目的 對比新泰市中醫(yī)醫(yī)院藥品集中帶量采購前后1年的降壓藥相關(guān)用藥數(shù)據(jù)，分析和探討藥品集采政策對基層醫(yī)療機(jī)構(gòu)降壓藥使用的影響，為相關(guān)政策的制定提供一定參考。方法 檢索醫(yī)院HIS系統(tǒng)，并比對藥品集采中選目錄，篩選出目標(biāo)藥物，查詢并確定其限定日劑量（DDD）值，采用Microsoft Excel 2019導(dǎo)出集采前后2個時間段內(nèi)降壓藥相關(guān)用藥信息，進(jìn)行分類統(tǒng)計整理，計算對比用藥頻度（DDDs）、限定日費用（DDC）、藥品價格指數(shù)（DPI）、仿制藥替代率和藥費節(jié)省率等評價指標(biāo)。結(jié)果 納入目標(biāo)藥物12個品種，涉及30個品規(guī)，中選品規(guī)的調(diào)整幅達(dá)66.67%；追蹤到16個品規(guī)的價格降幅為3.6%～82.79%，最大調(diào)整差價達(dá)3.091元/片；11個品種的平均仿制藥替代率高達(dá)91.19%，國產(chǎn)仿制藥的DDDs或DDDs占比明顯提高，8個品種進(jìn)口原研藥的DDDs降幅為13.07%～100%；所有品種共節(jié)省藥費1 726 946.66元，藥費總體節(jié)省率為69.37%，11個品種的DDC平均降幅為75.49%；藥理類別不同的6類降壓藥較基期調(diào)整后的DPI范圍為7.99%～56.57%；ARB、ACEI和BB類降壓藥的DDDs、DDDs占比都出現(xiàn)增長，DIU類和復(fù)合制劑的DDDs、DDDs占比都出現(xiàn)下降，CCB類的DDDs出現(xiàn)增加，而DDDs占比卻出現(xiàn)下降。結(jié)論 藥品集中采購后，基層醫(yī)療機(jī)構(gòu)優(yōu)先充實了中選藥品，對國產(chǎn)仿制藥的認(rèn)可度和使用量大大提高，藥物治療更加貼近基層患者的高血壓病特點；選擇藥物時更加兼顧價格因素和藥理特點，確實顯著地減輕了就診患者的藥費負(fù)擔(dān)，也為基層醫(yī)療機(jī)構(gòu)費用結(jié)構(gòu)的優(yōu)化提供了有力支撐。

Objective By comparing the data of antihypertensive drugs in Xintai Hospital of Traditional Chinese Medicine before and after centralized purchase of drugs in one year, the influence of centralized drug purchase policy on the use of antihypertensive drugs in primary medical institutions was analyzed and discussed, providing some reference for the formulation of related policies. Methods The hospital's HIS system was searched, and compared with the selected catalogue of centralized collection of drugs to screen out target drugs, query and determine their defined daily dose (DDD) value, and use Microsoft Excel 2019 to export the medication information related to antihypertensive drugs in two periods before and after centralized collection for classified statistical collation. DDDs, DDC, DPI, substitution rate of generic drugs and cost saving rate were calculated and compared. Results 12 varieties of target drugs were included, involving 30 drug specifications, and the adjustment amplitude of the selected drug regulations reached 66.67%. The prices of 16 specifications were tracked down to drop 3.6%-82.79%, and the maximum adjustment price difference reached 3.091 yuan for one pill. T'he average substitution rate of domestic generic drugs was as high as 91.19% for 11 varieties, and the proportion of DDDs or DDDs of domestic generic drugs increased significantly. The DDDs of imported original drugs of 8 varieties decreased 13.07%-100%. All varieties saved 1 726 946.66 yuan in total, the overall saving rate was 69.37%, and the average DDC of 11 varieties was down 75.49%. The DPI range of the six antihypertensive drugs with different pharmacological categories was 7.99%-56.57% after adjustment compared with the base period. The proportion of DDDs and DDDs of ARB, ACEI, and BB antihypertensive drugs were increased, while the proportion of DDDs and DDDs of DIU and compound preparations were decreased, the proportion of DDDs of CCB were increased, but the proportion of DDDs decreased. Conclusion After centralized procurement of drugs, basic medical institutions had given priority to enriching the selected drugs, and the recognition and use of domestic generic drugs had been greatly improved, the drug treatment was more close to the characteristics of hypertension in grassroots patients. The selection of drugs had given more consideration to price factors and pharmacological characteristics, which could significantly reduce the burden of drug costs of patients, and provided strong support for optimizing the cost structure of basic medical institutions.

R972

山東省藥品臨床綜合評價項目(2021YZ003)