分级诊疗与不同级别医院间药品使用研究

Study on Hierarchical Medical Service and Drug Use among Hospitals of Different Levels

目的研究基本药物制度下分级诊疗不同级别医院间药品体系衔接状况,探索实施过程中对推进分级诊疗制度的影响。方法选择我国东、中、西部三个省(浙江、安徽、陕西)的三甲、二甲、基层各1家医院共9家为样本医院,以高血压、糖尿病为样本病种,比较各省基本药物增补和不同级别医院之间用药衔接情况。结果各省增补品种以安徽省最多(22种,6种),陕西省最少(3种,1种)。各省不同级别医院比较,配备品种数、品规数以安徽省最好,陕西省较差。浙江省、陕西省的高血压、三个省的糖尿病药物使用频度占比有显著差异(p<0.05);三省高血压、糖尿病药物使用金额占比有显著差异(p<0.01)。结论我国东、中、西部地区对高血压、糖尿病治疗基本药物品种增补差距较大,不同级别医院药品体系衔接状况较差,难以满足分级诊疗模式用药需求。

Objective To study the coordination of drug system among different levels of hospitals under the essential drug system,and to explore the impact of the essential drug system on promoting the hierarchical medical system.Method A total of 9 hospitals were selected from three provinces(Zhejiang,Anhui,Shaanxi)in the east,middle and west of China.Three hospitals including a tertiary hospital,a secondary hospital,and a primary hospital were selected from each province.Hypertension and diabetes were sample diseases.The supplement of essential drugs of different provinces and coordination of drug system among different levels were compared.Results It was found that Anhui province had the maximum of supplementary varieties(22,6)and Shaanxi province had the least supplementary varieties(3,1).The number of varieties and specifications was highest in Anhui and the lowest in Shaanxi.There was significant difference in the DDDs proportion of hypertension drugs between Zhejiang and Shaanxi and diabetes drugs among three provinces(p<0.05).The proportion of drug expenditure of hypertension and diabetes drugs had significant differences in the three provinces(p<0.01).Conclusion There is a big gap in the supplementary varieties of essential drugs for hypertension and diabetes among east middle and west region of China.And the coordination of drug system among different levels of hospitals is poor to meet the need of drug use in hierarchical medical system.