高血压患者使用长处方对医疗服务利用及医疗费用的影响研究

Effects of Prescription Refills Use on Healthcare Service Utilization and Healthcare Cost in Hypertensive Patients

目的:探究国内长处方使用试点地区长处方使用对高血压患者医疗服务利用、医疗费用的影响。方法:采用2017~2019年宁波市鄞州区电子健康信息平台数据,使用倾向评分匹配法对长处方组患者和非长处方组患者进行1∶1匹配以控制混杂因素,根据随访期间患者降压药处方天数中位数是否大于28 d判断是否使用长处方,采用Wilcoxon符号秩检验比较匹配后两组患者间医疗服务利用、医疗费用差异。结果:研究获取持续降压药治疗时使用长处方患者和非长处方患者分别为19606和28148例,倾向评分匹配后各19135例;使用长处方患者季均高血压相关门诊次数(2.6 vs.3.0,P<0.001)、季均门诊降压药处方次数(1.5 vs.1.7,P<0.001)均显著低于使用非长处方患者;使用长处方患者季均高血压相关门诊总费用(448.9元vs.493.1元,P<0.001)和季均高血压相关门诊自付费用(11.9元vs.15.3元,P<0.001)均显著低于使用非长处方患者。结论:国内长处方使用试点地区高血压患者使用长处方可以减少高血压相关门诊医疗服务利用,降低医疗费用,建议加大长处方使用宣传教育与政策引导,进一步推进长处方使用安全有效实施。

Objective:To explore the effect of prescription refills use on patients’healthcare service utilization and cost.Methods:Using the data from Chinese Electronic Health Records Research in Yinzhou,from January 1 st,2017,to December 31 st,2019,the tendency score matching method was used to match the hypertension patients with ongoing use of prescription refills(during the follow-up period,the median number of antihypertensive drug prescription days was more than 28 d)and without ongoing use of prescription refills 1:1 to control the confounding factors.Wilcoxon signed rank test was used to compare the differences in medical service utilization and medical expenses between the two groups after matching.Results:19606 hypertension adults with ongoing use of prescription refills were compared with 28148 hypertension adults without ongoing use of prescription refills were identified in the database.After propensity score matching,19135 hypertension adults with ongoing use of prescription refills were compared with 19135 hypertension adults without ongoing use of prescription refills.Hypertension adults with ongoing use of prescription refills would accrue significantly fewer quarterly hypertension-related outpatient visits(2.6 vs.3.0,P<0.001),quarterly outpatient visits for antihypertension drugs(1.5 vs.1.7,P<0.001),lower quarterly healthcare costs of outpatient visits(448.9 yuan vs.493.1 yuan,P<0.001)and pay lower quarterly out-of-pocket healthcare costs of outpatient visits(11.9 yuan vs.15.3 yuan,P<0.001).Conclusion:The use of prescription refills may accrue fewer healthcare service utilization and costs.This study gave some suggestions:to improve the cognition and understanding of the benefits of prescription refills among medical staff,patients and their families through strengthened publicity,education and policy guidance;to provide timely,safe,effective and economical prescription refills services for patients with chronic disease.