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1.陆军军医大学大坪医院药剂科,重庆 400042
2.陆军军医大学大坪医院医研部医疗办,重庆 400042
3.陆军军医大学大坪医院医研部医保办,重庆 400042
药师,硕士。研究方向:临床药学、药物经济学。 E-mail:wuyuanlin8023@163.com
副主任药师,硕士生导师,博士。研究方向:药事管理、合理用药。E-mail:swhliuyao@163.com
纸质出版日期:2022-11-30,
收稿日期:2022-05-27,
修回日期:2022-09-21,
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伍渊麟,鲜秋婉,李晨等.DRG视角下临床药师参与肿瘤中心药事精细化管理的实践与思考Δ[J].中国药房,2022,33(22):2801-2806.
WU Yuanlin,XIAN Qiuwan,LI Chen,et al.Practice and exploration of clinical pharmacists participating in refined pharmaceutical management of oncology center from the perspective of DRG[J].ZHONGGUO YAOFANG,2022,33(22):2801-2806.
伍渊麟,鲜秋婉,李晨等.DRG视角下临床药师参与肿瘤中心药事精细化管理的实践与思考Δ[J].中国药房,2022,33(22):2801-2806. DOI: 10.6039/j.issn.1001-0408.2022.22.23.
WU Yuanlin,XIAN Qiuwan,LI Chen,et al.Practice and exploration of clinical pharmacists participating in refined pharmaceutical management of oncology center from the perspective of DRG[J].ZHONGGUO YAOFANG,2022,33(22):2801-2806. DOI: 10.6039/j.issn.1001-0408.2022.22.23.
目的
2
探讨临床药师基于疾病诊断相关分组(DRG)参与肿瘤中心住院患者药事精细化管理的成效。
方法
2
以陆军军医大学大坪医院肿瘤中心进入DRG病组且住院时间不超过60 d的出院患者为对象,分析临床药师参与药事精细化管理干预前(2019年1-12月)、干预后第1年(2020年1-12月)、干预后第2年(2021年1-12月)患者的DRG指标和住院相关指标的变化情况;根据DRG入组情况和疾病诊疗方式选取肿瘤中心重点DRG病组,分析其干预前后的住院相关指标和干预后的合理用药情况。
结果
2
与干预前比较,干预后第1、2年,DRG病组数增至157、184种,病例组合指数显著升高(
P
<0.05),费用消耗指数、时间消耗指数、平均住院日、次均住院费用均显著降低或缩短(
P
<0.05),次均药费均显著升高(
P
<0.05),无低风险死亡和严重药品不良反应发生。在4种重点DRG病组中,RE19、RU29病组干预后第1、2年的平均住院日和RU14病组干预后第1年的平均住院日,RE19病组干预后第1、2年的次均住院费用和RU14、RV19、RU29病组干预后第2年的次均住院费用,以及RU14病组干预后第2年的次均药费均显著低于干预前(
P
<0.05),RE19、RU29病组干预后第1、2年的次均药费均显著高于干预前(
P
<0.05);干预后次均药费显著增加的DRG病组存在药品联用不适宜、用法用量不适宜、超说明书用药等不合理用药情况。
结论
2
在DRG背景下,临床药师参与药事精细化管理后,肿瘤中心整体诊疗服务能力提升,诊疗效率有所提高,且无低风险死亡及严重药品不良反应病例,促进了医疗机构合理用药。
OBJECTIVE
2
To investigate the effectiveness of clinical pharmacists’ participation in the refined pharmaceutical management for inpatients of oncology center based on diagnosis related groups (DRG).
METHODS
2
Patients who entered DRG and stayed in hospital for less than 60 days in oncology center of Daping Hospital, Army Medical University were selected as the research objects to analyze the changes of DRG indicators and related hospitalization indicators before the intervention of clinical pharmacists’ participation in the refined pharmaceutical management (Jan.-Dec. 2019), the first year after the intervention (Jan.-Dec. 2020), and the second year after the intervention (Jan.-Dec. 2021); the key DRG groups were selected from the oncology center according to DRG enrollment and disease diagnosis and treatment methods, and related hospitalization indicators before and after the intervention and rational drug use after intervention were analyzed.
RESULTS
2
Compared with before intervention, in the first and second years after the intervention, the number of DRG groups increased to 157 and 184, and the case mix index increased significantly (
P
<0.05), while cost consumption index, time consumption index, average hospital stay and average hospitalization expense per time were decreased or shortened significantly (
P
<0.05); drug cost per time was increased significantly (
P
<0.05), and there were no low-risk deaths and severe adverse drug reactions. Among the 4 key DRG groups, the average hospital stay in RE19 disease group and RU29 disease group in the first and second year after intervention and those of RU14 disease group in the first year after intervention were significantly lower than before (
P
<0.05); the average hospitalization expense per time of RE19 disease group in the first and second year after intervention and those of RU14 disease group, RV19 disease group and RU29 disease group in the second year after intervention were significantly lower than before (
P
<0.05); drug cost per time of RU14 disease group in the second year after intervention was significantly lower than before, while those of RE19 disease group and RU29 disease group in the first and second year after intervention were significantly higher than before (
P
<0.05). There was some irrational drug use in the DRG disease groups with a significant increase in the drug cost per time after the intervention, such as inappropriate selection of drugs, inappropriate usage and dosage, off-label drug use, etc.
CONCLUSIONS
2
In the context of DRG, after the clinical pharmacists participated in the refined pharmaceutical management, the overall diagnosis and treatment service capacity of oncology center are improved, the efficiency of diagnosis and treatment are improved, and there are no low-risk deaths and severe adverse drug reactions, which promote the management of rational drug use in medical institutions.
疾病诊断相关分组临床药师药事精细化管理肿瘤中心成效
clinical pharmacistrefined pharmaceutical managementoncology centereffectiveness
ZHENG R S,ZHANG S W,ZENG H M,et al. Cancer incidence and mortality in China,2016[J]. J Natl Cancer Cent,2022,2(1):1-9.
2018全球癌症年报出炉[J]. 疾病监测,2018,33(12):984.
XIA C F,DONG X S,LI H,et al. Cancer statistics in China and United States,2022:profiles,trends,and determinants[J]. Chin Med J (Engl),2022,135(5):584-590.
ALLEMANI C,MATSUDA T,DI CARLO V,et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3):analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries[J]. Lancet,2018,391(10125):1023-1075.
周颖玉,徐冬艳,齐云,等. 中国医院抗肿瘤药物使用情况分析[J]. 中国医院药学杂志,2021,41(18):1817-1822.
国家卫生计生委,国家发展改革委,财政部,等.关于印发控制公立医院医疗费用不合理增长的若干意见的通知:国卫体改发〔2015〕89号[EB/OL].(2015-10-27)[2022-04-20]. http://www.mohrss.gov.cn/SYrlzyhshbzb/shehuibaozhang/zcwj/yiliao/201512/t20151208_228150.htmlhttp://www.mohrss.gov.cn/SYrlzyhshbzb/shehuibaozhang/zcwj/yiliao/201512/t20151208_228150.html.
林江洪. 医保支付方式改革对控制医药费用不合理增长效果研究[J]. 科技风,2019(10):206.
30城启动DRG试点[J]. 科技新时代,2019(4):40-41.
简伟研,胡牧,张修梅. 基于DRGs的医疗服务绩效评估方法与案例应用研究[J]. 中华医院管理杂志,2013,29(3):180-185.
刘婉如,张乐辉,仇叶龙,等. 病例组合指数在医院绩效评价中的调整方法与应用[J]. 中华医院管理杂志,2015,31(11):843-845.
张晓利. 决胜CMI,三甲医院“痛”并进步着[J]. 中国医院院长,2018(2):48-51.
江芹. DRG收付费政策设计与实施中的经验及启示[J]. 中国卫生经济,2022,41(1):6-11.
ALFREDO Á R,MARÍA MUÑOZ D,VALERIA S S. Implementation of diagnosis related groups methodology in a university hospital[J]. Rev Med Chil,2019,147(12):1518-1526.
罗明薇,谢世伟. 四川省地区医疗服务能力DRGs评价[J]. 解放军医院管理杂志,2020,27(7):617-620.
林雯琦. 国家医保谈判抗癌药对住院费用及医保支付的影响:以广州市某三甲医院为例[D]. 广州:广东药科大学,2021.
汪磊,何勇. 医保谈判背景下某院在用抗肿瘤药物综合干预效果与分析[J]. 中国药业,2021,30(14):15-19.
胡曼,王锦毓,缪艳瑶. DRG评价方法在肿瘤专科医院应用及问题探讨[J]. 医院管理论坛,2021,38(1):32-34.
LAM M S H,IGNOFFO R J. A guide to clinically rele-vant drug interactions in oncology[J]. J Oncol Pharm Pract,2003,9(2/3):45-85.
胡胜,臧爱华. 癌症治疗中药物相互作用[J]. 中国肿瘤,2006,15(1):25-28.
LI G,LIU Y,HU H,et al. Evolution of innovative drug R&D in China[J]. Nat Rev Drug Discov,2022,21(8):553-554.
李长龙,舒家华,李国兴,等. 4个进口PD-1/PD-L1抑制剂不良反应信号的挖掘与评价[J]. 中国药房,2022,33(7):873-878.
顾阳春,刘颖,谢超,等. 程序性死亡蛋白-1抑制剂治疗晚期肺癌出现垂体免疫不良反应3例[J]. 北京大学学报(医学版),2022,54(2):369-375.
吴紫阳,何娜,程吟楚,等. 基于美国FAERS数据库的恩美曲妥珠单抗和维布妥昔单抗不良反应信号挖掘[J]. 中国药房,2022,33(6):740-744.
陈健清,陈贵全,简晓顺,等. 两种抗肿瘤中药注射剂在乳腺癌化疗应用的药物经济学分析[J]. 国际医药卫生导报,2013,19(16):2481-2482.
黄建峰,聂勇,孙振芝,等. 放化疗联合靶向药物治疗晚期胆道恶性肿瘤的效果研究[J/OL]. 临床医药文献电子杂志,2020,7(24):55[2022-04-20]. https://kns.cnki.net/kcms/detail/detail.aspx?dbcode=CJFD&dbname=CJFDL-AST2020&filename=LCWX202024045&uniplatform=NZ-KPT&v=TMhQVzmDaQvwlDW7-TJxc5lWERjVMJrQf-dvwhq-2y4t1W_sc_7g35o-g3QZ4KVDxhttps://kns.cnki.net/kcms/detail/detail.aspx?dbcode=CJFD&dbname=CJFDL-AST2020&filename=LCWX202024045&uniplatform=NZ-KPT&v=TMhQVzmDaQvwlDW7-TJxc5lWERjVMJrQf-dvwhq-2y4t1W_sc_7g35o-g3QZ4KVDx. DOI:10.16281/j.cnki.jocml.2020.24.045http://dx.doi.org/10.16281/j.cnki.jocml.2020.24.045.
苏荣耀,陈洁瑶,黄晓婷,等. 对DRG试点医院临床医师及住院患者的调查研究[J]. 现代医院管理,2021,19(3):54-56,66.
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