某院门诊抗高血压药物治疗应用现况

发布时间：2018-04-21 00:41

本文选题：高血压 + 药物治疗　；参考：《首都医科大学》2017年硕士论文

【摘要】：目的明确首都医科大学附属北京安贞医院高血压患者门诊抗高血压药物的应用现况以及高血压患者门诊就诊趋向现况,为高血压患者药物治疗以及门诊随访提供科学依据。方法1.研究对象来源于我院门诊信息系统,研究对象选取2015.5-2015.12在首都医科大学附属北京安贞医院门诊就诊的北京市医疗保险的高血压患者。高血压患者的确定依据以门诊就诊信息中的主要诊断以及次要诊断、医嘱信息内包含抗高血压药物为准。主要诊断名称参照诊断ICD编码进行,抗高血压药物医嘱包括2015.5-2015.12期间安贞医院药房所收录的所有抗高血压药物。2.采集2015.5-2015.12期间到首都医科大学附属北京安贞医院门诊就诊的北京医保的患者就诊信息,筛选出主要诊断或次要诊断中有“高血压”,或医嘱项目中有抗高血压药物的患者,采集其门诊就诊信息,并清洗去除无效处方。共选入269389张处方,共涉及人头数为34453例。3.通过access软件对我院高血压患者的就诊科室、就诊次数、治疗方案数进行汇总及分类,并筛选出到我院门诊就诊次数1,且治疗方案总数为1(或治疗方案不发生改变)的就诊人头数为14768例,涉及到的处方数为187047张。利用excel软件的透视表功能将各个科室的高血压患者的门诊处方进行汇总,后续对各个科室抗高血压药物应用情况的分析。4.在合作单位(北京市医保中心)的信息系统中,调取选取的14768例研究对象在2015.5-2015.12期间在北京市所有医疗机构的门诊就诊信息,对研究对象的就诊医疗机构的选择进行现况描述,并加以分析。5.研究高血压患者门诊药物应用情况以及各个科室的抗高血压药物治疗方案的不同特点时,按照研究对象在安贞医院门诊就诊时选取的就诊科室行为进行自然分组,主要分为四个部分:全科医疗科、高血压科、心内科、其他科。对研究对象门诊就诊医疗机构等级特征进行分析时,将所就诊的医疗机构分为非社区卫生服务中心、社区卫生服务中心。6.本研究对象对医保患者鉴定以医保卡号为准,数据的初步提取与导入均有计算机进行完成,没有人工干预。结果1.通过高血压药物应用情况的分析得出我院门诊高血压患者单一用药比例为49.41%,联合用药的比例为50.59%。2.四个科室的联合用药方案有差异,且有统计学意义(p0.01)。全科、心内科、高血压科、其他科的联合用药方案的使用率分别为76.77%、74.31%、91.05%、76.05%,高血压科门诊抗高血压联合用药的使用率较其他三个科室高(p0.01),差异有统计学意义。3.我院门诊总的固定剂量复方制剂的使用率为41.06%,以新型复方制剂为主。全科、心内科、高血压科、其他科的复方制剂方案的使用在联合用药中的占比分别为4.74%、9.65%、17.64%、5.02%。4.我院门诊抗高血压门诊二联用药中,指南推荐方案使用比例为77.57%。各个科室的二联用药指南推荐方案使用有差异(p0.01),全科、心内科、高血压科、其他科使用比例分别为80.47%、76.72%、76.78%、75.58%。全科医疗科在二联抗高血压药物治疗方案中较其他三个分组更符合指南推荐.(p0.01),差异有统计学意义。5.女性、年龄大于或等于60岁、无合并症的高血压患者更倾向选择社区卫生服务中心进行就诊(p0.05)。结论本调查研究提示我院门诊高血压患者药物治疗方案以联合用药为主。固定剂量复方制剂的使用以新型复方制剂为主。各个科室的高血压治疗方案有差异,且具有统计学差异(p0.01),全科门诊高血压患者二联用药治疗方案的选择上较其他三个分组更符合指南推荐(p0.01)。女性、年龄大于或等于60岁、无合并症的高血压患者更倾向选择社区卫生服务中心进行就诊(p0.05)。
[Abstract]:Objective to clarify the current situation of antihypertensive drugs in the outpatient clinic of hypertension patients in An Zhen Hospital affiliated to Capital Medical University, and to provide the scientific basis for the treatment of hypertension patients and outpatient follow-up. Methods 1. research objects were derived from the outpatient information system in our hospital, and the research objects were selected 2015.5. -2015.12 medical insurance in Beijing, affiliated to An Zhen Hospital affiliated to Capital Medical University, Capital Medical University, medical insurance in Beijing city. The determination of hypertension patients is based on the main diagnosis and secondary diagnosis in the outpatient information. The medical advice information contains antihypertensive drugs. The main diagnosis name reference diagnosis ICD code, anti high blood The medicine doctor's order includes all the antihypertensive drugs included in the pharmacy of An Zhen Hospital during 2015.5-2015.12 during the period of 2015.5-2015.12 to collect the information about the medical insurance of the Beijing medical insurance in the clinic of Beijing, Beijing affiliated to the Capital Medical University, which is affiliated to the Affiliated Hospital of Capital Medical University. The patients with antihypertensive drugs collected the information of the outpatient service and cleaned out the invalid prescriptions. 269389 prescriptions were selected. The number of people's head number was 34453 cases of.3. through access software. The number of visits and the number of treatment schemes were collected and classified, and the number of visits to our hospital was 1, and the treatment was treated. The total number of patients with a total of 1 (or no changes in the treatment plan) was 14768, and the number of prescriptions involved was 187047. The outpatient prescriptions of the hypertension patients in various departments were summarized with the fluoroscopy function of the Excel software, and the subsequent analysis of the application of antihypertensive drugs in various departments (.4. in Beijing city medicine) In the information system of the insurance center, 14768 selected subjects were selected in the outpatient clinic of all medical institutions in Beijing during the period of 2015.5-2015.12. The status of the selection of medical institutions for the study was described, and the application of.5. in the study of the door diagnosis of hypertensive patients and the anti hypertension in various departments were analyzed. The different characteristics of the drug treatment plan are divided into four parts: the general medical department, the hypertension department, the Department of Cardiology, the other departments, and the medical institutions of the medical treatment department. It was divided into non community health service center. The research object of community health service center.6. was to identify medical insurance patients with medical insurance card number. The preliminary extraction and introduction of data were completed by computer, and no manual intervention was done. Results 1. the single drug use ratio of hypertensive patients in our hospital was obtained through the analysis of the application of hypertension drugs. For 49.41%, the combined use of the combination of 50.59%.2. and four departments was different and had statistical significance (P0.01). The use of combination regimen in the general department, Department of Cardiology, hypertension, and other subjects were 76.77%, 74.31%, 91.05%, 76.05%, and the use of antihypertensive in the outpatient department of the hypertension Department was more than the other three departments. High (P0.01), the difference was statistically significant.3., the use rate of the total fixed dose compound preparation in our hospital was 41.06%, with the new compound preparation mainly. The use of compound preparation scheme in the general department, Department of Cardiology, hypertension department and other subjects was 4.74%, 9.65%, 17.64%, and two of the outpatient antihypertensive outpatient clinic in our hospital, respectively, two. In the drug use, the guideline recommends the use of the two couplet guidelines recommended in the various departments of 77.57%. for the use of differential (P0.01), general department, Department of Cardiology, hypertension, and other subjects, with a ratio of 80.47%, 76.72%, and 76.78%. The 75.58%. Department of general medical treatment is more consistent with the other three groups than in the other three groups. Recommendation. (P0.01), the difference is statistically significant.5. women, age greater than or equal to 60 years old, without complication of hypertension patients more inclined to choose community health service center for medical treatment (P0.05). Conclusion this survey suggests that the drug treatment scheme of hypertension patients in our hospital is mainly combined with drug treatment. The use of fixed dose compound preparation is new. There were differences in the treatment scheme of hypertension in each department, and there was a statistical difference (P0.01). The choice of two combination therapy for hypertension patients in general clinic was more consistent with the guide recommendation than the other three groups (P0.01). Women, older than or equal to 60 years old, the hypertension patients without complication were more inclined to choose the community. Health Service Center (P0.05).

【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1

【参考文献】