美国药品成本管理策略对我国医疗机构药品费用控制启示

Enlightenment of ASHP strategies on medication cost management for medical institutions in China

目的:为控制我国药品费用的不合理增长和促进医疗机构药学服务提供参考。方法:分析美国卫生系统药师协会制定的药品成本管理策略,对比我国医疗机构卫生现状,从而提出完善医疗机构药学工作,进行药品控费的建议。结果:美国药品成本管理策略建议医疗机构基于往年采购量(或金额)和使用量(或金额)开展药品预算管理;规范临床药师素质及临床药学服务质量的同时常态化开展交互治疗;成立药师参与临床治疗且获取医务人员支持的治疗小组;制定药品处方集并将成本较低、效果明显的药品纳入电子处方管理系统;建立药品使用替换制度,严格规范药品替换流程。结论:我国医疗机构可以开展药品预算研究来控制药品使用金额;通过提升临床药师技能来增强药师职业认知;加强药师医师沟通以明确两者职能分工;注重药师处方集制定并管控药品不合理使用;完善药品替换制度来规范药品使用管理。

OBJECTIVE To provide reference for controlling the unreasonable increase of drug expenses in China and improving pharmaceutical care in medical institutions.METHODS This paper analyzed the strategies on medication cost management formulated by ASHP and compared it with hygienic status of medical institutions in China and put forward suggestions for improving pharmaceutical work in medical institutions and controlling drug expenses.RESULTS The drug cost management strategy in the United States recommends that medical institutions carry out drug budget management based on the purchase volume(or amount)and use volume(or amount)in previous years;standardize the quality of clinical pharmacists and the quality of clinical pharmaceutical services while normalizing the implementation of interactive therapy;establish a treatment group in which pharmacists participate in clinical treatment and obtain the support of medical staff;develop drug formularies and include the drugs with lower cost and significant effect in the electronic prescription management system;establish a drug use replacement system and strictly regulate the drug replacement process.CONCLUSIONS Medical institutions in our country can conduct research on drug budget to control drug use,improve the skills of clinical pharmacists to enhance the occupational cognition of pharmacists,strengthen negotiation between pharmacists and physicians to clarify functional division,focus on the formulation of formulary to control the unreasonable use of drugs and improve the therapeutic interchange to standardize drug use management.