Modelling spatial variation in the treatment costs of nonpoint source pollution in mountainous regions of southwest China

Non-point source(NPS) pollution is considered to be one of the main threats of the aquatic environment. Mountainous regions are particularly important water sources for urban areas. The various driving factors of NPS pollution such as terrain, precipitation, and vegetation type in mountainous regions show clear spatial heterogeneity. Consequently, the management systems required for NPS pollution in mountainous regions are complex. In this study, we developed a framework to estimate and map the treatment costs for NPS pollution in mountainous regions and applied this method in Baoxing County, a typical mountainous county in Sichuan Province of southwest China. The export levels of total nitrogen(TN) and total phosphorus(TP) in Baoxing County were estimated using the water purification model in InVEST(Itegrated Valuation of Ecosystem Services and Tradeoffs) tool. NPS pollutant treatment costs were calculated based on the level of pollutants exports, water yield, water quality targets, and treatment costs of NPS pollutants per unit mass. The results show that at the watershed level the amounts of TN and TP exported in Baoxing County were below threshold limits. However, at the sub-watershed level, TN and TP excesses of 291.64 and 2.96 tons per year were found, respectively, with mean TN and TP treatment costs of 6.58 US$/hm^2 and 0.35 US$/hm^2. Appraising pollution treatment cost intuitively reflects the overall expenditure in NPS pollution reduction from an economic perspective. This study provides a foundation for the implementation of Payment for Ecosystem Service(PES) and the prevention and control of NPS pollution.

Cost of Medical Treatment for Primary Open-Angle Glaucoma in Relation to Patients’ Income and Its Impact on the Prognosis of the Disease, in Bouaké University Hospital

Introduction: Medical treatment for POAG is continuous and lifelong treatment. The aim of this study was to evaluate the relationship between the cost of this treatment and patients’ income and the impact of this relationship on treatment compliance. Materials and Methods: Prospective cross-sectional study with a descriptive aim covering sociodemographic data, average incomes, and direct and indirect costs of treatment of 57 patients followed for POAG during the period from January 1, 2012, to December 31, 2016 (5 years). Results: The patients were aged 25 to 77 years (mean = 54.4 years) with a male predominance (sex ratio = 1.5). Retirees were the most represented (26.32%), followed by workers in the informal sector (14.04%) and housewives (12.28%). Patients who had an annual income less than or equal to 900,000 CFA francs (€1370.83) per year represented 56.14% and those who did not have health coverage represented 57.89%. The treatment was monotherapy (64.91%), dual therapy (31.58%) or triple therapy (3.05%) and the average ratio of “annual cost of treatment to annual income” was 0.56 with for maximum 2.23 and 0.02 as minimum. Patients who considered the cost of treatment unbearable for their income represented 78.95%. Conclusion: Prevention of blindness due to glaucoma requires early detection but also the establishment of health coverage mechanisms to improve compliance with medical treatment. In addition, consideration should be given to the development of glaucoma surgery in our country, the indication of which could be the first intention in certain patients, considering for those patients, the geographical and financial accessibility of medical treatment. .

Economic Burden of Illness of the Cervical Cancer Treatment Protocol in Bangladesh

Background: Cervical cancer is a significant health concern in Bangladesh, with high mortality rates due to limited awareness and costly treatments. The disease stages influence treatment protocols, ranging from surgery and radiotherapy for early stages to chemotherapy and radiation for advanced stages, but survival rates decrease as the cancer progresses. Objective: The objective of this study is to determine the economic impact of the disease and recommend cost-efficient strategies for prevention and treatment. Methods: A population-based, cross-sectional study was conducted with a stratified sample of cervical cancer patients from selected healthcare facilities across Bangladesh. Data collection involved structured interviews and validated questionnaires. The study measured the economic impact, treatment costs, and other related expenses. Quantitative data analysis was performed using SPSS v22, MS-Excel, and R Programming, with Multivariate regression analysis and Post Hoc tests, including the chi-square test, applied to selected indicators. Results: All respondents in the study were female, aged 34 - 75, with 72.3% aged 40 - 50. Most were illiterate (38.6%) and housewives (95.0%). Additionally, 98% were married, 85.10% married before age 18, and 46.50% experienced their first menstruation before age 12. Families typically had a monthly income of 10,000 - 30,000 Taka, spending similar amounts on treatment. Significant relationships were found between educational qualifications, occupation, personal hygiene practices, history of oral contraceptive use, and age of marriage (p Conclusion: The article emphasizes the impact of monthly family income on cervical cancer treatment costs, stressing the need for comprehensive support services to address the financial and emotional burdens faced by patients. Improving access to quality care and implementing measures can enhance outcomes for cervical cancer patients in Bangladesh.

Efficacy, patterns of use and cost of Pertuzumab in the treatment of HER2+ metastatic breast cancer in Singapore: The National Cancer Centre Singapore experience

BACKGROUND Pertuzumab is a humanized anti-human epidermal growth factor receptor 2(HER2)monoclonal antibody found in a Phase III clinical trial to significantly improve median survival in HER2 positive metastatic breast cancer(MBC)when used in combination with a taxane and Trastuzumab,and its clinical efficacy has transformed the therapeutic landscape of HER2-positive breast cancer.There are currently few reports on the pattern of use and value of Pertuzumab in real world settings.Our study describes the clinical efficacy and treatment costs of Pertuzumab in HER2-positive MBC treated in a tertiary cancer centre in Singapore in a predominantly Asian population.AIM To investigate the clinical efficacy and treatment costs of Pertuzumab in HER2-positive MBC in an Asian population in Singapore.METHODS A retrospective study of 304 HER2-positive MBC patients seen at National Cancer Centre Singapore between 2011-2017 was conducted.Demographic and clinical data were extracted from electronic medical records.Clinical characteristics and billing data of patients who received Pertuzumab were compared with those who did not.RESULTS Thirty-one(62.0%)of the fifty(16.4%)patients who received Pertuzumab as firstline therapy.With a median follow-up of 21.5 mo,there was a statistically significant difference in the median overall survival between Pertuzumab and non-Pertuzumab groups[51.5(95%CI:35.8–60.0)vs 32.9(95%CI:28.1–37.5)mo;P=0.0128].Two(4.88%)patients in the Pertuzumab group experienced grade 3(G3)cardiotoxicity.The median treatment cost incurred for total chemotherapy for the Pertuzumab group was 130456 Singapore Dollars compared to 34523 Singapore Dollars for the non-Pertuzumab group.The median percentage of total chemotherapy costs per patient in the Pertuzumab group spent on Pertuzumab was 50.3%.CONCLUSION This study shows that Pertuzumab use in the treatment of metastatic breast cancer is associated with a significantly better survival and a low incidence of serious cardiotoxicity.However,the proportionate cost of Pertuzumab therapy remains high and further cost-effectiveness studies should be conducted.

Differences in Treatment Patterns and Health Care Costs among Non-Hodgkin’s Lymphoma and Chronic Lymphocytic Leukemia Patients Receiving Rituximab in the Hospital Outpatient Setting versus the Office/Clinic Setting

Objective: To examine whether differences in treatment patterns and health care costs exist among chronic lymphocytic leukemia (CLL) and non-Hodgkin’s lymphoma (NHL) patients receiving rituximab in a hospital outpatient setting versus those receiving rituximab in a physician office/community clinic setting. Methods: This retrospective database study used medical and pharmacy claims (1/2007-7/2012) from a large US health plan. Patients ≥18 years with ≥2 rituximab claims and ≥2 claims for either NHL or CLL were identified. The date of the first rituximab claim were set as the index date, and differences in treatment patterns and health care costs were examined during the period following the index date. Costs were adjusted for patient characteristics using a multivariate regression model. Results: A total of 4441 patients were identified;3167 received rituximab in the office/clinic setting, and 1274 in the hospital outpatient setting. From 2007 to 2012, the percentage of patients receiving rituximab in the hospital outpatient setting increased from 22% to 39%. Patients treated in the hospital outpatient setting vs. the office/clinic setting had fewer average counts of rituximab infusions (5.60 vs. 7.49, p 0.001), higher total health care costs (cost ratio = 1.325, p 0.001), higher infusion day drug and administration costs (cost ratio = 1.509, p 0.001), and higher rates of ER visits and inpatient stays (both p 0.001). Conclusions: These findings suggest that site of care may impact treatment patterns and costs of patients receiving rituximab, and additional research is needed to better understand the reason(s) for these differences by site of service.

Treatment Patterns and Healthcare Costs among U.S. Patients with Advanced Melanoma Initiating Subsequent Systemic Therapy Following Use of Ipilimumab (IPI)

As the treatment landscape for advanced melanoma continues to evolve, it is critical to focus on unmet needs and understand the cost of therapy. While Ipilimumab (IPI), an immunotherapy indicated for unresectable advanced melanoma, has been a mainstay of 1st-line treatment, there was no standard of care following progression until recently. The objective of this study was to examine real-world treatment patterns and healthcare costs following IPI use in advanced melanoma patients prior to the anti-PD-1 class approval. Adult stage III or IV melanoma patients treated with IPI were selected between April 1, 2011, and September 30, 2013, from a large U.S. commercial and Medicare claims database. Patients were evaluated for therapy after IPI, with an index date set as the first systemic therapy after IPI. Per-Patient Per-Month (PPPM) healthcare costs while on active treatment were evaluated from index until treatment discontinuation, inpatient death, end of insurance enrollment, or September 30, 2013. Of 361 eligible patients, 111 (30.7%) initiated subsequent systemic therapy (mean age, 57 years;64.9% male). The most common therapies, single-agent or combination, included vemurafenib (32.4%), paclitaxel (28.8%), temozolomide (20.7%), and carboplatin (17.1%). During a median follow-up of 130 days, mean [standard deviation] PPPM all-cause total healthcare costs were $20,383 [$18,988], of which $4800 (23.6%), $5899 (28.9%), and $9684 (47.5%) were related to melanoma drug costs, medical claims with a diagnosis of melanoma, and other (non-specified) utilization, respectively. When considering total care, the costs of U.S. patients with advanced melanoma post-IPI were substantial across all commonly used agents.

来那度胺与环磷酰胺治疗多发性骨髓瘤患者的效果比较

目的:比较来那度胺与环磷酰胺治疗多发性骨髓瘤患者的效果。方法:回顾性分析2019—2022年该院收治的112例多发性骨髓瘤患者的临床资料,根据治疗方法不同将其分为对照组(n=53)与研究组(n=59)。两组均给予硼替佐米、地塞米松治疗,在此基础上,对照组联合环磷酰胺治疗,研究组联合来那度胺治疗。比较两组临床疗效、不良反应发生率及治疗成本。结果:研究组高质量缓解率为62.71%(37/59),高于对照组的35.85%(19/53),差异有统计学意义(P<0.05);两组总缓解率比较,差异无统计学意义(P>0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05);研究组总成本、成本-效果均高于对照组,差异有统计学意义(P<0.05)。结论:在硼替佐米、地塞米松治疗基础上采用来那度胺治疗多发性骨髓瘤患者可提高高质量缓解率的效果优于环磷酰胺治疗,但需增加治疗成本。

人工流产术围术期综合干预措施替代口服抗生素的短期临床效果研究

目的:探讨围术期综合干预措施对人工流产术的临床疗效,为人工流产围手术期管理提供一种安全、有效且无抗生素的新型替代方案。方法:选择2020年3月-2022年3月本院就诊要求行人工流产术且既往流产史≥2次的女性240例,随机分为两组,综合组采用阴道冲洗、阴道及宫颈喷涂抗菌凝胶、术后放置宫颈抗菌膜等综合干预措施,对照组采用常规口服抗生素预防。比较两组术后感染发生率、不良反应发生率、月经复潮情况、子宫内膜厚度恢复、宫腔粘连发生率及总体治疗有效率。结果:综合组术后感染发生率(1.7%)与对照组(3.3%)无差异(P>0.05);不良反应发生率(1.7%)低于对照组(7.5%),月经复潮时间(32.9±6.3d)、内膜厚度恢复(7.01±0.53 mm)优于对照组(55.4±9.1d、5.72±0.51 mm),宫腔粘连发生率(1.7%)低于对照组(9.2%),总治疗费用(5173±325元)高于对照组(4540±286元)(均P<0.05)。结论:人工流产术围手术期综合干预措施安全有效,能够加速女性术后恢复,降低并发症发生,是值得推广的无抗生素替代方案。

辅助生殖技术治疗费用分担机制研究

当前,辅助生殖技术治疗需求不断增加,但在我国目前的多层次医疗保障体系下,尚未形成辅助生殖技术治疗费用分担机制。可借鉴德国、澳大利亚、日本辅助生殖技术治疗费用分担的实践经验:破除政策障碍,为辅助生殖技术费用保障提供合规性支持;强化政府责任,完善建立多元主体的费用共担机制;拓宽筹资渠道,形成稳定的资金来源;明确资金使用条件,控制医疗费用支出水平;采用综合控费手段,减轻患者自付费用负担。

北京市综合医改前后社区卫生服务机构治疗费用的受益人群分析

背景厘清社区卫生服务机构主要服务的人群特点,对下一步社区卫生服务机构的精准改革具有十分重要的意义。目的通过分析综合改革前后北京市社区卫生服务机构治疗费用的受益人群特征,为下一步改革政策制定和调整提供精准的数据支持。方法本研究基础数据来源于2016—2019年北京市卫生总费用核算基础数据库,其他数据来源于2016—2019年《北京市卫生健康统计年鉴》《北京市卫生财务统计年报》《北京市卫生费用核算报告》等。采用多阶段分层整群抽样的方案选取社区卫生服务机构,从HIS系统纳入全年的门诊数据、住院患者的数据。采用卫生费用核算体系2011(SHA2011)核算、分析社区卫生服务机构治疗费用的受益人群状况。结果2016—2019年北京市社区卫生服务机构治疗费用从121.81亿元增长至222.45亿元,年均增长19.07%。40岁以上中老年患者治疗费用历年占比均在92%以上,60~岁、80~岁两个年龄组患者治疗费用增长较快,年均增速分别为24.08%、25.84%;治疗费用中内分泌、营养和代谢疾病,症状、体征和检验异常、循环系统疾病占比最高,内分泌、营养和代谢疾病,神经系统疾病,症状、体征和检验异常疾病治疗费用增长较快,年均增速分别为40.11%、48.40%和32.43%。结论综合改革后分级诊疗成效初显,社区医疗服务资源主要由中老年患者、内分泌、循环系统等慢性非传染性疾病患者所消耗,改革引导更多中老年和慢性病患者流向社区,社区卫生服务机构应该从服务能力、人才队伍、慢性病管理、医联体建设等多方面着手,提升其服务能力,巩固和维持改革的效果。

气负荷变化对天然气净化工艺及经济性的影响研究分析

天然气净化装置气负荷变化对装置运行的稳定性和天然气处理成本具有重要的影响。对川西北气矿两个气源气质相似的天然气净化厂的气负荷变化对装置运行的影响及经济性进行研究分析。结果表明:120%超负荷运行的A厂装置运行工艺参数与设计参数偏差不大,装置能够稳定运行,尾气SO_(2)排放浓度稳定且低于国家标准,天然气处理成本为0.014元/m^(3);B厂受气藏储量影响,气负荷持续走低,装置运行稳定性降低,导致尾气SO_(2)排放出现超标情况,装置运行能耗增加,天然气处理成本达到0.092元/m^(3),是A厂处理成本的6.6倍,天然气净化的经济性显著降低。

基于互联网医院建设的肿瘤患者自助开单服务探索与实践

目的:探索自助开单服务模式的设计及实施效果,为患者提供高效、便捷的就医服务,提升患者服务效率。方法:采用χ~2检验、独立样本t检验对使用自助开单服务的患者及同期使用APP自约号来院就诊的患者的性别、年龄、来源、预约挂号至就诊的等待时间进行比较;测量系统应用后为患者节省的就医成本并对患者的就医流程进行比较。结果:使用自助开单服务的患者相比自约号的患者,老年人比例提升了5.4%(P=0.02)、京外患者比例下降了3.6%(P=0.028),患者预约挂号至就诊的平均等待时间减少了51.8个小时(P<0.01),平均为每位患者节省费用1 790元/次。结论:自助开单服务系统的应用有助于优化就医流程、缩短预约挂号到就诊的等待时间,节省就医成本,促进医疗资源合理配置,提高医疗服务效率。

不同黄体酮给药方案对行胚胎植入前遗传学检测的冻融胚胎移植患者的影响及治疗成本分析

目的分析不同黄体酮给药方案对行胚胎植入前遗传学检测的冻融胚胎移植(PGT-FET)患者的影响及治疗成本。方法回顾性分析2020年8月至2022年7月在十堰市太和医院生殖医学中心进行PGT-FET的169例不孕患者的临床资料,根据患者采用的黄体酮给药方案将其分为A组(黄体酮胶囊口服,82例)和B组(黄体酮软胶囊阴道上药,87例)。比较两组注射人绒毛膜促性腺激素(HCG)日激素指标及获卵情况、注射HCG日和移植日子宫内膜厚度及容受性指标[阻力指数(RI)、搏动指数(PI)和收缩期峰值流速/舒张末期流速(S/D)]、囊胚移植、妊娠结局、阴道出血情况及成本-效果比。结果两组注射HCG日促黄体生成素(LH)、注射HCG日雌二醇(E2)、注射HCG日孕酮(P)、获卵数、MⅡ卵子数,注射HCG日和移植日子宫内膜厚度及子宫动脉S/D、RI、PI,移植囊胚数、移植优质囊胚率、生化妊娠率、临床妊娠率、早期流产率及继续妊娠率比较差异无统计学意义(P>0.05)。A组阴道早期出血率和晚期出血率显著低于B组(P<0.05)。A组成本-效果比为6.72,低于B组的8.41。结论PGT-FET患者采用黄体酮胶囊口服治疗与黄体酮软胶囊阴道上药治疗所获临床效果及对子宫内膜容受性的保护作用较为接近,但前者可以降低阴道出血率和治疗成本。

一锅法一次性合成片状羟基磷灰石及其对废水中铀的去除性能及机理研究

水体中存在的铀会损害人体健康,因此铀的去除是一个需要研究的课题。以低成本的CaCO_(3)和(NH_(4))_(2)HPO_(4)为原料,通过一锅法一次性合成羟基磷灰石(OP-HAP),并将其应用于去除溶液中的铀。通过单因素和正交试验探究了OP-HAP对铀的吸附性能,并利用SEM、EDS、XRD、FTIR及XPS对其进行表征。结果表明:最优条件下,OP-HAP对10 mg·L^(-1)铀的最大去除率为97%左右,拟合最大吸附量为1 584.79 mg·g^(-1);OP-HAP对铀的吸附过程符合Langmuir等温吸附模型和准二级动力学模型;热力学研究表明吸附过程是吸热且自发的;通过Zeta电位及对吸附铀前后的OP-HAP进行表征,发现吸附机理主要是静电吸附、离子交换、配合作用及溶解沉淀。OP-HAP对铀的吸附表现出较高的吸附量,是一种潜在的铀吸附材料。

基于“SHA2011”的某省综合医院治疗费用分布维度分析

[目的]分析某省综合医院治疗费用分布维度,为相关政策的完善调整提供参考。[方法]以某省2018年综合医院数据为基础,应用卫生费用核算体系2011核算方法,对该省综合医院治疗费用在不同维度的分布以及分布维度、筹资方案的矩阵分析结果进行描述性分析。[结果]该省综合医院治疗费用依次来源于社会医疗保险、家庭个人卫生支出、自愿筹资。从疾病流向看,33.5%流向循环系统疾病和消化系统疾病;从年龄流向看,45.43%流向60岁及以上人群;从性别流向看,53%流向男性群体;从医疗机构级别流向看,73.8%流向省市级医疗机构。[结论]居民疾病经济负担较重,重点疾病、重点人群、高级别医院占用的治疗费用较高。

侵袭性肺炎克雷伯菌肝脓肿综合征的临床特征及不同治疗方式的有效性与费用分析

目的:细菌性肝脓肿是常见的消化系统感染性疾病之一。侵袭性肺炎克雷伯菌肝脓肿综合征(invasive Klebsiella pneumoniae liver abscess syndrome,IKLAS)是指除肝脓肿外,存在迁徙感染病灶或其他侵袭表现,其临床特征和危险因素尚未完全阐明,不同治疗方式的有效性与经济性也鲜有研究。本研究比较IKLAS与非IKLAS患者的临床特征,探讨有效且经济的治疗方式。方法:回顾性收集2010年1月至2023年12月中南大学湘雅医院收治的肺炎克雷伯菌肝脓肿患者的病历资料,共纳入201例患者,分为IKLAS组(n=37)和非IKLAS组(n=164)。比较2组患者的一般资料、症状和体征、实验室指标、影像学特点、合并症、治疗方式、治疗结局、直接治疗成本的差异;分析不同治疗方式对结局指标和住院费用的差异,进一步探讨治疗方式的有效性和经济性。结果:与非IKLAS组相比,IKLAS组合并糖尿病、快速感染相关器官衰竭评分(Quick Sequential Organ Failure Assessment,qSOFA)≥2、免疫功能低下状态、贫血和血小板下降的患者比例更高,发病时降钙素原水平更高(均P<0.05);在症状和体征方面,IKLAS组有视觉症状的比例更高,有腹痛症状的比例更低(均P<0.05);在并发症方面,IKLAS组胸腔积液、肺部感染、急性肾功能不全、呼吸衰竭、多器官功能衰竭的发生率更高(均P<0.05)。IKLAS组采用单纯抗菌药物治疗的比例更高(24.32%vs 11.59%),而非IKLAS组更多采用抗菌药物联合穿刺引流方案(86.59%vs 64.86%),差异均有统计学意义(均P<0.05)。IKLAS组整体有效率(83.78%)低于非IKLAS组(95.73%),治疗费用和药品费用更高(均P<0.05)。采用抗菌药物联合手术切除感染病灶治疗的肺炎克雷伯菌肝脓肿患者好转率达100%,抗菌药物联合脓肿穿刺引流治疗好转率84.9%,单纯抗菌药物治疗好转率82.1%,三者的差异具有统计学意义(P<0.05)。同时,在治疗费用方面,单纯抗菌药物治疗方式的费用最高(P<0.05)。结论:细菌性肝脓肿发生侵袭综合征的患者预后较差且直接医疗成本更高。联合脓肿穿刺引流或手术的方案相比单纯抗菌药物治疗好转率更高,住院费用更低,提示外科干预的手段可以减少抗菌药物花费,节约医疗成本。

复合树脂多层修复技术与复合树脂直接粘接修复技术在前牙间隙美学修复中的效果对比

目的:对比分析复合树脂多层修复技术与复合树脂直接粘接修复技术在前牙间隙美学修复中的效果。方法:纳入笔者医院2020年6月-2021年6月收治的98例(共104颗患牙)前牙间隙患者作为研究对象,按照随机数表法分为A组和B组,各49例。A组患者接受复合树脂多层修复技术,B组患者接受复合树脂直接粘接修复技术。对比两组修复效果、美学效果和治疗总费用,比较两组修复前和修复30d后、6个月后的咬合力、咀嚼效率和焦虑自评量表(Self-ratinganxietyscale,SAS)、抑郁自评量表(Self-rating depression scale,SDS)评分。结果:修复30 d后,A组优秀率高于B组(P<0.05),两组良好率和不良率比较无统计学意义(P>0.05)。修复6个月后,A组优秀率和不良率均高于B组(P<0.05),两组良好率比较无统计学意义(P>0.05)。患者的咬合力在时间、交互作用上差异有统计学意义(P<0.05),在组间作用上差异无统计学意义(P>0.05)。患者的咀嚼效率在时间、组间、交互作用上差异均有统计学意义(P<0.05)。修复6个月后,两组患者咬合力和咀嚼效率均较修复30d后和修复前升高,且A组咬合力和咀嚼效率高于B组(P<0.05)。A组修复后的边缘密合性、颜色匹配性、修复体崩裂、继发龋损、形态匹配、修复体脱落和牙龈健康评分均低于B组(P<0.05)。患者的SAS评分和SDS评分在时间、组间、交互作用上有统计学意义(均P<0.05)。修复30d后和修复6个月后,两组患者SAS和SDS评分均较修复前降低,且A组低于B组(P<0.05)。A组治疗总花费高于B组(P<0.05)。结论:与复合树脂直接粘接修复技术相比,在前牙间隙美学修复中应用复合树脂多层修复技术可取得更佳的修复效果,有助于恢复患者咬合力和咀嚼功能,使患者获得良好美学效果,改善其心理状态。但治疗总花费相对较高,临床治疗需结合患者经济情况选择合适治疗方案。

药物重整与药学服务模式用于心血管内科效果分析

目的 探讨药物重整与药学服务模式用于心血管内科的效果。方法 参考《医疗机构药学服务规范》(第3部分药物重整)及澳大利亚药学会综合药物管理评价指南,建立心血管内科的药物重整与药学服务模式。选取医院心血管内科2019年3月至2021年3月(模式实施前)收治的340例心血管疾病患者为对照组,采用常规药学服务模式;以2021年4月至2022年4月(模式实施后)收治的340例心血管疾病患者为观察组,采用药物重整与药学服务模式,比较两组患者用药不一致、不合理用药、药品不良反应(ADR)的发生情况及药品相关费用。结果 观察组患者药物用法用量改变、品种更换、厂家更换、种类增加比例均显著低于对照组,用药途径不合理、联合用药不合理、药物剂量过大、严重ADR的发生率均显著低于对照组,观察组患者的住院药品费用、住院总费用及出院1个月药品费用均显著少于对照组(P <0.05)。结论 药物重整与药学服务模式用于心血管内科,能显著减少心血管疾病患者的治疗费用,并有效提高用药安全性。

DRG付费对脑梗死患者费用结构及医疗行为的影响研究

[目的]分析DRG付费对脑梗死患者的住院费用结构及医疗行为可能产生的影响,了解DRG付费实施后对临床产生的影响及医疗机构的应对措施。[方法]分析首都医科大学宣武医院DRG付费改革前后“脑梗死”病组837例患者的费用结构,并结合对该院162名临床医生发放的问卷进行调查,统计分析费用构成及医疗行为变化情况。[结果]DRG付费后“脑梗死”患者费用构成中药占比明显下降,检查费、化验费、治疗费占比显著提升,平均住院日有所降低。DRG付费后医疗机构可能存在异化行为和患者选择偏见的风险。[结论]研究表明DRG付费制度对优化医疗机构费用结构、提高治疗效率起到积极作用,也对医疗行为的规范起到了促进作用。同时也产生了推诿病人、低码高编等异化行为,医保经办机构应积极探索适应DRG付费制度的监管新措施。

基层医疗机构中不同种类抗生素治疗多重耐药鲍曼不动杆菌肺部老年感染的临床应用及安全性评估

目的探讨基层医疗机构中不同种类抗生素治疗多重耐药鲍曼不动杆菌肺部老年感染的临床应用及安全性评估。方法选取2022年12月至2023年12月涵江区江口镇卫生院收治的100例多重耐药鲍曼不动杆菌肺部老年感染患者为研究对象,根据抗生素类型不同分为头孢曲松组、头孢唑啉钠组、左氧氟沙星组及阿奇霉素组,各组25例。记录治疗期间用药情况并判断不同抗生素的临床应用价值。结果头孢曲松组、头孢唑啉钠组、左氧氟沙星组以及阿奇霉素组临床疗效分别为88.00%、84.00%、88.00%、92.00%,组间对比后,四组患者临床治疗有效率占比无统计学意义(P>0.05);治疗后,左氧氟沙星组治疗总费用较其他三组低,头孢唑啉钠组较头孢曲松组、阿奇霉素组低,头孢曲松组较阿奇霉素组低(P<0.05);对比四组患者治疗后TNF-α、CRP、IL-6、IL-8变化,差异无统计学意义(P>0.05);四组不同种类抗生素药物不良反应比较无统计差异(P>0.05)。结论多重耐药鲍曼不动杆菌肺部老年感染患者治疗过程中不同抗生素治疗疗效、炎症因子及不良反应情况无明显差别,但对比用药经济学方面,左氧氟沙星治疗费用较低,临床上应根据患者情况科学性选择合适的抗生素治疗。