基于医保大数据的老年医保患者部分国家基本药物门（急）诊使用情况

Big data based analysis of the utilization of national essential medicines for elderly patients with medical insurance

目的了解目前我国65岁及以上老年医保患者化学药品和生物制品类国家基本药物的门（急）诊使用现状及特点。方法利用中国医疗保险研究会课题组数据库数据，统计分析2013-2015年我国不同年龄段医保患者化学药品和生物制品类基药门（急）诊用药总金额及次均费用情况，重点对≥65岁老年患者的各基本药物用药金额、处方数（用药人次数）等进行统计排序和分析，并进一步按“东、中、西、东北”4个区域及医疗机构等级进行分析。结果研究数据包含近2000万条患者用药信息（≥65岁患者用药信息443万余条）、307种基本药物；我国西部地区≥65岁老年门（急）诊患者调研基本药物总费用在该地区全年龄层人群中的占比高于其他地区（46．68％）；全国≥65岁老年门（急）诊患者相关基本药物费用中，三级医院产生的费用在各级医疗机构中占比最高；全国各区域及各级医疗机构中，心血管系统用药、激素及内分泌用药、抗微生物药在≥65岁老年人中的门（急）诊用药金额及处方数均位前列；全国≥65岁老年患者与中青年患者比较门（急）诊基本药物处方数排名存在一定差异；分区域及分医疗机构等级分析结果显示，全国≥65岁老年门（急）诊患者处方数前20位的药品品种相差甚微，仅个别药品排名有异。结论我国≥65岁老年医保患者门（急）诊常用基药品种及排名与中青年患者相比存在一定差异，以心血管系统用药最为常用，基本符合老年患者的疾病谱及生理特点；各地区、各级医疗机构的老年医保患者门（急）诊常用基药品种基本稳定且相似度较高，此为老年人的全额保障基本药物遴选提供了一定的临床数据信息。

Objective To investigate the current status and characteristics of the use of essential medicines in Chinese Medicare patients aged 65 and over. Methods Using the database from China Medical Insurance Research Association＇s research group to statistically analyze the total amount and the average cost of chemical and biological essential medicines for outpatients and emergency cases according to age groups in 2013- 2015, and ranking and analysis were focused on the expenditure and the number of prescriptions of essential medicines for patients aged 65 and over. Additional analyses were made based on four regions （Eastern, Central,West and Northeast） and medical institutions of different levels. Results The data included nearly 20 million items of medications （4.43 million for patients ≥65 years,） and 307 essential medicines. In Western China, the portion of consumption of national essential medicines by patients aged 65 and over was 46.68%, which was higher than in any other regions. The portion of consumption by tertiary hospitals was the highest among all levels of medical institutions （〉 40.00%）. In all regions and medical institutions, cardiovascular drugs, hormones and endocrine drugs, and antimicrobials were the top categories for patients aged above 65,in terms of both expenditure and prescription numbers. There were some differences in the rankings of prescription numbers for essential medicines between patients aged 65 and over and those aged below 65. The numbers of prescriptions of the top 20 drugs varied little in different regions and medical institutions,and only a few drugs＇ rankings were different. Conclusions There are some differencesin categories and rankings of commonly used essential medicines between younger and elder patients with medical insurance,and cardiovascular drugs are the most commonly used in patients aged 60 and over. These are in line with the spectrum and pathophysiological characteristics of diseases in the elderly. The types of basic drugs most commonly used by outpatients aged 65 and over have stayed stable across regions, and can provide clinical data for the selection of essential medicines with full cost reimbursement for elderly patients.