社区健康管理对高血压患者门诊及药店购药费用的影响

Expenditure in outpatient department and pharmacy on patients with hypertension and the influence from community health management program

目的 探索社区健康管理服务对高血压患者相关医疗费用的影响,为相关政策的制定提供科学依据。方法 研究数据来源于2011年中国慢性病及其危险因素监测,该项目在全国疾病监测系统的161个监测县（区）及新疆生产建设兵团农二师展开。以问卷方式通过面对面访谈收集高血压患者信息,使用两部模型法分析高血压健康管理对各类费用的影响情况。结果 共纳入11 294例≥35岁高血压患者,其中男性4 904人（43.42%）,女性6 390人（56.58%）。门诊总医疗费用M=100（30～200）元,参加高血压管理者费用低于未参加者（P〈0.05）;药店购药总费用M=30（15～100）元,参加管理者与未参加者费用差异无统计学意义（P〉0.05）。门诊医疗费用分析结果显示,参加管理者更易发生门诊医疗行为（OR=2.50,95% CI：2.26～2.76）,且费用仅是未参加管理者的0.78倍,城市高血压患者更易发生医疗行为（OR=1.31,95% CI：1.18～1.45）且费用为农村患者的1.69倍。药店购药费用分析结果显示,参加管理者对药店购药行为及费用影响均无统计学意义,城市高血压患者更易发生购药行为（OR=1.10,95% CI：1.01～1.20）且费用是农村患者的1.19倍。结论 高血压社区健康管理服务在降低高血压患者门诊治疗相关费用上已初见成效,应继续推广实施。

Objective To explore the impact of health management programs on hypertension related to their cost of the hypertensive, so as to provide evidence for related policy-making.Methods Data was from the 2011 China Non-communicable and Chronic Disease Survey Project which was developed in 161 counties（districts） and Xinjiang production and Construction Corps.Information regarding hypertensive patients were collected through a questionnaire.Two-part model was used to analyze the influence from health management scheme.Results This study included 11 294 participants who were 35 years old or beyond, with 4 904（43.42%） males and 6 390（56.58%） females.The median cost from the outpatient was 100（30-200） Yuan, and the cost of patients under management program were significantly lower than those without（P〈0.05）.Median pharmacy cost appeared as 30（15-100） Yuan but there was no significant difference noticed between the cost from the managed or unmanaged patients（P〉0.05）.Regarding the calculation on the outpatient cost, Results showed that the patients under the management program were more likely to practice‘outpatient-medical-behavior’（OR=2.50, 95% CI：2.26-2.76） with nearly three quarters of the cost from the unmanaged patients.Hypertensive patients from the urban areas were more likely to adopt‘medical behavior’（OR=1.31, 95% CI：1.18-1.45） which was 1.69 times of the costs from the rural patients.Results of the pharmacy cost showed that the urban hypertension patients were more likely to purchase medicine（OR=1.10, 95% CI：1.01-1.20） and was 1.19 times the costs of the rural patients.Conclusion Health management program on hypertension showed preliminary but promising Results in reducing the out-patient cost in the treatment of hypertension, thus should be promoted and implemented.