所说的那样,要把抗菌药物管理工作做得更好,单靠人工操作是远远不够的,它必须有强大的电子信息化管理系统来支撑,我院的抗菌药物信息化管理系统,上个月才开始进入调试运用阶段,希望在未来的抗菌药物管理能够做得更加规范。

桂花香 发表于 2012-4-2 09:09

antimicrobial stewardship programs (ASPs).
目前在我国,还是以行政干预为主,如果没有卫生部的强有力推动,恐怕难以有好的效果。

神通广大 发表于 2012-4-2 15:24

神通广大 发表于 2012-4-2 08:45 static/image/common/back.gif
如同蓝鱼老师所说的那样,要把抗菌药物管理工作做得更好,单靠人工操作是远远不够的,它必须有强大的电子信 ...

太好了,谢谢蓝鱼老师的提醒,我会抽时间关注并学习相关文献的。

蓝鱼o_0 发表于 2012-4-2 22:43

神通广大 发表于 2012-4-2 15:24 static/image/common/back.gif
太好了,谢谢蓝鱼老师的提醒,我会抽时间关注并学习相关文献的。

感谢您的参与!多读英文文献,为2013APSIC努力了!

蓝鱼o_0 发表于 2012-4-2 22:46

桂花香 发表于 2012-4-2 09:09 static/image/common/back.gif
antimicrobial stewardship programs (ASPs).
目前在我国,还是以行政干预为主,如果没有卫生部的强有力推 ...

现在是政策是有了,关键是如何贯彻。并且如何持续的贯彻。

跟手卫生类似,短期的活动有效,但是效果并不持久,想要更好的效果,还需要多从其他方面想办法,比如连续性干预,并用计算机软件系统进行控制,及时反馈总结等等。
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