运用药物利用研究指标评价药品对DRGs费用合理性影响——以抗菌药物和质子泵抑制剂为例的实证研究

Evaluating of the influence of drugs on the rationality of DRGs cost by using drug utilization research indexes——an empirical study on the case of antimicrobial agents and PPI

目的:通过药物利用研究相关指标对DRGs药品费用的合理性进行评价,为医院及医保部门对各组药品费用的管理提供方法与依据。方法:根据CN-DRGs分组方案,选取某院两年5个消化系统疾病非手术DRGs组。对各组住院费用及药品费用等情况进行汇总整理,并对各组的抗菌药物和质子泵抑制剂(PPI)的药物利用指标进行统计分析。结果:5个DRGs组的药占比最低的为GU15组(43.85%),最高为GT19组(60.16%)。各DRGs组抗菌药物的使用率范围38.46%(GT19)~64.86%(GS11);药物利用指数范围在0.59(GU15)~0.78(GT19);使用强度范围在20.99(GU11)~53.28(GS15)。PPI的使用率范围51.65%(GT19)~97.83%(GS11);药物利用指数范围在1.35(GU15)~2.25(GS15);使用强度范围在61.57(GT19)~310.63(GS15)。结论:该院GT19、GU11和GU15组的PPI和抗菌药物的使用可能存在不合理现象,药品费用有进一步下降的空间;利用药物利用研究的方法来进行DRGs分组的用药合理性评价具有可行性。

OBJECTIVE To evaluate the rationality of drug costs of DRGs through the relevant indicators of drug utilization research,and to provide methods and basis for the management of drug costs of each group by hospitals and medical insurance departments.METHODS According to the CN-DRGs grouping scheme,five non-surgical DRGs groups of digestive system diseases in a hospital in two years were selected.The hospitalization costs and drug costs of each group were summarized and collated,and the drug utilization indicators of antibacterial drugs and proton pump inhibitors(PPIs)in each group were statistically analyzed.RESULTS The lowest proportion of drugs in the five DRGs groups was GU15 group(43.85%),and the highest was GT19 group(60.16%).The use rate of antibacterial drugs in each DRGs group ranged from 38.46%(GT19)to 64.86%(GS11);the drug utilization index ranged from 0.59(GU15)to 0.78(GT19);and the use intensity ranged from 20.99(GU11)to 53.28(GS15).PPI use ranged from 51.65%(GT19)to 97.83%(GS11);drug utilization index ranged from 1.35(GU15)to 2.25(GS15);and intensity of use ranged from 61.57(GT19)to 310.63(GS15).CONCLUSION There could be some inappropriate use of antimicrobial agents and PPIs in GU11,GU15,and GT19 and the drug expense in these groups seemed to have room for a decline in this hospital;It is feasible to evaluate the rationality of drug expenses in DRGs by using the method of drug utilization research.