| 分级诊疗制度下不同级别医院间糖尿病基本药物使用现状研究 |
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| 引用本文： | 章小敏,陈翔,陈将,鲍俞燕,叶爱菊,洪冰. 分级诊疗制度下不同级别医院间糖尿病基本药物使用现状研究[J]. 中国全科医学, 2021, 24(12): 1546-1551. DOI: 10.12114/j.issn.1007-9572.2021.00.028 |
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| 作者姓名： | 章小敏 陈翔 陈将 鲍俞燕 叶爱菊 洪冰 |
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| 作者单位： | 1.317100浙江省台州市，浙江大学医学院附属第一医院三门湾分院药剂科 2.317100浙江省台州市，浙江大学医学院附属第一医院三门湾分院院部 3.317100浙江省台州市，浙江大学医学院附属第一医院三门湾分院医保办公室 #br# *通信作者：章小敏，主任药师；E-mail：287896623@qq.com |
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| 基金项目： | 浙江省药学会医院药学专项科研资助项目（2017ZYY30）；台州市科技计划项目（1802ky90） |
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| 摘 要： | 背景 我国糖尿病患病率逐年剧增，防治工作异常严峻，做好糖尿病防治管理是分级诊疗制度建设的重点任务。但是，基层医院以基本药物使用占绝对主导地位的药品供应保障体系，能否与其转诊的上级医院糖尿病用药对接是非常重要的环节，其直接影响基层糖尿病防治能力和同质化水平的提高。目的 研究分级诊疗制度下不同级别医院间糖尿病治疗药物衔接状况，探索基本药物制度的实施对慢性病防治药物保障体系的影响。方法 选择浙江、安徽、陕西省不同级别样本医院共9家，基于中国药学会全国医药经济信息网2016-2018年药品采购数据，通过对糖尿病治疗药物及基本药物使用品种结构、用药频度、金额等情况比较，分析变化趋势，研究不同级别医院间用药衔接状况。结果 3个省份基本药物品规数占糖尿病治疗药物总品规的25.58%（33/129），不同级别医院2018年用药频度占比比较，差异均有统计学意义（P<0.01）。基本药物进入用药频度前10位的品规数，以安徽省最多（占7种）、陕西省最少（占3种），用药频度和金额占比最高的分别是安徽省的三级医院（64.08%和41.49%）和基层医院（38.11%和28.77%）、浙江省的二级医院（40.63%和35.00%）。不同级别医院基本药物与非基本药物用药频度、用药金额3年增长率比较，除陕西省用药频度增长率差异无统计学意义（P>0.05）外，浙江省和安徽省其余各项指标比较差异均有统计学意义（P<0.01）。结论 糖尿病治疗药物利用情况在不同地区、不同级别医院存在较大差异，药物衔接状况较差，基本药物难以满足分级诊疗基层医院慢性病用药需求，亟须完善。
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| 关 键 词： | 分级诊疗 糖尿病 基本药物 药物利用 慢性病管理 浙江 安徽 陕西 |
Use of Essential Medicines for Diabetes in Different Levels of Hospitals during the Implementation of Hierarchical Medical System |
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| ZHANG Xiaomin,CHEN Xiang,CHEN Jiang,BAO Yuyan,YE Aiju,HONG Bing. Use of Essential Medicines for Diabetes in Different Levels of Hospitals during the Implementation of Hierarchical Medical System[J]. Chinese General Practice, 2021, 24(12): 1546-1551. DOI: 10.12114/j.issn.1007-9572.2021.00.028 |
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| Authors: | ZHANG Xiaomin CHEN Xiang CHEN Jiang BAO Yuyan YE Aiju HONG Bing |
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| Abstract: | Background Due to increasing diabetes prevalence year by year，diabetic prevention and treatment have become extremely severe challenges to China，and the associated hierarchical diabetes management is a key part of the ongoing development of hierarchical diagnosis and treatment. Whether diabetes medication services in primary hospitals in which essential medicines make up the largest proportion of medicines can appropriately link up the diabetes medication services in higher level referral hospitals is an important issue that may directly affect the improvement of diabetes prevention and treatment ability and uniformity of diabetic treatments in primary hospitals. Objective To study the connection of diabetes medication services in different levels of hospitals under the implementation of the hierarchical medical system，and to explore the impact of the implementation of the national essential medicine system on the supply guarantee system of drugs for chronic disease prevention and treatment. Methods A total of 9 hospitals were selected from Zhejiang，Anhui，and Shaanxi provinces（a provincial tertiary hospital，a county secondary hospital，and a primary hospital were selected from each province）. Drug purchase data were collected from China Medical Economic Information Network of Chinese Pharmaceutical Association from 2016 to 2018. The connection of medication services among three levels of hospitals was studied by comparatively analyzing the forms，specifications，DDDs and costs of antidiabetic drugs and essential antidiabetic drugs and related trend of changes. Results Overall，it was found that the forms and specifications of essential antidiabetic drugs accounted for 25.58%（33/129） of those of antidiabetic drugs in hospitals in these provinces，and the proportions of DDDs in hospitals of different levels in 2018 were significantly different（P<0.01）. The number of essential antidiabetic drugs of different forms and specifications in terms of DDDs listed in the top 10 was the most in Anhui's hospitals（7） and the least in Shaanxi's hospitals（3）．Comparisons by the level of hospital among provinces showed that the hospital of Anhui had the highest proportion of DDDs and costs of essential antidiabetic drugs（64.08% and 41.49%） at the tertiary level as well as at the primary level（38.11% and 28.77%）. Zhejiang's secondary hospital had the highest proportion of DDDs and costs of essential antidiabetic drugs（40.63% and 35.00%） among the three secondary hospitals. Compared with the three-year growth rate of drug use frequency and sum of money of essential drugs and non essential drugs in different levels of hospitals，except for the growth rate of drug use frequency in Shaanxi Province（P>0.05），the differences of other indicators were statistically significant in Zhejiang Province and Anhui Province（P<0.01）. Conclusion Our study suggests that the use of antidiabetic drugs differed significantly by region as well as the level of hospitals，the connection of diabetic medication services among different levels of hospitals was unsatisfied，and the essential antidiabetic drugs in primary hospitals could not meet the needs of chronic disease patients，which need to improve urgently. |
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| Keywords: | Hierarchical medical system Diabetes Essential medicines Drug utilization Chronic disease management Zhejiang Anhui Shaanxi |
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