2009-2013年天津市某区基层医疗机构心血管系统用药的药物利用研究

发布时间：2018-02-26 16:12

本文关键词： 基层医疗机构心血管系统用药药物利用研究金额限定日剂量用药频度　出处：《天津医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：了解“新医改”和国家基本药物制度实施后,基层医疗机构心血管药物的利用状况,分析其用药合理性及药物利用趋势,为政府部门、药监管理部门、医疗保险机构及制药企业等的决策提供依据。方法：采用天津市某区全部9家基层医疗机构2009年-2013年的药品采购记录作为本研究的对象,运用药物利用研究中的金额分析、限定日剂量和用药频度分析的方法进行数据处理分析评价。具体运用的工具和计算的指标包括：(1)药物ATC分类；(2)确定购药金额并排序；(3)确定限定日剂量(DDD)；(4)计算用药频度DDDs并排序,DDDs=药品消耗总量/该药的DDD值。对基层医疗机构心血管系统药物的使用情况进行分析。结果：该区全部基层医疗机构5年采购药品金额共14131.46万元。其中,抗高血压药占比例最大,列第一位,为7248.89万元；抗心绞痛药和调脂及抗动脉粥样硬化药分列第二、三位,分别为4280.24万元和1929.63万元；抗心律失常药为665.80万元,居第四位,其他类别药物所占金额较小。从DDDs看,5年总计为71,912,860,与金额排序一致,抗高血压药、抗心绞痛药、调脂及抗动脉粥样硬化药和抗心律失常药分列前四位,DDDs分别为38,562,187、26,999,267、2,941,076和2,736,020,其他类别的药物数量较少。具体药物方面,单硝酸异山梨酯、氨氯地平、硝苯地平等药物各年的DDDs和金额均较高。结论： (1)药物类别：天津市某区基层医疗机构2009-2013年使用的心血管系统药物中,抗高血压药占使用金额的51%和DDDs的53%,比例最高；其次是抗心绞痛药,占使用金额的30%和DDDs的37%；再次是调脂及抗动脉粥样硬化药,占使用金额的14%和DDDs的4%；其他药物的使用量较少。 (2)药物品种：天津市某区基层医疗机构2009-2013年使用的心血管系统药物中,使用金额位居前三位的分布是氨氯地平、单硝酸异山梨酯、硝苯地平。另外,缬沙坦、替米沙坦、阿托伐他汀、贝那普利的金额也较高；DDDs排序,单硝酸异山梨酯、氨氯地平、替米沙坦、硝苯地平、阿司匹林分列前5位。 (3)国家基本药物所占比例：在本研究涉及的所有药物中,属于国家基本药物的比例仅为42.4%；其中总计金额排序或DDDs排序居前10位的13个药物属于国家基本药物的仅有4个,比例仅为30.8%。这种现象需要有关部门和医疗机构进行干预。
[Abstract]:Objective: to understand the utilization of cardiovascular drugs in primary medical institutions after the implementation of "New Medical Reform" and the national essential drugs system, and to analyze the rationality of drug use and the trend of drug use. Medical insurance institutions and pharmaceutical enterprises to provide the basis for decision-making. Methods: the drug purchase records from 2009 to 2013 in all 9 primary medical institutions in a district of Tianjin were used as the object of this study, and the amount of money in the drug utilization study was analyzed. Data processing and evaluation of methods for analysis of defined daily dose and drug use frequency. Specific tools and calculated indicators include: 1) ATC classification / 2) determination of purchase sum and 3) determination of defined daily dose (DDDX) 4) calculation of drug use. The frequency of DDDs and the order of DDDs = total drug consumption / DDD value of the drug. The use of cardiovascular drugs in primary medical institutions was analyzed. Results: the total amount of drugs purchased in five years by all primary medical institutions in this area was one hundred and forty-one million three hundred and fourteen thousand and six hundred yuan. Among them, the proportion of antihypertensive drugs was the largest, ranking first (seventy-two million four hundred and eighty-eight thousand and nine hundred yuan), and that of anti-angina pectoris drugs, lipid-regulating drugs and anti-atherosclerosis drugs were second and third, respectively. The value of antiarrhythmic drugs was six million six hundred and fifty-eight thousand yuan, which was 4th, and the amount of other kinds of drugs was relatively small. From the point of view of DDDs, the total value of antihypertensive drugs, anti-angina pectoris drugs, anti-atherosclerotic drugs and antiarrhythmic drugs in the first four positions in 5 years were 38,562n 1877269999C267N 941076 and 2736C020 respectively, and the quantity of other drugs was less than that of other drugs, and the total amount of antihypertensive drugs, anti-angina pectoris drugs, anti-atherosclerotic drugs and antiarrhythmic drugs were 38,562n, 18726999, 267U / 267N 994 1076 and 2736C 020 respectively. The DDDs and sum of money of isosorbide mononitrate, amlodipine and nifedipine were higher in each year. Conclusion:. (1) Drug categories: antihypertensive drugs accounted for 51% of the total amount used and 53% of DDDs's, followed by anti-angina drugs, among the cardiovascular system drugs used by a primary medical institution in a district of Tianjin from 2009 to 2013. 30% of the total amount used and 37% of DDDs; third, lipid and antiatherosclerosis drugs, 14%% of the total amount used and 4% of DDDs; other drugs are less used. (2) Drug varieties: among the cardiovascular system drugs used in a primary medical institution in a district of Tianjin from 2009 to 2013, the top three used drugs were amlodipine, isosorbide mononitrate, nifedipine. In addition, valsartan, telmisartan, Atto vastatin and benazepril also ranked higher in DDDs, isosorbide mononitrate, amlodipine, telmisartan, nifedipine and aspirin were the top five. (III) proportion of national essential drugs: of all the drugs covered in this study, the proportion of those belonging to national essential drugs was only 42.4; of these, only 4 of the 13 drugs in the top 10 in the total sum of money or DDDs ranked among the national essential drugs, The ratio is only 30.8. This phenomenon requires the intervention of relevant departments and medical institutions.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R95

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