本文選題：高血壓 + 藥物治療�。� 參考：《首都醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的明確首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院高血壓患者門診抗高血壓藥物的應(yīng)用現(xiàn)況以及高血壓患者門診就診趨向現(xiàn)況,為高血壓患者藥物治療以及門診隨訪提供科學(xué)依據(jù)。方法1.研究對(duì)象來(lái)源于我院門診信息系統(tǒng),研究對(duì)象選取2015.5-2015.12在首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院門診就診的北京市醫(yī)療保險(xiǎn)的高血壓患者。高血壓患者的確定依據(jù)以門診就診信息中的主要診斷以及次要診斷、醫(yī)囑信息內(nèi)包含抗高血壓藥物為準(zhǔn)。主要診斷名稱參照診斷ICD編碼進(jìn)行,抗高血壓藥物醫(yī)囑包括2015.5-2015.12期間安貞醫(yī)院藥房所收錄的所有抗高血壓藥物。2.采集2015.5-2015.12期間到首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院門診就診的北京醫(yī)保的患者就診信息,篩選出主要診斷或次要診斷中有“高血壓”,或醫(yī)囑項(xiàng)目中有抗高血壓藥物的患者,采集其門診就診信息,并清洗去除無(wú)效處方。共選入269389張?zhí)幏?共涉及人頭數(shù)為34453例。3.通過(guò)access軟件對(duì)我院高血壓患者的就診科室、就診次數(shù)、治療方案數(shù)進(jìn)行匯總及分類,并篩選出到我院門診就診次數(shù)1,且治療方案總數(shù)為1(或治療方案不發(fā)生改變)的就診人頭數(shù)為14768例,涉及到的處方數(shù)為187047張。利用excel軟件的透視表功能將各個(gè)科室的高血壓患者的門診處方進(jìn)行匯總,后續(xù)對(duì)各個(gè)科室抗高血壓藥物應(yīng)用情況的分析。4.在合作單位(北京市醫(yī)保中心)的信息系統(tǒng)中,調(diào)取選取的14768例研究對(duì)象在2015.5-2015.12期間在北京市所有醫(yī)療機(jī)構(gòu)的門診就診信息,對(duì)研究對(duì)象的就診醫(yī)療機(jī)構(gòu)的選擇進(jìn)行現(xiàn)況描述,并加以分析。5.研究高血壓患者門診藥物應(yīng)用情況以及各個(gè)科室的抗高血壓藥物治療方案的不同特點(diǎn)時(shí),按照研究對(duì)象在安貞醫(yī)院門診就診時(shí)選取的就診科室行為進(jìn)行自然分組,主要分為四個(gè)部分:全科醫(yī)療科、高血壓科、心內(nèi)科、其他科。對(duì)研究對(duì)象門診就診醫(yī)療機(jī)構(gòu)等級(jí)特征進(jìn)行分析時(shí),將所就診的醫(yī)療機(jī)構(gòu)分為非社區(qū)衛(wèi)生服務(wù)中心、社區(qū)衛(wèi)生服務(wù)中心。6.本研究對(duì)象對(duì)醫(yī)保患者鑒定以醫(yī)�？ㄌ�(hào)為準(zhǔn),數(shù)據(jù)的初步提取與導(dǎo)入均有計(jì)算機(jī)進(jìn)行完成,沒(méi)有人工干預(yù)。結(jié)果1.通過(guò)高血壓藥物應(yīng)用情況的分析得出我院門診高血壓患者單一用藥比例為49.41%,聯(lián)合用藥的比例為50.59%。2.四個(gè)科室的聯(lián)合用藥方案有差異,且有統(tǒng)計(jì)學(xué)意義(p0.01)。全科、心內(nèi)科、高血壓科、其他科的聯(lián)合用藥方案的使用率分別為76.77%、74.31%、91.05%、76.05%,高血壓科門診抗高血壓聯(lián)合用藥的使用率較其他三個(gè)科室高(p0.01),差異有統(tǒng)計(jì)學(xué)意義。3.我院門診總的固定劑量復(fù)方制劑的使用率為41.06%,以新型復(fù)方制劑為主。全科、心內(nèi)科、高血壓科、其他科的復(fù)方制劑方案的使用在聯(lián)合用藥中的占比分別為4.74%、9.65%、17.64%、5.02%。4.我院門診抗高血壓門診二聯(lián)用藥中,指南推薦方案使用比例為77.57%。各個(gè)科室的二聯(lián)用藥指南推薦方案使用有差異(p0.01),全科、心內(nèi)科、高血壓科、其他科使用比例分別為80.47%、76.72%、76.78%、75.58%。全科醫(yī)療科在二聯(lián)抗高血壓藥物治療方案中較其他三個(gè)分組更符合指南推薦.(p0.01),差異有統(tǒng)計(jì)學(xué)意義。5.女性、年齡大于或等于60歲、無(wú)合并癥的高血壓患者更傾向選擇社區(qū)衛(wèi)生服務(wù)中心進(jìn)行就診(p0.05)。結(jié)論本調(diào)查研究提示我院門診高血壓患者藥物治療方案以聯(lián)合用藥為主。固定劑量復(fù)方制劑的使用以新型復(fù)方制劑為主。各個(gè)科室的高血壓治療方案有差異,且具有統(tǒng)計(jì)學(xué)差異(p0.01),全科門診高血壓患者二聯(lián)用藥治療方案的選擇上較其他三個(gè)分組更符合指南推薦(p0.01)。女性、年齡大于或等于60歲、無(wú)合并癥的高血壓患者更傾向選擇社區(qū)衛(wèi)生服務(wù)中心進(jìn)行就診(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).

【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R544.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 馬洪武;陳杰;范冉;王凱麗;田英機(jī);陳洪群;趙興山;;慢性病規(guī)范管理對(duì)原發(fā)性高血壓的療效觀察[J];心肺血管病雜志;2016年08期

2 郭莉娜;劉琰;杜麗紅;孔軍輝;;高血壓直接經(jīng)濟(jì)負(fù)擔(dān)趨勢(shì)分析[J];醫(yī)學(xué)與社會(huì);2016年05期

3 馮芮華;王增武;王小萬(wàn);李建;王馨;陳祚;崔月穎;朱曼璐;;高血壓社區(qū)規(guī)范化管理中常用抗高血壓藥物的成本-效果研究[J];中國(guó)全科醫(yī)學(xué);2016年01期

4 石越;趙鐵夫;閆振嫻;張樂(lè)輝;;心肌血運(yùn)重建術(shù)后患者隨訪的研究進(jìn)展[J];心肺血管病雜志;2015年12期

5 吳來(lái)陽(yáng);王馨;王增武;劉遠(yuǎn)立;;淺談國(guó)內(nèi)外高血壓管理模式[J];中國(guó)醫(yī)學(xué)前沿雜志(電子版);2015年07期

6 馮芮華;王小萬(wàn);王增武;李建;王馨;陳祚;崔月穎;朱曼璐;;5種社區(qū)常用單片復(fù)方制劑降壓藥成本-效果分析[J];中華高血壓雜志;2015年03期

7 ;中國(guó)高血壓基層管理指南(2014年修訂版)[J];中華高血壓雜志;2015年01期

8 劉斌;葉麗娜;盧向紅;王濟(jì)緯;陳紅燕;;公立醫(yī)院與社區(qū)衛(wèi)生服務(wù)機(jī)構(gòu)雙向轉(zhuǎn)診機(jī)制的探討[J];中國(guó)公共衛(wèi)生管理;2014年05期

9 吳兆蘇;霍勇;王文;趙連友;朱鼎良;;中國(guó)高血壓患者教育指南[J];中國(guó)醫(yī)學(xué)前沿雜志(電子版);2014年03期

10 高鵬;付希婧;孫茂;孔彩;梁敏洪;郝光磊;朱文濤;;國(guó)內(nèi)藥物經(jīng)濟(jì)學(xué)應(yīng)用研究的相關(guān)問(wèn)題探討[J];中國(guó)藥房;2014年06期

，

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