医疗机构施行总药师制对促进临床合理用药和医保控费的作用探索

Exploration of effect of chief pharmacist system in medical institutions on promoting clinical rational drug use and medical insurance cost control

目的探索医疗机构施行总药师制,对提升药师服务水平、促进合理用药、降低医保药品费用的作用。方法以2022年为实验组,施行总药师制对药品相关事项进行集中管理,通过合理用药绩效考核、施行药事管理与药物治疗学委员会管理工作、药品采购预算、成立审方中心、发挥临床药师作用,推动基本药物和医保药品集中带量采购药品应用、参与临床路径和学科发展。以2021年未实施总药师制为对照组。对比分析2021年和2022年的药占比、抗菌药物使用率、使用强度等合理用药指标以及药品费用等经济学指标。结果2022年1—12月产科、妇科及全院住院患者抗菌药物使用率、使用强度均明显下降,基本药物临床使用金额占比提升,带量采购药品顺利完成任务量。门诊人均次药品费用减少(95.66±15.18)元,住院患者人均降低药品费用(221.18±36.48)元。结论医疗机构施行总药师制,可以促进合理用药,降低患者药品费用,有利于促进临床合理用药和医保控费。

Objective To explore the role of the chief pharmacist system in medical institutions in improving the service level of pharmacists,promoting rational drug use,and reducing the cost of medical insurance drugs.Methods Taking 2022 as the experimental group,the chief pharmacist system was implemented to centrally manage drug-related matters,and through the performance evaluation of rational drug use,the implementation of pharmaceutical management and therapeutics committee management,drug procurement budget,the establishment of a prescription review center,and the role of clinical pharmacists,the application of basic drugs and medical insurance drugs was promoted to procure drugs in a centralized manner,and participate in the development of clinical pathways and disciplines.The chief pharmacist system was not implemented in 2021 as the control group.In 2021 and 2022,the proportion of drugs,the use rate of antimicrobial drugs,the intensity of use of drugs and other rational drug use indicators,as well as economic indicators such as drug costs were compared and analyzed.Results From January to December 2022,the use rate and intensity of antimicrobial drugs in obstetrics,gynecology and hospital-wide inpatients decreased significantly,the proportion of clinical use of essential drugs increased,and the volume of drugs purchased with volume successfully completed the task.The per capita drug cost for outpatient patients decreased by(95.66±15.18)yuan,and the per capita drug cost for inpatients decreased by(221.18±36.48)yuan.Conclusion The implementation of the chief pharmacist system in medical institutions can promote the rational use of drugs,reduce the cost of drugs for patients,and promote the rational use of drugs in clinical practice and the control of medical insurance costs.