【作者】 谢靳希； 田野； 洪妍； 胡华杰； 管晓东； 史录文；

【Author】 XIE Jin-xi;TIAN Ye;HONG Yan;HU Hua-jie;GUAN Xiao-dong;SHI Lu-wen;School of Pharmaceutical Sciences, Peking University;International Research Center of Medicinal Administration, Peking University;

【机构】 北京大学药学院； 北京大学医药管理国际研究中心；

【摘要】 目的:对比实施总额预付和按项目付费的县级公立医院住院患者的用药差异,探讨总额预付改革对住院患者合理用药的影响,为科学推进医保支付方式改革提供建议。方法:针对样本医院儿科和呼吸科主要诊断为社区获得性肺炎的医嘱用药信息,使用单因素分析法探究两种支付方式在住院指南推荐用药符合率、抗菌药使用率、抗菌药联合使用率以及激素使用率四项指标上的差异。结果:相比按服务项目付费,总额预付制下的指南推荐用药符合率更高,抗菌药使用和联用率均更低,激素使用率更低。结论:总额预付对促进合理用药有一定效果,但合理用药水平仍有待加强,建议实施多种促进合理用药的策略来提升合理用药水平。更多还原

【Abstract】 objective: Comparing the inpatients drug use at global budgets with fee-for-service at county hospitals, explore the impact of global budgets reform on inpatients rational drug use, so as to provide valuable advice to scientifically promote the reform of medical insurance payment Methods: In terms of the drug use information of inpatients medical records of pediatric and pneumology departments,univariate analysis was applied to analyze the difference of 4 indicators, including percentage of patients treated according to standard treatment guideline, percentage of patients receiving antibiotics, percentage of patients receiving antibiotics combination, and percentage of patients receiving hormone, under two different ways of medical insurance payment. Results: Compared with the fee-for-service group, the global budgets group has higher percentage of patients treated according to standard treatment guideline, but lower percentage of patients receiving antibiotics, lower percentage of patients receiving antibiotics combination, and lower percentage of patients receiving hormone. However, there is some difference in pneumology departments Conclusion: Global budgets has positive effects on rational drug use to some extent, improving rational use in county-level hospitals is still urgently needed更多还原