目的 探讨自主研发合理用药管理系统结合药事行政管理干预对提升基层医院医保限制用药管理的成效,为广大基层医院提供参考.方法 2022年9月中山市南朗医院上线基于医院信息系统(HIS)系统架构,自主研发的具有处方抽取、线上点评、医保限制用药处方信息提醒及拦截功能的合理用药管理系统;同期通过临床宣教、目录维护、处方专项点评等多维度药事管理措施干预.研究干预后2022年9-12月,较2021年9-12月医保限制支付范围药品使用的支付符合率、超限支付的处罚金额、药品占比、住院次均药费.结果 医保限制用药使用支付符合率从63.52％提高到80.95％;医保专项检查现场抽取处方中,医保限制用药扣罚金额从8.0300万元下降到2.5799万元,同比下降67.87％;医保限制用药使用金额在全院药品中所占比例由干预前的6％下降到4％;医保限制用药住院次均药费由17 316.59元下降到13 733.18元;全院药品比例由干预前的23.22％下降到18.78％.结论 基于自主研发合理用药管理系统及多维度药事管理干预,能提高基层医院医保限制用药管理效能,可供广大基层医院参考.
Objective To investigate the efficiency of independent research and development of rational medication management system combined with pharmaceutical administration intervention on improving the management of medical insurance restricted medication in primary hospitals,so as to provide reference for the majority of primary hospitals.Methods In September 2022,an architecture based on hospital information system(HIS)was launched by Zhongshan Nanlang Hospital,and a rational medication management system with prescription extraction,online review,medical insurance restricted medication prescription information reminder and interception functions was independently developed.At the same time,multi-dimensional pharmaceutical management measures such as clinical education,catalogue maintenance and prescription special comment were implemented to intervene.After intervention,the payment coincidence rate,the penalty amount of over-limit payment,the proportion of drugs,and the average drug cost of hospitalization from September to December,2022 were compared with September to December,2021.Results The coincidence rate of medical insurance restricted medication payment was increased from 63.52％to 80.95％.In the prescriptions drawn from the medical insurance special inspection site,the amount of medical insurance restricted medication deduction amount decreased from 80 300 yuan to 25 799 yuan,a year-on-year decrease of 67.87％.The proportion of medical insurance restricted medication in the whole hospital decreased from 6％before intervention to 4％.The average drug cost per hospitalization for medical insurance restricted medication decreased from 17 316.59 yuan to 13 733.18 yuan.The proportion of drugs in the hospital decreased from 23.22％before intervention to 18.78％.Conclusion Based on independent research and development of rational medication management system and multi-dimensional pharmaceutical management intervention,it can improve the management efficiency of medical insurance restricted medication in primary hospitals,which can be used as a reference for the majority of primary hospitals.
陈利芳;叶青松;吴宇枫;阮倩文;梁凤珊
广东省中山市南朗医院(中山市人民医院南朗分院)药剂科,广东中山 528451
药学
自主研发;药事管理干预;医保限制用药;管理效能
Independent research and development;Pharmaceutical management intervention;Medical insurance restricted medication;Management efficiency
《中国医药科学》 2024 (014)
108-111,134 / 5
2022年度中山市医学科研项目(2022J200).
10.20116/j.issn2095-0616.2024.14.26
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