皮肤病专科医院药占比及影响因素分析

Analysis on the proportion of drugs in a dermatology hospital and the influencing factors

目的探究皮肤病专科医院药占比的影响因素及其关系路径,为科学控制药占比、减轻患者疾病经济负担、医院管理实践提供理论依据。方法收集广东省某大型三级皮肤病专科医院近5年15315例住院患者病案首页数据进行通径分析。结果患者的平均药占比21.45%,中位药占比19.27%,性别、婚姻状况、是否医保、是否手术、是否月内再入院、是否使用抗菌药物、临床路径、住院天数等变量会直接影响药占比,差异有统计学意义(P<0.05);Bootstrap检验显示是否手术、住院天数、是否医保、婚姻状况、是否月内再入院、临床路径、是否使用抗菌药物、性别、病例分型、年龄、是否院感、是否合并症可通过作用于住院天数,间接影响药占比(P<0.05)。结论控制药占比合理化应加强对患者住院天数、是否手术等可控因素的把握,并采取合理举措促使性别、年龄、婚姻状况等不可控因素向可控因素转化,精准施策,以达到综合管理药占比、使其处于合理区间的效果,从而降低病患疾病经济负担,提升医疗服务质量,改善民生。

Objective To explore the influencing factors of the drug proportion in hospitals specializing in dermatology and the relationship paths,so as to provide theoretical basis for scientific control of drug proportion,alleviation of patients′disease economic burden and hospital management practice.Methods Path analysis was performed on the first page of medical records of 15315 inpatients in a large tertiary dermatology hospital in Guangdong Province in recent 5 years.Results The average drug proportion of patients was 21.45%,and the median drug proportion was 19.27%.Variables such as gender,marital status,medical insurance,surgery,readmission within a month,use of antibiotics,clinical path,and hospitalization days directly affected the drug proportion,with statistical significance(P<0.05);Bootstrap test showed that surgery,hospitalization days,medical insurance,marital status,readmission within a month,clinical path,use of antibiotics,gender,case type,age,nosocomial infection and complications could indirectly affect the proportion of drugs through the effects on hospitalization days(P<0.05).Conclusion In order to rationalize the drug proportion control,it is necessary to strengthen the grasp of controllable factors such as hospitalization days and surgery,take reasonable measures to transform uncontrollable factors such as gender,age,marital status into controllable factors,and accurately implement policies to achieve the effect of comprehensive management of the drug proportion and keep them in a reasonable range,so as to reduce the economic burden of patients and improve the quality of medical services and people′s livelihood.