Long prescription for comments: 8 types of drugs were excluded, 4 cases were terminated

A few days ago, the National Health Commission publicly solicited opinions from the public on the "Long-term Prescription Management Standards (Trial Draft for Comment)" (hereinafter referred to as the Draft for Comment).

Class 8 drugs should not be used for long-term prescriptions

The "Draft for Solicitation of Comments" clarified that the so-called long-term prescription refers to a prescription that qualified physicians prescribed to eligible patients with chronic diseases in accordance with regulations, with an appropriate increase in the amount of prescriptions.

However, medical toxic drugs, radioactive drugs, precursor drugs, narcotic drugs, psychotropic drugs, biological agents, antibacterial drugs ( except drugs for the treatment of chronic bacterial and fungal infectious diseases such as tuberculosis ), and drugs with special requirements for storage conditions Not to be used for long-term prescriptions.

The amount of long-term prescriptions is generally within 4 weeks.

For the first time, it needs to be issued by a doctor with relevant qualifications from a medical institution above the second level

The "Draft for Solicitation of Comments" requires that medical institutions that issue long-term prescriptions should be equipped with physicians who have the ability to assess the patient's condition, pharmacists who can review and adjust long-term prescriptions, and corresponding equipment and facilities.

At the same time, for the first long-term prescription, it is required to be issued by a doctor with an intermediate or higher qualification for a disease-related professional in a medical institution above the second level, or by a doctor with an intermediate or higher qualification for a professional and technical position in a primary medical and health institution.

Patients can choose to adjust and take medicines independently

After the doctor has issued a long-term prescription, the patient can choose to dispense the medicine at a medical institution or social retail pharmacy.

In principle, long-term prescription drugs are collected by the patient himself.

4 types of situations need to judge whether to terminate the long-term prescription

The patient's long-term medication management does not meet the expected goals; other diseases require other medications; the patient is hospitalized for any reason; other situations that require the termination of long-term prescriptions.

Attached with long-term prescription management practices (trial implementation? Draft for comments)

Chapter One General Provisions

Article 1 Standardize long-term prescription management, promote hierarchical diagnosis and treatment , promote rational use of drugs, and ensure medical quality and medical safety.

Article 2 The term “long-term prescriptions” as used in this specification refers to the prescriptions prescribed by qualified physicians in accordance with regulations to appropriately increase the amount of prescriptions prescribed by qualified patients with chronic diseases.

Article 3 Long-term prescriptions are applicable to patients with chronic diseases with clear clinical diagnosis, stable medication regimen, good compliance, stable disease control, and long-term drug treatment.

Article 4 Commonly used drugs for the treatment of chronic diseases can be used for long-term prescriptions.

Article 5 The local health administrative department shall, based on the actual situation, formulate a list of diseases and diseases applicable to long-term prescriptions and long-term prescription drugs.

Article 6 This specification applies to the long-term prescription management work of various medical institutions at all levels and types across the country.

Long-term prescriptions for chronic diseases that are not suitable for primary treatment should be issued by medical institutions above the second level.

Article 7 The National Health Commission is responsible for the supervision and management of long-term prescriptions nationwide.

Local health administrative departments at or above the county level are responsible for the supervision and management of long-term prescriptions within their administrative areas.

Chapter II Organization Management

Article 8 A medical institution shall perform its main responsibility for long-term prescription management, establish and improve its long-term prescription management work system, ensure medical quality and medical safety, and meet the needs of patients for medication.

Article 9 Medical institutions that issue long-term prescriptions shall be equipped with physicians who have the ability to assess the patient's condition, pharmacists who can review and adjust long-term prescriptions, and corresponding equipment and facilities.

If the primary medical and health institution does not have the corresponding conditions, it can be issued under the guidance of the qualified superior medical institution in the medical consortium through telemedicine and other routes.

Article 10 According to the needs of patients for diagnosis and treatment, the amount of long-term prescriptions is generally within 4 weeks.
In areas where conditions permit, it can be extended appropriately according to the characteristics of chronic diseases, and the maximum length is no more than 12 weeks.

For long-term prescriptions exceeding 4 weeks, physicians should strictly evaluate, strengthen patient education, and record in the medical record, and the patient should sign for confirmation.

Article 11 Medical institutions shall provide long-term prescription services to eligible patients in accordance with the long-term prescription applicable disease types and the long-term prescription drug list formulated by the health administrative department.

Article 12 When issuing long-term prescriptions, medical institutions shall give priority to the selection of national essential drugs, and the state organizes centralized procurement and use of drugs and drugs in the national medical insurance catalogue.

Article 13 Primary medical and health institutions shall strengthen the provision of drugs in the long-term prescription drug catalog to ensure that patients' long-term medication is accessible and stable.

Chapter III Issuance and Termination of Long-term Prescriptions

Article 14 For patients who apply for long-term prescriptions, doctors must conduct medical examinations in person and judge whether they meet the conditions for long-term prescriptions.

During the diagnosis and treatment activities, doctors can proactively propose long-term prescription recommendations to eligible patients.

Article 15 Physicians should explain to patients the precautions for the use of long-term prescriptions, and they should voluntarily choose whether to use them; for patients who do not meet the conditions, they should explain the reasons to the patients.

Article 16 Before issuing a long-term prescription for the first time, the physician shall conduct a comprehensive assessment of the patient’s past history, current medical history, medication regimen, compliance, disease control, etc.
, and formulate the prescription when it is determined that the current medication regimen is safe, effective, and stable.
Long-term prescriptions can be prescribed for patients.
When a long-term prescription is issued for the first time, relevant information should be recorded in detail in the patient's medical record.

Article 17: In principle, the first long-term prescription should be issued by a doctor with a qualification for an intermediate or above professional and technical position in a disease-related medical institution at a secondary level or above, or by a doctor with an intermediate or above professional and technical qualification for a primary medical and health institution.
Issued.
When a long-term prescription is issued again, it should be issued by a doctor from a disease-related professional in a medical institution above the second level, or a doctor from a primary medical and health institution.
Encourage patients to sign long-term prescriptions with family doctors through primary medical and health institutions.

For remote areas or areas where conditions are not available, the requirements may be appropriately relaxed, and the specific requirements shall be separately formulated by the provincial health administrative department based on the actual situation.

Article 18 Physicians should evaluate patients based on the long-term prescription information and health files issued for the first time in the patient's medical record information.
After evaluation, if the patient's condition is stable and the long-term medication management goal is reached, the long-term prescription can be issued again; if the condition is not met, the long-term prescription shall be terminated.
If the long-term prescription is used again after stopping, it shall be managed according to the long-term prescription issued for the first time.

Article 19 In the following situations, it is necessary to reassess the patient's condition and determine whether to terminate the long-term prescription:

(1) The patient's long-term medication management fails to reach the expected goal;

(2) Suffering from other diseases requires other medication;

(3) The patient is hospitalized for any reason;

(4) Other circumstances requiring termination of long-term prescriptions.

Article 20: Primary medical and health institutions that issue long-term prescriptions and higher-level hospitals must do a good job of linking up, and establish a patient prescription information sharing and circulation mechanism through informatization methods.

Article 21 The form and content of long-term prescriptions shall comply with the requirements of ordinary prescription management in the "Prescription Management Measures".
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Chapter 4 Long-term prescription adjustments

Article 22: After a doctor has issued a long-term prescription, the patient may choose to dispense the medicine at a medical institution or social retail pharmacy.

Article 23 Pharmacists review long-term prescriptions, provide medication guidance and medication education to patients, and distribute medication education materials.
If the primary medical and health institutions do not have the conditions, the pharmacists of the higher-level hospitals in the medical association shall remotely conduct prescription review or provide medication guidance services through the Internet.

Article 24 When pharmacists review long-term prescriptions, provide consulting services, or dispense drugs, if they discover drug treatment-related problems or patients have potential drug safety risks, and need to carry out long-term prescription adjustments, drug reorganizations and other interventions, they should immediately contact the physicians Communicate for processing.

Article 25 In principle, long-term prescription drugs shall be collected by the patient himself.
Under special circumstances, due to inconvenience and other reasons, personnel who are familiar with the basic situation of the patient can pick up the card on behalf of the person and the patient with a valid ID card.

Chapter 5 Long-term prescription drug management

Article 26 Primary medical and health institutions shall include the long-term prescription information issued by the institution into the patient's health file, and record the patient's diagnosis and treatment and medication records in detail.
The family doctor team should conduct regular follow-up management of patients, evaluate changes in the patient's condition, medication compliance, and adverse drug reactions, and adjust or terminate long-term prescriptions if necessary.

Article 27: Medical institutions shall establish safe medication monitoring and reporting systems.
After a serious adverse drug event occurs, the patient should be actively treated, immediately reported to the medical and pharmaceutical departments, and observed and recorded.
Report adverse drug reactions and other information to relevant departments in accordance with relevant regulations.

Article 28: Medical institutions should strengthen medication education for patients who use long-term prescriptions, increase their knowledge of rational medication, improve self-administration ability and medication compliance, and inform patients that they should see a doctor promptly if they experience any discomfort during medication.

Article 29 Medical institutions shall instruct patients who use long-term prescriptions to self-monitor and keep records of drug treatment effect indicators.
Encourage the use of wearable devices to improve the informatization level of drug treatment effect indicator monitoring.
On the premise of ensuring the safety of data and privacy, it is possible to explore the use of remote monitoring equipment connected to the Internet to carry out monitoring.

Article 30 Medical institutions shall instruct patients who use long-term prescriptions, preserve medicines as required, and ensure the quality of medicines.

Article 31 Medical institutions shall incorporate the diagnosis and treatment of patients with long-term prescriptions into the overall arrangements for medical management, strictly implement the requirements for the diagnosis and treatment of relevant diseases, strengthen quality control and management, and ensure medical quality and medical safety.

Article 32: Encourage regions with conditions to open WeChat official accounts, patient clients, etc.
, to facilitate patients' inquiries about long-term prescription information, drug usage and dosage, precautions, etc.
Explore the development of medication reminder, follow-up, medication consultation and other services for patients with long-term prescriptions.

Chapter VI Supplementary Provisions

Article 33 The local administrative department of health and health shall formulate and implement detailed rules for the long-term prescription management within its jurisdiction.

Article 34: Primary medical and health institutions refer to township health centers, community health service centers (stations), village clinics, infirmaries, outpatient departments and clinics, etc.
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Article 35 This specification shall be implemented from the date of issuance.