甘肃省公立医院门诊糖尿病患者处方费用及影响因素  

Prescription cost analysis and influencing factors for diabetes mellitus outpatients of public hospitals in Gansu Province

作　　者：何静 刘杰 吴君桐 陈永聪[1] 马永恒 赵德芳 程龙 HE Jing;LIU Jie;WU Juntong;CHEN Yongcong;MA Yongheng;ZHAO Defang;CHENG Long(School of Public Health,Lanzhou University,Lanzhou,Gansu 730000,China)

机构地区：[1]兰州大学公共卫生学院,甘肃兰州730000

出　　处：《现代疾病预防控制》2024年第7期481-485,539,共6页MODERN DISEASE CONTROL AND PREVENTION

基　　金：国家第六批药物集中带量采购政策控费效果研究(横20220401)。

摘　　要：目的分析2019-2022年甘肃省3家公立医院门诊糖尿病患者处方费用变化情况及影响因素,为相关部门有效控制处方费用提供参考依据。方法收集2019-2022年甘肃省3家公立医院门诊糖尿病患者处方数据,采用SPSS 25.0和R 4.2.3软件进行非参数秩和检验、多重线性回归分析和随机森林回归树模型分析门诊糖尿病患者处方费用及其影响因素。结果共纳入糖尿病患者门诊处方410142张,门诊糖尿病患者单张处方金额主要集中在100~<500元,平均处方金额为513.71元,由2019年的484.52元上升至2022年的539.17元;单张处方金额<100元的处方数构成比由2019年的21.91%升至2022年的39.05%,≥500元的处方数构成比由2019年的23.35%降至2022年的20.10%。单因素分析结果显示,医疗机构级别、年份、性别、年龄、诊断类型、有无并发症、处方用药数、有无注射制剂等差异均有统计学意义(P均<0.05)。多重线性回归分析结果显示,医疗机构级别(以省级为参照,市级和县级β值分别为-2.958、-2.953)、年份(以2019年为参照,2020年、2021年、2022年β值分别为-0.122、-0.216、-0.239)、性别(β=-0.048)、年龄(以0~<45岁年龄组为参照,45~<65岁、≥65岁年龄组β值分别为0.072、0.020)、诊断类型(以1型糖尿病为参照,2型及其他类型糖尿病β值分别为0.204、0.016)、有无并发症(β=0.096)、处方用药数(β=0.457)、有无注射制剂(β=-0.817)是门诊糖尿病患者处方费用的影响因素(P均<0.05)。随机森林回归树模型分析结果显示,重要程度排名前4位的影响因素依次为处方用药数、是否有注射、医疗机构级别和年份。结论甘肃省门诊糖尿病患者处方金额较高,需进一步优化治疗方案。积极推进分级诊疗就医秩序,落实糖尿病分级诊疗举措,合理开具处方用药数,优先使用集中带量采购中选药品,减轻患者经济负担。Objective To analyze the prescription cost changes and their influencing factors for outpatients with diabetes mellitus in public hospitals in Gansu Province from 2019 to 2022,providing a reference for effective prescription cost control costs.Methods The prescription data for diabetes outpatients from three public hospitals in Gansu Province were collected from2019 to 2022.Nonparametric rank sum test,multiple linear regression,and random forest regression tree models were utilized to analyze the prescription cost and its influencing factors the software used was SPSS 25.0 and R 3.6.0.Results A total of 410142prescriptions of diabetes outpatients were collected.The single prescription costs for diabetes outpatients were predominately in the 100-<500 yuan range,with an average cost of 513.71 yuan,increasing from 484.52 yuan in 2019 to 539.17 yuan in 2022.The proportion of prescriptions costing less than 100 yuan rose from 21.91%in 2019 to 39.05%in 2022,while the proportion of prescriptions costing 500 yuan or more decreased from 23.35%in 2019 to 20.10%in 2022.Univariate analysis showed significant differences in by medical institution level,year,gendar,age,diagnosis type,presence of complications,number of prescribed drugs,and presence of injections(all P<0.05).Multiple linear regression analysis identified factors including medical institution level(provincial level as reference,municipalβ=-2.958,and county levelβ=-2.953),year(with 2019 as reference,2020β=-0.122,2021β=-0.216,2022β=-0.239),gender(β=-0.048),age(0-<45 years as the reference,45-<65 yearsβ=0.072,≥65yearsβ=0.020),diagnostic type(type I diabetes as a reference,type II diabetesβ=0.204,other diagnostic typesβ=0.016),presence of complications(β=0.096),number of medications(β=0.457),and presence of injections(β=-0.817)as significant influencing factors on prescription costs(P<0.05).The Random Forest Regression Tree model highlighted the number of medications,presence of injections,medical institution level and year as the top four influencing

关 键 词：糖尿病 处方费用 影响因素 多重线性回归 随机森林 

分 类 号：R587.1[医药卫生—内分泌]