某医院基于医保控费系统重点监控药品管理模式实践  

Management mode practice of key monitoring drugs based on insurance cost control system in our hospital

作　　者：李聪 李志浩 陈富超 朱雪松 刘慧敏 李华 LI Cong;LI Zhihao;CHEN Fuchao;ZHU Xuesong;LIU Huiming;LI Hua(Department of Pharmacy,Dongfeng Hospital Affiliated to Hubei medical College,Shiyan,Hubei 442008,China;General quality office,Dongfeng Hospital Affiliated to Hubei medical College,Shiyan,Hubei 442008,China)

机构地区：[1]湖北医药学院附属东风医院药学部,湖北十堰442008 [2]湖北医药学院附属东风医院全面质量办公室,湖北十堰442008

出　　处：《安徽医药》2020年第1期189-193,共5页Anhui Medical and Pharmaceutical Journal

基　　金：十堰市科技局软科学项目（2019SS21,2019SS59)

摘　　要：目的建立有效的重点监控药品管控模式,旨在合理用药、降低医疗费用,积极推进医保控费工作。方法国药东风总医院引进医保控费系统,药学部、医保办、全面质量管理办公室、医务部等多部门协作,成立医保控费管理小组,制订重点监控药品目录及限制使用适应证,落实医嘱点评制度、加强合理用药能力、严格监督与考核,初步建立了基于医保控费系统的重点监控药品管控模式。结果住院药占比由管控前的37.18%下降至21.83%,住院人均药费从管控前的4159元下降至管控后2169元,重点监控药品使用总金额管控后下降56%,同时违规情况明显减少,节约费用成本,促进合理用药。结论我院基于医保控费系统的重点监控药品管控模式初步形成,药师价值逐渐凸显,临床合理用药有待进一步加强,最终形成“以病人为中心”的多部门协作的药事管理模式。Objective To establish effective control mode of key monitoring medicine,aiming at improving rational use of drugs,lowering medical expenses,and actively advancing the process of health insurance cost control.Methods Our hospital introduced the health insurance cost control system and set up health care cost control group composed of department of pharmacy,medical in⁃surance office,quality management office and medical department,formulating the directory of intensive monitoring drugs and limit⁃ed indication,simultaneously reviewing medication strengthening the capacity to rational drug use,strictly enforcing control.The key monitoring drug control model based on the medical insurance control system was preliminarily established.Results The propor⁃tion of in⁃patient drugs decreased from 37.18%before control to 21.83%,and the per capita drug cost decreased from 4,159 yuan before control to 2,169 yuan after control.The total amount of key drugs used decreased by 56%after control.At the same time,ill⁃fitted situation was significantly reduced.Cost was saved in hospital and rational drug use was promoted.Conclusion The control mode of key monitoring drug based on insurance cost control system in our hospital was established preliminary.The value of phar⁃macists was gradually became prominent.Rational medication in clinical should be further strengthened.Finally,the multi⁃depart⁃ment cooperative pharmaceutical management model with"patient⁃oriented"is formed.

关 键 词：管理医疗规划 药费支出 保险 住院 目录 药物 药学服务 医保控费 重点监控药品 

分 类 号：R95[医药卫生—药学]