市属公立医疗机构重点监控药品目标性管控的成效分析

目的 评价市属公立医疗机构对重点监控药品进行目标性管控的成效分析，为优化管控策略、促进临床合理用药提供依据。方法 根据国家级和省级重点监控药品目录纳入重点监控药品调查，对比市属公立医疗结构2018年10月—2020年9月的采购金额、药占比、限定日剂量等数据并进行分层分析，通过帕累托图分析法对监控后数据分析，评价重点监控药品使用情况及管控实施效果。结果 根据目录及临床应用纳入18种重点监控药品，管控前后对比，采购金额从9 941.86万元下降至4 343.27万元，用药频度下降41.34%，占总药品采购金额比例从3.80%下降至1.98%。其中，二级医院的重点监控药品占总药品比例显著高于三级医院和基层医院；心脑血管辅助用药、中药注射剂在二级以上公立医疗机构中降幅较大；而丁苯酞、胞磷胆碱等口服制剂在三级医院下降较大。结论 重点监控药品的目标性管控有显著成效，三级以下公立医疗机构应进一步加强管控，对重点监控药品使用情况分析，有助于优化管控策略和措施。

Effectiveness Analysis of Targeted Management of Key Monitoring Drugs in Municipal Public Medical Institutions

OBJECTIVE To evaluate the effect of targeted management of key monitoring drugs in municipal public medical institutions, and provide empirical evidence for control strategy optimization and rational drug use. METHODS Key monitoring drugs were picked according to the national and provincial key monitoring drug lists. The implementation effect of targeted management of key monitoring drug was evaluated by comparing the drug income, drug proportion in total drug income, defined daily dose between October 2018-September 2020 in public medical institutions. The data after targeted management were analyzed by pareto chart analysis. RESULTS According to the catalogue and clinical application, 18 kinds of key monitoring drugs were included. Compared with before and after control, the purchase amount decreased from 99.418 6 million yuan to 43.432 7 million yuan, DDDs decreased by 41.34%, and the proportion of total drug purchase amount decreased from 3.80% to 1.98%. Among them, the proportion of key monitoring drugs in secondary hospitals was significantly higher than that in tertiary hospitals and primary hospitals. Cardiovascular and cerebrovascular adjuvant drugs and traditional Chinese medicine injections decreased significantly in public medical institutions above second level. Oral preparations such as butylphthalide and citicoline decreased greatly in tertiary hospitals. CONCLUSION The targeted control of key monitored drugs has achieved remarkable results. Public medical institutions below the third level should further strengthen the control. The analysis of the use of key monitored drugs helps to optimize the control strategies and measures.