基于医保控费需求的质子泵抑制剂临床应用干预效果分析

Analysis of Intervention Effects of Proton Pump Inhibitors in Clinic Application Based on Demand of Medical Insurance

目的:探讨鄂尔多斯市中心医院临床药师对院内质子泵抑制剂(proton pump inhibitor,PPI)合理应用的干预效果,为进一步促进合理用药提供参考。方法:采用回顾性调查方法,收集干预前(2018年5—8月)6179例、干预后(2019年5—8月)5976例使用PPI的住院患者,对比分析干预前后PPI的使用情况。结果:干预前后,使用PPI患者在性别、年龄及科室分布等方面的差异均无统计学意义(P>0.05)。干预后,无论是PPI的总销售金额,还是PPI注射剂型的销售金额,均较干预前降低了30%以上,PPI口服剂型的销售金额较干预前增长;单病例PPI销售金额由干预前的286.32元降至203.99元,单病例PPI注射剂型销售金额由干预前的344.98元降至267.80元,单病例PPI口服剂型销售金额由干预前的93.27元降至79.42元;PPI的总DDDs、PPI注射剂型的DDDs分别较干预前降低了12.05%、30.26%,而PPI口服剂型的DDDs较干预前升高了17.61%;使用PPI患者的住院人均费用由干预前的344.98元降至267.80元,住院人均日用药费用由干预前的62.31元降至52.03元,平均治疗天数由干预前的5.54 d缩短至3.86 d;销售金额排序/DDDs排序的比值方面,PPI口服剂型普遍升高;价格水平方面,大部分PPI保持稳定;PPI的总体用药合理性优于干预前。结论:临床药师合理用药管理有利于PPI的合理使用,可使患者使用PPI的药费支出大幅度降低,具有进一步实施的价值。

OBJECTIVE:To probe into the intervention effects of clinical pharmacists on rational application of proton pump inhibitors(PPI)in Ordos Central Hospital,so as to provide reference for further promotion of rational drug use.METHODS:Retrospective analysis was adopted,a total of 6179 patients who were hospitalized with PPI before intervention(from May to Aug.2018)and 5976 patients who were hospitalized with PPI after intervention(from May to Aug.2019)were collected,the application of PPI were compared and analyzed the before and after intervention.RESULTS:Before and after intervention,there were no statistically significant differences in gender,age and department distribution of patients using PPI(P>0.05).After intervention,both the total consumption sum of PPI and the consumption sum of PPI injection decreased by more than 30%compared with those before intervention,the consumption sum of PPI oral preparation in single case after intervention generally increased compared with that before intervention.The consumption sum of PPI in single case decreased from 286.32 yuan before intervention to 203.99 yuan,the consumption sum of PPI injection in single case decreased from 344.98 yuan before intervention to 267.80 yuan,and the consumption sum of PPI oral preparation in single case decreased from 93.27 yuan before intervention to 79.42 yuan.The total DDDs of PPI and the DDDs of PPI injection decreased by 12.05%and 30.26%,respectively,while the DDDs of PPI oral preparation increased by 17.61%.The per capita hospitalization cost of patients using PPI decreased from 344.98 yuan before intervention to 267.80 yuan,the per capita daily medication cost decreased from 62.31 yuan before intervention to 52.03 yuan,and the average number of treatment days decreased from 5.54 d before intervention to 3.86 d.The ratio of consumption sum sequencing/DDDs sequencing of PPI with oral dosage form was generally increased.The price level of most PPIs remained stable.The application rationality of PPI application before intervention was better than that before intervention.CONCLUSIONS:Rational medication management of clinical pharmacists is conducive to the rational application of PPI,which can greatly reduce the pharmaceutical cost of patients with PPI,with the value of further implementation.