The cost of acute outpatient primary care in a preferred provider organization

This report is a case study analysis of the relative costs of preferred provider organization (PPO) and non-PPO managed episodes. Results indicate that the episode costs of PPO providers are not significantly different from the episode costs of non-PPO providers for general acute primary outpatient health care. PPO provider episode costs were 3.12% higher for acute upper respiratory illness. Higher PPO physician charges of 10-16% appear to be the main reason for relatively higher PPO episode costs. For general primary health care, drug charges are 23% higher in PPO episodes than in non-PPO episodes. Higher physician and drug charges are partially compensated for by diagnostic charges, which are 14-18% lower in PPO-managed episodes. In light of these findings and the cost-sharing arrangement with the PPO, it is likely that the employer/insurer plan paid expenditures for outpatient care will increase, contrary to expectations.     

Clinical and economic consequences of reference pricing for dihydropyridine calcium channel blockers

OBJECTIVE: Reference pricing is a medication cost-sharing policy that fully covers medications which are less expensive than a standard reference price and requires patients to pay the extra cost of higher-priced drugs in a class of therapeutically substitutable drugs. Little information exists on the clinical and economic consequences. We analyzed changes in drug utilization, physician visits, hospitalizations, long-term care admissions, and expenditures after the introduction of reference pricing for dihydropyridine calcium channel blockers (CCBs) among patients aged 65 years or older in British Columbia, Canada. METHODS: This quasiexperimental longitudinal study was performed in the setting of Pharmacare, the state-funded drug benefits plan of all elderly persons in British Columbia. Study patients comprised all elderly residents of British Columbia who were enrolled in the provincial health insurance program and received dihydropyridine CCBs at the time of the policy change (35,886) and a subgroup of high-priced dihydropyridine CCB users (23,116). We studied the implementation of reference drug pricing on Jan 1, 1997, affecting all elderly Pharmacare beneficiaries. The main outcome measures were drug utilization, drug expenditures, physician visits, hospitalizations, long-term care, and net savings. RESULTS: The start of reference pricing was followed by a significant reduction in high-priced dihydropyridine CCBs (-150 monthly doses per 10,000 elderly persons), with a corresponding increase in fully covered dihydropyridine CCBs (+116). Overall, antihypertensive use did not decline (P =.46). Low-income status was a risk factor for discontinuing treatment (odds ratio, 1.64; 95% confidence interval [CI], 1.36 to 1.99); however, this was already observed to a similar magnitude 12 months before reference pricing (odds ratio, 1.46). In the overall study cohort, there was no increase in rates of physician visits, hospitalizations, and long-term care admissions. However, the 9% of patients who actually switched medications showed an 18% increase (95% CI, 8% to 28%) in physician visits and an increase of Canadian $13 (95% CI, Canadian $3 to Canadian $24) in costs of physician visits per patient as compared with nonswitchers during the transition but not afterward. This temporary increase may have been a result of additional prescribing and monitoring in switchers. Changes in drug expenditures and physician services resulted in net savings of Canadian $1.6 million in the first 12 months of policy implementation. CONCLUSIONS: Reference pricing as implemented in British Columbia may be a model for successful pharmaceutical cost-containment without adversely affecting patients or cost-shifting.     

我院门诊抗菌药物处方点评结果与分析

目的：分析我院门诊抗菌药物处方合理性及抗菌药物处方点评对我院门诊抗菌药物处方合理性的影响，持续性改进我院门诊抗菌药物的规范使用。方法：收集我院门诊药房收到的2019.01-2020.01所有含抗菌药物的处方及门诊药房点评小组对抗菌药物处方点评的结果，汇总出门诊不同科室抗菌药物消耗量并进行排名；对所选处方进行按月份的汇总分析，得出我院门诊每月抗菌药物处方的数量、不合格抗菌药物处方的数量、抗菌药物处方不合格率、抗菌药物处方不合格类型及数量。结果：经汇总分析得出我院门诊抗菌药物消耗量前十的科室有消化科、呼吸科、口腔科、皮肤科、耳鼻喉科、全科医学科、泌尿外科、内镜中心、肾脏病科、妇科；我院2019.01-2020.01期间抗菌药物处方数为18982张，占总处方数的5.14%，抗菌药物处方的不合格率为8.12%，其中占比对大的不合格类型为处方的规范性（93.02%），其次为用药的适宜性（6.98%），超常处方为0。讨论：我院药剂科持续改进抗菌药物处方的管理，实践证明，加强抗菌药物处方的管理可以降低抗菌药物处方不合格率，提高各科室抗菌药物的临床应用水平，降低不良反应的发生，减少耐药细菌的产生等。     

四川省宜宾市第一人民医院2012年门诊处方点评与典型处方分析

目的对四川省宜宾市第一人民医院门诊处方进行点评,促进临床合理用药。方法随机抽取我院2012年3600张门诊处方,根据《处方管理办法》《医院处方点评管理规范（试行）》进行点评,并统计分析。结果3600张门诊处方中,不合理处方514张,占处方总数14．28％,其中不规范处方366张（占处方总数10．17％）,不适宜处方117张（占处方总数3．25％）,超常处方31张（占处方总数0．86％）。结论我院门诊处方存在较多的问题,处方合格率较低。通过点评处方,能及时发现问题,对不合理用药及时干预,从而保障用药安全。     

精神病患者门诊处方点评分析

目的了解精神病患者门诊处方的质量,为促进临床合理用药提供依据。方法对4800张门诊处方进行点评,并对点评结果进行统计分析。结果4800张门诊处方合格率为97．73％,不合格处方占2．27％（不规范处方86．24％）;平均每张处方用药品种数为3．32种,金额为217．14元,通用名使用率为99．92％,抗菌药品、注射剂使用率分别为0、0．67％,基本药品使用率为68．79％。结论精神病患者门诊处方质量较高,处方书写日益完善,但仍存在不规范现象,需进一步改善和提高。     

处方点评制度对临床合理用药影响的调查分析

目的探讨处方点评制度对临床合理用药的影响。方法随机抽取深圳市宝安区福永人民医院2012-2013年825张处方为调查对象,按是否介入改进的处方点评制度,将调查对象分为非干预组395张(未介入改进的处方点评制度)和干预组430张(介入改进的处方点评制度),比较2组处方基本指标情况及不合理处方比例。结果干预组处方基本指标均较非干预组显著改善,2组比较差异有统计学意义(P<0.05);干预组的不规范处方、用药不适宜处方及超常处方比例均显著低于非干预组,2组比较差异有统计学意义(P<0.05)。结论处方点评制度能显著提高合理处方比例,降低不合理用药导致的不良反应和医疗费用负担,具有重要的临床应用价值。     

急性上呼吸道感染患者使用抗生素情况分析

目的 通过对全年门诊处方进行回顾性分析,了解上呼吸道感染处方抗生素的使用率,以提高基层卫生服务机构医务人员用药的合理性.方法 选择2010年1月至12月全部门诊处方,以Excel表格形式整理,进行率的比较.结果 6101份处方中上呼吸道感染处方2462份,占总处方的40.35％,其中使用抗生素1962份,占上呼吸道感染处方的79.69％,上呼吸道感染的处方量及抗生素的使用率明显高于其他感染性疾病的处方量.结论 本调查显示基层医疗机构抗生素滥用问题已经到了非常严重的程度,在对基层医务人员进行针对性培训的同时要加大宣传力度,让医师及患者都能了解滥用抗生素的危害.