对药品采取不同的限量措施后单病种付费病例的用药变化分析

李纪伟

摘要：目的  分析單病种付费在对药品采取不同的限量措施后，用药情况的变化。方法  选择我院2017年5月～2018年8月各单病种付费的病例数，抽取前3位单病种付费病例数，估算其频率标准误，得出用其估计全院单病种付费用药情况变化的可靠性;计算前3位单病种付费病例各时间段日均药品总费用、采取不同的限量后与采取限量措施的药品相同药理作用的药品的人均药品使用频度、DDC，并对结果进行分析。结果  对前3位单病种付费的用药情况估计全院单病种付费用药情况是可靠的;对药品采取不同的限量措施对单病种付费病例的日均药品费用有影响;引进DDC较低的药品，并对原药品采取限量措施后，该类相同药理作用的药品的人均药品使用频度呈上升趋势、DDC呈下降趋势;对使用量较大的辅助、高价药品采取限量措施后，该类相同药理作用的药品的人均药品使用频度呈上升趋势、DDC呈下降趋势;有针对性地对某一类药品采取限量措施后，该类相同药理作用的药品的人均药品使用频度、DDC均呈下降趋势。结论  降低单病种付费的药品费用需要将强合理用药监控，同时采取一些行政手段，对于降低单病种付费病例药品费用是有效的。

关键词：单病种付费; 药品限量措施; DDC ;DDDS

中图分类号：R197.3                                  文献标识码：A                                DOI：10.3969/j.issn.1006-1959.2019.06.047

文章编号：1006-1959（2019）06-0148-03

Abstract：Objective  To analyze the changes in medication use after a single disease type has been treated with different restrictions on drugs. Methods  The number of cases paid for each single disease in our hospital from May 2017 to August 2018 was selected. The number of the first three single-species paid cases was estimated， and the frequency standard error was estimated. The reliability of the changes in the use of drugs; calculate the total daily average drug cost of each of the first three single-species paid cases， and the frequency of drug use per capita， DDC， for drugs with the same pharmacological effects after taking different limits. And analyze the results. Results  It is estimated that the payment of the first three single-species drugs is reliable in the case of single-medical drugs. The different measures for drugs have an impact on the daily average drug costs of single-patient paid cases; the introduction of DDC is lower. After taking the limited measures for the original drugs， the frequency of per capita drug use of the drugs with the same pharmacological effects is on the rise， and the DDC is on the downward trend. After taking the limited measures for the auxiliary and high-priced drugs with large usage， the frequency of per capita drug use of drugs with the same pharmacological effects is on the rise， and DDC is on a downward trend. After targeted measures for certain types of drugs， the frequency of per capita drug use and DDC of drugs with the same pharmacological effects Both showed a downward trend. Conclusion  Reducing the cost of medicines for single disease requires strong and rational drug monitoring， and at the same time， some administrative measures are taken to reduce the cost of drugs for single-patient paid cases.