摘要
目的促进医院合理使用静脉输液。方法基于疾病诊断相关分组(DRG)支付进行药事管理干预,干预时间为2021年10月至12月,干预手段包括加强宣传教育培训,梳理静脉输液药品品种与疾病谱,制订病种相应临床路径,增加输液处方专项点评内容,将不合理处方开具情况纳入绩效考核,开展信息系统管控。通过医院信息系统与合理用药软件提取医院门/急诊与住院部2021年1月至9月(药事管理干预前)与2022年1月至9月(药事管理干预后)的病例资料,分析干预前后全部处方及含抗菌药物、含中药注射剂、含激素类药物(或辅助药品)处方中静脉输液相关指标及住院病例DRG相关药事指标。结果静脉输液相关指标,与干预前比较,干预后的门/急诊患者总体及不同类型药物静脉输液率(以人次、处方数计)均显著降低(P<0.01),住院患者除抗菌药物外的静脉输液率(以人次计)均显著降低(P<0.01);门/急诊与住院患者药品使用金额均不同幅度降低;门/急诊患者处方退回修改率显著升高(3.54%比2.41%,P<0.01);患者对静脉输液服务的总满意度显著升高(94.20%比73.20%,P<0.01)。DRG相关指标,与干预前比较,干预后的住院患者DRG总权重、病例组合指数(CMI)及基本药物使用金额占比均升高,费用消耗指数、时间消耗指数和患者次均费用均降低,且患者死亡率及静脉输液药品结构比、辅助药品结构比、次均药费、次均辅助药费均降低。结论该药事管理模式显著降低了静脉输液率,并提高了医院合理用药水平,减少了患者的就医费用,并提高了患者满意度,继而整体提升了该院的医疗服务能力。
Objective To promote the rational use of intravenous infusion in hospitals.Methods The pharmaceutical administration intervention was conducted based on the diagnosis related groups(DRG)payment from October to December 2021.The intervention measures included strengthening publicity and education,sorting out the types of intravenous infusion and disease spectrum,formulating corresponding clinical pathways for diseases,adding special review for infusion prescriptions,incorporating irrational prescribing into performance assessment and implementing information system control.The patients'data of the outpatient/emergency and inpatient departments of the hospital from January to September 2021(before pharmaceutical administration intervention)and from January to September 2022(after pharmaceutical administration intervention)were extracted by the hospital information system and rational drug use software.The intravenous infusion-related indicators of all prescriptions and prescriptions containing antibiotics,traditional Chinese medicine injections,hormones(or adjuvant drugs)and DRG-related pharmaceutical indicators of inpatients before and after intervention were analyzed.Results Compared with those before intervention,the overall use rate of intravenous infusion and use rates of different intravenous infusions(calculated by person-times and quantity of prescriptions)in outpatient/emergency patients significantly decreased after intervention(P<0.01),and the use rate of intravenous infusion(calculated by person-times)in inpatients significantly decreased except for antibiotic infusion(P<0.01);the drug costs in outpatient/emergency patients and inpatients decreased to varying degrees;the return and modification rate of prescriptions in outpatient/emergency patients significantly increased from 2.41% to 3.54%(P<0.01);the overall satisfaction degree of patients with service significantly increased from 73.20% to 94.20%(P<0.01).Compared with those before intervention,the inpatients'DRG total weight,case-mix index(CMI)and t
作者
葛欣
刘平
张士伟
朱妍莹
程慎令
GE Xin;LIU Ping;ZHANG Shiwei;ZHU Yanying;CHENG Shenling(Tengzhou Central People's Hospital,Zaozhuang,Shandong,China 277500)
出处
《中国药业》
CAS
2024年第2期6-10,共5页
China Pharmaceuticals
关键词
DRG支付
基层医院
药事管理
静脉输液率
合理用药
DRG payment
primary hospital
pharmaceutical administration
use rate of intravenous infusion
rational drug use
