摘要
目的探讨临床药师在疾病诊断相关分组(DRGs)付费制度下对呼吸科药品控费管理的作用。方法选取2021—2022年广州中医药大学顺德医院呼吸科住院患者,筛选出住院金额超出本院支付标准患者,排名前五的DRGs,分为DRGs 1组(ET29慢性气道阻塞病)、DRGs 2组(ES33呼吸系统感染/炎症,伴一般并发症或合并症)、DRGs 3组(EJ13呼吸系统其他手术,伴一般并发症或合并症)、DRGs 4组(ER13呼吸系统肿瘤,伴并发症或合并症)、DRGs 5组(ER15呼吸系统肿瘤,不伴并发症或合并症),各20例。并根据临床药师开展药品控费干预的时间节点,分为干预前(2021年)和干预后(2022年)2个时段。观察比较干预前后各组住院时间、住院总费用、药品总费用及药占比,抗菌药物使用排名前10的总金额和抗菌药物使用频率(DDDs),以及抗菌药物费用占比。结果干预后患者住院天数、住院总费用、药品总费用、药占比均低于干预前,除DRGs 3组住院总费用和DRGs 5组住院总费用与药品总费用比较差异无统计学意义(P>0.05),其余各组干预前后住院时间、住院总费用、药品总费用及药占比比较均有统计学差异(P<0.05或P<0.01);干预后组患者的排名前10的抗菌药物总金额除头孢哌酮舒巴坦,厄他培南,西他沙星,环丙沙星外,其余药物使用总金额均降低,且干预后抗菌药物前10总金额低于干预前;干预后,DDDs排名前10的抗菌药物总DDDs值低于干预前;干预后DRGs 1组、DRGs 2组、DRGs 3组抗菌药物费用占比低于干预前。DRGs 4组和DRGs 5组的抗菌药物费用占比高于干预前。结论DRGs付费模式下临床药师能有效参与呼吸科药品控费管理,在保障临床疗效和安全的前提下控制药品费用,促进DRGs模式的合理运作。
Objective To explore the role of clinical pharmacists in drug cost management in respiratory medicine under the diagnosis related groups(DRGs)payment system.Methods From hospitalized patients in the hospital′s respiratory department between 2021 and 2022,cases were selected where inpatient costs exceeded the hospital′s payment standards,and ranking in the top five DRGs.These groups were divided into DRGs 1(ET29 Chronic airway obstruction),DRGs 2(ES33 Respiratory system infection/inflammation with general complications or comorbidities),DRGs 3(EJ13 Other respiratory system surgeries with general complications or comorbidities),DRGs 4(ER13 Respiratory system tumors with complications or comorbidities),and DRGs 5(ER15 Respiratory system tumors without complications or comorbidities),each comprising 20 cases.And based on the time points of drug cost management interventions conducted by clinical pharmacists,divided into two periods:pre-intervention(2021)and post-intervention(2022).Comparison was made between pre-intervention(2021)and post-intervention(2022)periods for each group regarding length of hospital stay,total hospital costs,total drug costs,drug proportion,total expenditure and frequency(DDDs)of the top 10 antimicrobial agents used,and the proportion of antimicrobial drug expenses.Results After intervention,hospital stay,total hospital costs,total drug costs,and drug proportion for patients were lower than before intervention.Except for non-statistically significant differences in total hospital costs for DRGs 3 and total hospital and drug costs for DRGs 5(P>0.05),statistically significant differences were observed in hospital stay,total hospital costs,total drug costs,and drug proportion before and after intervention across all other groups(P<0.05 or P<0.01).After intervention,the total expenditure on the top 10 antimicrobial agents used by patients decreased for all drugs except Cefoperazone/Sulbactam,Ertapenem,Sitafloxacin and Ciprofloxacin.Additionally,the total expenditure on the top 10 antimicrobia
作者
何杏仪
庞雨
欧阳燕婷
吴端仪
HE Xingyi;PANG Yu;OUYANG Yanting;WU Duanyi(Shunde Hospital Guangzhou University of Chinese Medicine,Guangdong Province,Foshan 528000,China)
出处
《临床合理用药杂志》
2024年第23期11-16,共6页
Chinese Journal of Clinical Rational Drug Use
基金
顺德区竞争性扶持人才项目(SDRC20220002)
2022年佛山市自筹经费类科技计划项目(2220001004964)
佛山市卫生健康局医学科研课题(20230815A010075)。
关键词
临床药师
疾病诊断相关分组
呼吸科
药品控费
Clinical pharmacist
Diagnosis related groups
Respiratory department
Drug cost control
