医保病种分值付费模式下临床药师的药学服务及效果评价

Evaluation of Pharmaceutical Services and Their Effects Provided by Clinical Pharmacists under the Medical Insurance Diagnosis-intervention Packet Payment Model

目的本研究对医保病种分值付费(DIP)模式下临床药师通过降低住院医保患者的药品费用来降低人均住院费用等进行分析,总结其工作模式。方法在江西省胸科医院优势且治疗方案比较明确的病种中选择呼吸系统结核归类的医保患者作为研究对象,以2020-2022年医保核定的医院同分组均值数据作为对照组,100例临床药师在住院期间提供了药学服务的同分组患者为观察组。观察组中,临床药师与医生共同建立了专门的药学服务小组,在纳入疾病的既往区域医保支付费用的基础上,制定了药物治疗方案,分析对比了两组人均总费用、药占比和人均住院天数的差异。结果经过干预,观察组呼吸系统肺结核三分组的人均总费用和药品占比均显著下降(P<0.01),但人均住院天数的变化无统计学意义(P>0.05)。结论临床药师通过利用自身专业优势,结合DIP总额控费机制、临床路径及医疗机构相关药学数据,优化药物治疗方案,成功降低了干预分组疾病的医保药品费用支出,促进了合理用药。

Objective The aim of this study is to explore the feasibility,rationality under the diagnosis-intervention packet(DIP)payment model,with the goal of reducing per capita hospitalization costs by lowering medication expenses for patients covered by health insurance.Methods In this study,patients with respiratory tuberculosis classified under the health insurance system were selected from Jiangxi Provincial Chest Hospital where clinical pharmacists provided pharmaceutical services during their hospitalization.The average data of similar diseases covered by health insurance in the hospital between 2020 and 2022 were used as the control group.The intervention group consisted of 100 patients in the same disease group who received pharmaceutical services from clinical pharmacists during their hospitalization.In the intervention group,the clinical pharmacists and doctors established a specialized pharmaceutical service team and developed a medication treatment plan based on the previous regional health insurance payment for the included diseases.The differences in per capita total costs,medication proportion,and length of stay between the two groups were analyzed and compared.Results After the intervention,the per capita total costs and medication proportion of the respiratory tuberculosis 3-group in the intervention group significantly decreased(P<0.01),but there was no statistically significant change in the length of stay(P>0.05).Conclusion Clinical pharmacists,utilizing their professional knowledge and combining it with the DIP payment mechanism,clinical pathways of diseases and relevant pharmaceutical data of medical institutions,successfully optimized medication treatment plans and effectively reduced health insurance medication expenses for diseases targeted by hospital interventions,promoting rational medication use.