2021 年第 1 期 第 16 卷

基于“三医联动”的合理用药管理模式在P2Y12受体抑制剂管理中的效果评价

Evaluation of effect of "Tripartite system reform" rational drug use management model on P2Y12 receptor inhibitor management

作者：韩嘉伦1张翼1林阳1石秀锦1林佰弟1李渝2陈颖3孔晴宇4

英文作者：Han Jialun1 Zhang Yi1 Lin Yang1 Shi Xiujin1 Lin Baidi1 Li Yu2 Chen Ying3 Kong Qingyu4

单位：1首都医科大学附属北京安贞医院药事部100029；2首都医科大学附属北京安贞医院医务处100029；3首都医科大学附属北京安贞医院医疗保险管理办公室100029；4首都医科大学附属北京安贞医院心外科十病房100029

英文单位：1Department of Pharmaceutical Affairs Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Medical Service Division Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 3Medical Insurance Management Office Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 4the 10th Ward Department of Cardiac Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：合理用药；三医联动；P2Y12受体抑制剂

英文关键词：Rationaldruguse;Tripartitesystemreform;P2Y12receptorinhibitor

• 摘要：

• 目的 评估基于“三医联动”（医疗、医药、医疗保险）的合理用药管理模式在P2Y12受体抑制剂管理中的效果。方法构建基于“三医联动”的合理用药管理模式，调取首都医科大学附属北京安贞医院2018年4—9月（合理用药管理模式实施前）及2019年4—9月（合理用药管理模式实施后）药品费用数据及使用P2Y12受体抑制剂的住院患者病历进行统计分析。结果 在纳入的3 356例患者中，合理用药管理模式实施后血小板抑制率较实施前有所上升［（53.2±0.7）%比（51.4±0.6）%］（t=-1.896，P=0.058)；实施后与实施前血小板抑制达标率差异无统计学意义［80.8%（988/1 223）比78.7%（1 678/2 133）］（χ2=2.132，P=0.144）。实施后与实施前尿潜血、便潜血、出血事件及中重度出血发生率差异均无统计学意义（均P>0.05）。模式实施后P2Y12受体抑制剂总体药品费用较实施前同期下降700.0万元，降幅27.9%（700.0/2 507.3），用药结构指数为0.95。结论 基于“三医联动”的合理用药管理模式降低了药品费用，保障了患者用药安全，对促进临床合理用药有重要意义。

• Objective To evaluate the effect of the rational drug use management model of "Tripartite system reform"(medical treatment, medicine and medical insurance) on P2Y12 receptor inhibitor management. Methods A rational drug use management model based on "Tripartite system reform" was established. Drug cost data and inpatient medical records of Beijing Anzhen Hospital, Capital Medical University were collected from April to September 2018(before the implementation of rational drug use management model) and April to September 2019(after the implementation of rational drug use management model) for statistical analysis. Results After the implementation of the rational drug use management model, the platelet inhibition rate increased compared with that before the implementation of the rational drug use management model ［(53.2±0.7)% vs (51.4±0.6)%］(t=-1.896, P=0.058). There was no significant difference in the rate of reaching the standard between after implementation and before implementation ［80.8%(988/1 223) vs 78.7%(1 678/2 133)］(χ2=2.132, P=0.144). There were no significant differences in urine occult blood, fecal occult blood, bleeding events and the incidence of moderate to severe bleeding between before and after the implementation(all P>0.05). After the implementation of the model, the overall drug costs of P2Y12 receptor inhibitor decreased by 7 million yuan and 27.9%(700.0/2 507.3) decrease compared with the same period before the implementation, and the drug structure index was 0.95. Conclusions  The rational drug use management model of our hospital based on "Tripartite system reform" reduces drug costs and ensures drug safety for patients. It is of great significance to promote rational drug use in clinical practice by promoting multi-department cooperation and exploring the linkage relationship among medical treatment, medicine and medical insurance.