本文關(guān)鍵詞： 基層醫(yī)療機(jī)構(gòu) 心血管系統(tǒng)用藥 藥物利用研究 金額 限定日劑量 用藥頻度　出處：《天津醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：了解“新醫(yī)改”和國家基本藥物制度實(shí)施后,基層醫(yī)療機(jī)構(gòu)心血管藥物的利用狀況,分析其用藥合理性及藥物利用趨勢,為政府部門、藥監(jiān)管理部門、醫(yī)療保險(xiǎn)機(jī)構(gòu)及制藥企業(yè)等的決策提供依據(jù)。 方法：采用天津市某區(qū)全部9家基層醫(yī)療機(jī)構(gòu)2009年-2013年的藥品采購記錄作為本研究的對(duì)象,運(yùn)用藥物利用研究中的金額分析、限定日劑量和用藥頻度分析的方法進(jìn)行數(shù)據(jù)處理分析評(píng)價(jià)。具體運(yùn)用的工具和計(jì)算的指標(biāo)包括：(1)藥物ATC分類；(2)確定購藥金額并排序；(3)確定限定日劑量(DDD)；(4)計(jì)算用藥頻度DDDs并排序,DDDs=藥品消耗總量/該藥的DDD值。對(duì)基層醫(yī)療機(jī)構(gòu)心血管系統(tǒng)藥物的使用情況進(jìn)行分析。 結(jié)果：該區(qū)全部基層醫(yī)療機(jī)構(gòu)5年采購藥品金額共14131.46萬元。其中,抗高血壓藥占比例最大,列第一位,為7248.89萬元；抗心絞痛藥和調(diào)脂及抗動(dòng)脈粥樣硬化藥分列第二、三位,分別為4280.24萬元和1929.63萬元；抗心律失常藥為665.80萬元,居第四位,其他類別藥物所占金額較小。 從DDDs看,5年總計(jì)為71,912,860,與金額排序一致,抗高血壓藥、抗心絞痛藥、調(diào)脂及抗動(dòng)脈粥樣硬化藥和抗心律失常藥分列前四位,DDDs分別為38,562,187、26,999,267、2,941,076和2,736,020,其他類別的藥物數(shù)量較少。 具體藥物方面,單硝酸異山梨酯、氨氯地平、硝苯地平等藥物各年的DDDs和金額均較高。 結(jié)論： (1)藥物類別：天津市某區(qū)基層醫(yī)療機(jī)構(gòu)2009-2013年使用的心血管系統(tǒng)藥物中,抗高血壓藥占使用金額的51%和DDDs的53%,比例最高；其次是抗心絞痛藥,占使用金額的30%和DDDs的37%；再次是調(diào)脂及抗動(dòng)脈粥樣硬化藥,占使用金額的14%和DDDs的4%；其他藥物的使用量較少。 (2)藥物品種：天津市某區(qū)基層醫(yī)療機(jī)構(gòu)2009-2013年使用的心血管系統(tǒng)藥物中,使用金額位居前三位的分布是氨氯地平、單硝酸異山梨酯、硝苯地平。另外,纈沙坦、替米沙坦、阿托伐他汀、貝那普利的金額也較高；DDDs排序,單硝酸異山梨酯、氨氯地平、替米沙坦、硝苯地平、阿司匹林分列前5位。 (3)國家基本藥物所占比例：在本研究涉及的所有藥物中,屬于國家基本藥物的比例僅為42.4%；其中總計(jì)金額排序或DDDs排序居前10位的13個(gè)藥物屬于國家基本藥物的僅有4個(gè),比例僅為30.8%。這種現(xiàn)象需要有關(guān)部門和醫(yī)療機(jī)構(gòu)進(jìn)行干預(yù)。
[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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R95

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