上海市慢性病门诊用药现状调查：以高血压、糖尿病为例

摘要

目的：比较分析各级医疗机构慢性病门诊处方行为的合理性与差异性，寻找慢性病患者下沉社区就诊在药品配备与使用方面的障碍因素。方法：采用整群抽样的方法，抽取医疗机构2014年5月和11月高血压和糖尿病患者处方进行处方合理性分析；采用药物结构治疗化学分类系统及限定日剂量（ATC/DDD）方法分析药品利用情况。结果：二、三级医疗机构高血压、糖尿病处方费用明显高于社区卫生服务中心；高血压、糖尿病患者主要在社区配药，药品使用类别上略有差异；各级医疗机构高血压、糖尿病用药的采购一致性较差。结论：缓解或解决社区慢性病患者“配不到药”现象的根源，是解决社区卫生服务中心与二、三级医疗机构的药品配备使用范围的一致性问题，建议适当放开社区慢性病药品配备范围、医保控费额度和处方时长。%Objective:To comparatively analyze the rationality and diversity of outpatient prescription behavior among medical institutions at all levels,and to explore the influencing factors on storing up and using drugs in community health service centers where chronic disease patients get initial visiting. Methods:Based on cluster sampling,medical prescription of hypertension and diabetes in May and November of 2014 were used to analyze the rationality of prescription. Anatomical therapeutic chemical and defined daily dose(ATC/DDD)was used to analyze drug utilization. Results:The prescription charges for outpatients with hypertension or diabetes in secondary and tertiary medical institutions were significantly higher than that in community health service centers. Patients with hypertension and diabetes got medicine mostly from community health service centers. There was a slight difference among drug category between community health service centers and other medical institutions. Medical institutions had poor consistency on purchase of hypertension and diabetes drugs. Conclusion:The fundamental method to alleviate or solve the phenomenon of “hard to get related medicine in community health service centers”is to keep consistency among community health service centers,secondary medical institutions and tertiary medical institutions. It is recommended to open the range of chronic disease medicine in the communities appropriately and the control line of health insurance as well as prescription duration.