全程药学干预模式应用于某院医保限制性药品的管理实践与成效评价  

Whole-course pharmaceutical intervention model was applied to the management practice and effectiveness evaluation of the restricted drugs in a hospital

作　　者：刘猛 方可 何曼云 严家菊 刘梦 徐茂红[2] LIU Meng;FANG Ke;HE Manyun;YAN Jiaju;LIU Meng;XU Maohong(Department of Clinical Pharmacy,Affiliated Hospital of West Anhui Health Vocational College,Lu'an 237008,China;West Anhui Health Vocational College,Lu'an 237005,China)

机构地区：[1]皖西卫生职业学院附属医院临床药学部,六安237008 [2]皖西卫生职业学院,六安237005

出　　处：《中国临床药学杂志》2024年第4期255-259,共5页Chinese Journal of Clinical Pharmacy

基　　金：安徽省高校科学研究项目(编号KJ2021B006)。

摘　　要：目的探讨全程药学干预模式用于医保限制性药品管控的效果。方法构建以事前实时拦截、事中互动审核以及事后针对性处方点评为一体化全程药学干预模式,对全程药学干预模式实施前(2021年11月-2022年4月)和全程药学干预模式实施后(2022年5月-2022年10月)医保局检查涉及违规药品金额、处方点评情况及医保拒付金额进行对比分析。结果在全程药学干预模式实施后,我院涉及违规药品金额、处方点评不合理率和医保拒付金额均低于干预模式实施前(P<0.05)。结论全程药学干预模式有利于提升医保限制性药品的合理使用,明显改善医保拒付情况,进一步规范临床用药行为。AIM To explore the effectiveness of a full process pharmaceutical intervention model for controlling restricted drugs in medical insurance.METHODS An integrated full process pharmaceutical intervention model that included real-time interception in advance,interactive review during the process,and targeted prescription review after the implementation was build.The amount of illegal drugs,prescription reviews,and medical insurance refusal amount involved in the medical insurance bureau's inspection before the implementation of the full process pharmaceutical intervention model(November 2021 to April 2022)and after the implementation of the full process pharmaceutical intervention model(May 2022 to October 2022)were compared and analyzed.RESULTS After the implementation of the full pharmaceutical intervention model,our hospital found that the amount of illegal drugs involved,the unreasonable rate of prescription reviews,and the amount of medical insurance refusal were lower than before the implementation of the intervention model(P<0.05).CONCLUSION The full process pharmaceutical intervention model is beneficial for improving the rational use of restricted drugs in medical insurance,significantly improving the situation of medical insurance refusal,and further standardizing clinical medication behavior.

关 键 词：全程药学干预 医保限制性药品 合理用药 医保拒付 效果评价 

分 类 号：R95[医药卫生—药学]