基于药品采购数据库的医疗机构药品配备使用现状研究:以江苏省为例

Research on Drug Using Situation in Medical Institutions Based on Drug Procurement Database in Jiangsu Province

关键词:  用药数量及集中度  上下级用药衔接  基药与医保药品使用现状

Key words:  quantity and concentration of medication  coherence of drug usage between different medical facilities at different levels  drug utilization situation of the NEML and NRDL

摘要:

目的 基于医疗机构药品采购数据,厘清医疗机构药品配备使用现状及存在的问题,并给出相应建议。方法 以江苏省2019年2 555家医疗机构药品采购数据为基础,围绕用药数量及用药需求集中度、上下级用药衔接、基药目录和医保药品目录的使用现状,对医疗机构药品配备使用情况进行梳理与分析。结果 医疗机构临床常用药品品种数在3 200种左右,远小于当前上市药品总数,但各级医疗机构用药需求集中度在<10%的药品均>1 000个。医疗机构日常配备使用的药品可形成良好的上下级用药衔接。医疗机构用药需求集中度在>30%的药品中,基层与二级医疗机构药品重合率为74.29%,二级与三级医疗机构药品重合率为97.99%。医疗机构虽然基本形成了以基药为主导、医保药品为重点的"1+X"用药模式,但基药的配备情况与达到国家"986"目标仍存在一定距离。结论 未来需要进一步提升医院药事管理的精细化水平,提高医疗机构用药集中度和用药合理性;继续强化上下级医疗机构间的用药衔接,助力分级诊疗制度建设;以基本医疗卫生需求、基本医疗保障水平以及中国疾病谱的变化为前提调整和完善基药目录,持续巩固基药目录和医保药品目录对临床用药的指导作用。

Abstract:

OBJECTIVE To learn about the drug utilization situation and problems in medical institutions based on the drug purchasing database, and give corresponding suggestions. METHODS Based on the drug purchasing statistics of 2 555 public medical institutions in Jiangsu Province in 2019, analyzing the median drug using quantity and concentration, coherence of drug usage between different medical facilities at different levels, and the drug using situation of the National Essential Medicine List(NEML) and National Reimbursement Drug List(NRDL). RESULTS At present, medical institutions at different levels usually use about 3 200 drugs in daily practice, which was far less than drugs on the market in China. The numbers of drug whose concentration was lower than 10% was over 1 000. In terms of drugs mainly equipped and used in medical institutions, the coherence of drug usage between different medical facilities at different levels seemed good. Among drugs with concentration over than 30% in medical institutions, the coincidence rate of drugs between primary and secondary medical institutions was 74.29%, and that of drugs between secondary and tertiary medical institutions was 97.99%. Though medical institutions now have basically formed a “1+X” drug using mode, which was dominated by the NEML list and focused on the NRDL list, the scaling of essential medicines doesn’t achieve the goal of “986”. CONCLUSION In the future, it is necessary to improve the hospital pharmacy management, ameliorate the concentration and rationality of drug use in medical institutions. Strengthen the drug use connection to promote the construction of hierarchical diagnosis and treatment system. Adjusting the NEML list according to basic medical and health needs, basic medical security level and the changes of disease spectrum, so that the guiding role of the NEML and NRDL list in clinical drug use should be continuously consolidated.