杭州地区公立医院实行药品“零差率”前后处方金额和数量的对比分析
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篇名: 杭州地区公立医院实行药品“零差率”前后处方金额和数量的对比分析
TITLE:
摘要: 目的:分析药品“零差率”政策对公立医院处方金额和数量的影响,为药品政策的评估和持续改进提供参考。方法:采用回顾性分析方法,分别统计杭州地区7家省级医院和5家市县级公立医院实行药品“零差率”前后处方金额和处方数的变化以及对不同类别药品、不同科室和常见慢性病诊断的处方数和处方金额的影响。结果:实行药品“零差率”后,12家医院药品处方总金额增长率为16.51%,其中省级医院(18.20%)高于市县级医院(7.58%)。市县级医院的门诊处方总金额、处方总张数和平均处方金额均比“零差率”前增加,省级医院门诊处方总金额和平均处方金额均有所增加,而处方张数有所下降。抗恶性肿瘤药物的门诊处方金额占比由实行前的7.00%上升至9.10%,神经系统用药的住院处方金额占比由9.40%上升至11.20%,抗感染药物无论是门诊还是住院处方金额占比均下降10%以上。门诊处方总金额排名前10位科室中除肾内科和普通内科出现下降外,其他科室均有不同程度增加,平均处方金额增加幅度最大的是泌尿外科(16.89%),而下降幅度最大的是肾内科(-4.31%)。实行“零差率”后,诊断为高血压、糖尿病和高脂血症的平均处方金额和平均处方药品种数均有所上升。结论:药品“零差率”政策对省级和市县级医院用药带来的变化存在一定差异,对门诊和住院医师用药行为的影响也有所不同。
ABSTRACT: OBJECTIVE: To analyze the effects of drug “zero-profit policy” on amount and number of prescriptions in the public hospital, and to provide reference for drug policy evaluation and continuous improvement. METHODS: Retrospective analysis was used to analyze the change of prescription amount and quantity before and after the implementation of drug “zero-profit policy”, and the effects of the policy on prescription amount and quantity of different categories, different departments and common chronic disease diagnosis in 7 provincial hospitals and 5 municipal hospitals in Hangzhou area. RESULTS: After the implementation of drug “zero-profit policy”, increase rate of total prescription amount was 16.51% in 12 hospitals, among which the provincial hospitals (18.20%) was higher than municipal hospitals (7.58%). Total prescription amount and quantity, average prescription amount in outpatient department of municipal hospitals were all increased, compared to before the implementation of the policy. Total prescription amount and average prescription amount in outpatient department of provincial hospitals were both increased, while prescription quantity was decreased. Constituent ratio of anti-tumor agent outpatient prescription amount increased from 7.00% to 9.10%; constituent ratio of nervous system drugs inpatient prescriptions increased from 9.40% to 11.20%; constituent ratio of anti-infective drug outpatient and inpatient prescription both decreased by more than 10%. Total amount of outpatient prescription all increased in each department except for nephrology department and general internal department among top 10 departments. The average prescription amount of urology surgery department increased by 16.89% at most, while that of nephrology department decreased mostly (-4.31%). The average prescription amount and drug types of hypertension, diabetes and hyperlipidaemia were all increased after the implementation of the policy. CONCLUSIONS: There are some differences in the change of prescription between provincial and municipal hospitals, medication behavior of physicians in outpatient and inpatient department after the implementation of the policy.
期刊: 2017年第28卷第2期
作者: 王鼎盛,葛敏,蒋晓蕊
AUTHORS: WANG Dingsheng,GE Min,JIANG Xiaorui
关键字: 药品“零差率”;公立医院;处方金额;处方数量;杭州地区
KEYWORDS: Drug “zero-profit policy”; Public hospitals; Prescription amount; Prescription number; Hangzhou area
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