门诊2型糖尿病患者临床药学服务的成本效果分析

Analysis on the cost-effectiveness of pharmaceutical care for typeⅡdiabetic outpatients

目的:评价临床药师为门诊糖尿病患者提供健康教育服务的经济,探索临床药学服务经济学评价方法。方法:自身干预前后对照试验。研究对象:2011年5-6月纳入研究范围的101名糖尿病门诊初诊和复诊患者;临床药学干预措施:由临床药师给予健康教育;成本指标:测算临床药学服务时间成本和临床药师薪酬作为直接成本,临床药师培训成本作为间接成本。效果指标:采用用药依从性调查问卷,通过干预前调查和干预15 d后电话随访调查评价用药干预前后用药依从性评分。结果:(1)临床药师提供健康教育前患者用药依从性得分为66.5,健康教育后为86.4,提高19.9%;(2)从医院支付角度,干预前医院临床药师服务成本为1 480.76元,干预后成本为1 899.13元,上升418.37元;(3)临床药师为患者提供健康教育服务的成本/效果比为21.98,相对不提供服务的成本/效果比22.27,具有积极经济学意义。结论:(1)临床药学服务对改善用药结果有显著效果,(2)临床药师为门诊患者开展健康教育服务具有积极的经济效果,(3)开展临床药学服务经济学评价可为医疗机构药事服务费改革提供参考,(4)临床药学服务经济学评价方法还需完善。

OBJECHVE To evaluate the economic outcome of health education service for diabetic outpatients provided by clinical pharmacists, and explore the method of economic evaluation of clinical pharmacy service in China. METHODS Sel~ control trial was adopted. 101 diabetic outpatients from May to June 2011 were involved in study. Patients were given with health education by clinical pharmacist. Questionnaire survey was conducted by clinical pharmacist before and 15 days after in tervention to obtain the score of compliance with medication as outcome indicator. Period of intervention, fee of clinical pharma- cist training, salary of clinical pharmacist were estimated and recorded as the cost of clinical pharmacy intervention. RESULTS （1） The score of compliance with medication of diabetic outpatients is was 66. 5 before health education, While it rose to 86. 4 15 days after health education, increased by 19.9~/oo ; （2） For the hospital, the cost of pharmacy service without health education was 1 480. 76 yuan, and 1 899. 13 yuan with health education; （3）the C/E of pharmacy service with health education provided by clinical pharmacist was 21.98 and 22.27 without education. There was cost-efficacy significance. CONCLUSION （1） Clini cal pharmacy service had evident effect for patient health outcome; （2） Clinical pharmacy service had positive economics out come as we｜l~ （3） The economic evaluation of clinical pharmacy service can provide evidence and support for the pharmaceutical service charge reform in hospitals; （4） The method of evaluation should be improved