DRGs支付背景下泌尿外科药师用药管控模式构建与效果分析 点击下载
| 论文标题： | DRGs支付背景下泌尿外科药师用药管控模式构建与效果分析 |
| 英文标题： | |
| 中文摘要： | 目的 探讨按疾病诊断相关分组付费（DRGs）支付背景下，外科药师参与泌尿外科合理用药管控的工作模式和实践成效。方法在DRGs背景下，外科药师针对泌尿外科病例数较多的重点DRGs病组，从3个阶段构建合理用药管控工作模式：事前阶段，包括制订围术期用药指引、合理用药管理系统干预；事中阶段，包括结合DRGs病组开展专项点评、开展药学查房和医嘱审核、开展合理用药培训和科普；事后阶段，包括建立针对临床科室与外科药师的绩效考核制度、收集外科医师未采纳外科药师建议的原因。选取佛山市第二人民医院进入DRGs病组并在泌尿外科出院的患者为研究对象，对比外科药师参与用药管控前（2022年6－12月）、管控1年（2023年6－12月）和管控2年（2024年6－12月）时科室DRGs指标[包括DRGs病组数、总权重、病例组合指数（CMI）、平均住院日、时间消耗指数、次均费用、费用消耗指数、次均药品费用、药品消耗指数、低中风险死亡率]的变化情况，并统计分析病例数排名前5位的DRGs病组的用药合理率（抗菌药物、蛇毒血凝酶类药物和质子泵抑制剂）和药事绩效考核指标[次均药品费用、用药频度（DDDs，不含中药）、抗菌药物使用强度（AUD）]的改进情况，并进一步分析泌尿外科医师未采纳外科药师用药干预建议的原因，计算未采纳率。结果随着外科药师参与泌尿外科合理用药管控，泌尿外科的DRGs病组数、总权重和CMI均升高，而平均住院日、次均费用和次均药品费用等均逐年下降，管控前后均未出现低中风险死亡病例。病例数排名前5的重点DRGs病组LE15、LE13、MC15、MC13和LK19的次均药品费用、DDDs（不含中药）和AUD均较管控前显著下降（P＜0.05）；上述5个重点病组的用药合理率（抗菌药物、蛇毒血凝酶类药物和质子泵抑制剂）较管控前显著升高（P＜0.05）。药师管控2年时，泌尿外科医师对抗菌药物、蛇毒血凝酶类药物和质子泵抑制剂相关用药干预的未采纳率均较管控1年时显著降低（P＜0.05）；蛇毒血凝酶类药物相关干预未被采纳的主要原因为外科医师认为“增加日剂量能缩短止血疗程”，抗菌药物相关干预未被采纳的主要原因为“术后炎症指标升高需延长疗程”。结论该院已成功构建外科药师参与泌尿外科合理用药管控模式；该模式改善了科室DRGs指标与药事绩效考核指标，提升了用药合理率。 |
| 英文摘要： | OBJECTIVE To explore the working model and practical effectiveness of surgical pharmacists participating in the rational medication management of urology department under the background of diagnosis related groups （DRGs） payment system.METHODS In the context of DRGs， surgical pharmacists have constructed a rational drug use control model for key DRGs disease groups with a high number of urological cases in three stages： the pre stage， which includes developing perioperative drug use guidelines and implementing a rational drug use management system intervention； the mid-term stage， which includes conducting specialized evaluations in conjunction with DRGs disease groups， conducting pharmaceutical ward rounds and medical order reviews， conducting rational drug use training and science popularization； the post event stage， which includes establishing a performance evaluation system for clinical departments and surgical pharmacists， and collecting reasons why surgical physicians did not adopt surgical pharmacist recommendations. Patients who entered DRGs groups and were discharged from the urology department of Foshan Second People’s Hospital were selected as the research subjects. The changes in departmental DRGs indicators [including number of DRGs groups， total weight， case mix index （CMI）， average length of stay， time consumption index， average cost per case， cost consumption index， average drug cost per case， drug consumption index， and mortality in low- and medium-risk] were compared before pharmacist intervention （June to December 2022）， after 1 year of intervention （June to December 2023）， and after 2 years of intervention （June to December 2024）. The improvement in medication rational rates （for antibiotics， hemocoagulase， and proton pump inhibitors） and pharmacy performance assessment indicators [average drug cost per case， defined daily doses （DDDs， excluding traditional Chinese medicine）， and antibiotic use density （AUD）] in the top 5 DRGs groups by case volume were statistically analyzed. The reasons for non-adoption of medication intervention recommendations by urologists were further analyzed.RESULTS With the participation of surgical pharmacists in the rational medication management of urology department， the number of DRGs groups， total weight， and CMI in the urology department increased year by year， while the average length of stay， average cost per case， and average drug cost per case decreased year by year， there were no low- to medium-risk deaths before and after the medication management. The average drug cost per case， DDDs， and AUD in the top 5 key DRGs groups （LE15， LE13， MC15， MC13， and LK19） were significantly decreased compared with those before intervention （ P ＜0.05）. The medication rational rates （for antibiotics， hemocoagulase， and proton pump inhibitors） in the above 5 key DRGs groups were significantly increased compared with those before intervention （ P ＜0.05）. After 2 years of pharmacist intervention， the non-adoption rates of urologists for medication interventions related to antibiotics， hemocoagulase， and proton pump inhibitors were significantly lower than those after 1 year of intervention （ P ＜0.05）； the main reason for not adopting interventions related to hemocoagulase was that surgeons believed “increasing the daily dose could shorten the hemostasis course”， the main reason for not adopting interventions related to antibiotics was “postoperative elevation of inflammatory indicators necessitates prolonged treatment”.CONCLUSIONS The hospital has successfully established a model of surgical pharmacists participating in the rational medication management of urology department. This model has improved departmental DRGs indicators and pharmacy performance assessment indicators， and enhanced the medication rational rate. |
| 期刊： | 2026年第37卷第16期 |
| 作者： | 丘经纬；庞慧诗；郑秋勇；姚晖 |
| 英文作者： | QIU Jingwei，PANG Huishi，ZHENG Qiuyong，YAO Hui |
| 关键字： | 疾病诊断相关分组；泌尿外科；外科药师；用药管控；合理用药 |
| KEYWORDS： | diagnosis related groups;urology department;surgical pharmacist;medication management;Rational drug use |
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