基本药物制度在医院的实施效果评价——基于大数据的模型构建及实证研究

Evaluation of the implementation results of essential medicines system in hospitals——by model construction and empirical study based on big data

目的:以药物利用大数据为支撑,探索建立基本药物制度实施效果的评价模型,并通过江苏省的实证研究来评估模型的可行性和科学性,为国家基本药物制度实施提供评估方法。方法:模型构建采用德尔菲法结合层次分析法,构建由4个一级指标及9个二级指标组成的基本药物政策实施结果的评价体系,并对一级和二级指标进行权重赋值。设定模型的期望满分为10分,在0~10分范围内设定3种效果区间:8~10分效果较好,5~8分有效果,0~5分无效果,以获得最终的实施效果评价结论。实证研究是采集江苏省2018年二三级医院基本药物相关数据,来源于4个大型数据库:全国医药经济信息网数据库,国家药品食品监管局药品不良反应监测网,全国药品抽检数据库及江苏省公共资源交易中心数据库,运用模型进行验证。结果:构建的评价模型的4个一级指标及9个二级指标的权重为:可获得性(A:0.23;A1:0.10;A2:0.13)、可负担性(B:0.24;B1:0.09;B2:0.15)、质量安全性(C:0.35;C1:0.19;C2:0.07;C3:0.09)和用药合理性(D:0.18;D1:0.12;D2:0.06)。模型稳定且具有满意一致性。通过大数据采集对江苏省的实证研究结果评估得分为5.6分,显示江苏省基药的政策实施在有效果区间。结论:基于药物利用大数据构建的基本药物制度的实施效果评价模型稳定、简单而易行,可以全面真实地反映基药在城市医院的实施效果,以江苏省为例也得到很好的验证。

OBJECTIVE To explore the establishment of evaluation model for the implementation effect of essential drug system supported by big data of drug utilization,and to evaluate the feasibility and scientificity of the model through empirical research in Jiangsu Province,and to provide evaluation methods for the implementation of national essential drug system.METHODS Delphi method combined with analytic hierarchy process was used to construct the evaluation system of the implementation results of essential drug policy consisting of 4 first-level indicators and 9 second-level indicators,and the first-level and second-level indicators were weighted and assigned.Set the expected full score of the model to 10 points,set three effect intervals in the range of 0 to 10 points:8 to 10 points have better effect,5 to 8 points have effect,and 0 to 5 points have no effect,in order to obtain the final implementation effect evaluation conclusion.The empirical study is to collect the data related to essential drugs in the secondary and tertiary hospitals in Jiangsu Province in 2018,which is derived from four large databases:National Pharmaceutical Economic Information Network Database,National Drug and Food Administration Adverse Drug Reaction Monitoring Network,National Drug Sampling Inspection Database and Jiangsu Public Resources Trading Center Database.The model is used for verification.RESULTS The weights of the four first-level indicators and nine second-level indicators of the constructed evaluation model were as follows:availability(A:0.23;A1:0.10;A2:0.13),affordability(B:0.24;B1:0.09;B2:0.15),quality safety(C:0.35;C1:0.19;C2:0.07;C3:0.09),and medication rationality(D:0.18;D1:0.12;D2:0.06).The model is stable and in satisfactory agreement.The score of 5.6 points for the evaluation of empirical study results in Jiangsu Province through big data collection showed that the policy implementation of base drugs in Jiangsu Province was in the effective interval.CONCLUSION The implementation effect evaluation model of essential drug system constructed based on big data of drug utilization is stable,simple and easy,which can comprehensively and truly reflect the implementation effect of base drug in urban hospitals,and has also been well verified in Jiangsu Province.