目的:编制药品采购价格指数和采购量指数,药品价格与供应呈现动态变化,反映政策导向下的上海市药品市场供应全貌.方法:纳入上海市医药采购服务与监管信息系统中2018—2021 年共48个月的全市医疗机构药品采购记录,作为指数测算的数据基础.结果:与上一年度相比,2019—2021 年西药全品种采购价格指数分别是93.3、95.8和93.9,维持稳中有降的总体趋势,采购量则有上升趋势.医保品种的采购价格变化相似,其中心血管药品、抗肿瘤药及免疫调节剂的价格降幅大于其他品种.自费药品采购价格略有下降.结论:上海市药品采购价格指数和采购量指数验证了其应用于药品价格监测与管理的可行性,为政策决策和评价提供了有力证据.

目的:通过分析上海市抗肿瘤药物的采购配备与临床使用情况,为制定针对性的肿瘤药物规范管理策略提供参考.方法:基于上海市医疗机构药品招标采购数据库和医院临床用药信息分析系统,分析不同等级医疗机构、药品分类、通用名的抗肿瘤药品的采购金额分布情况,以及抗肿瘤药物处方的总数、总金额、单张处方金额、处方药品种类和数量.结果:从采购金额看,三级医院(占81.04%)、细胞毒类药品(占34.62%,尤其是影响核酸合成的药物)、生物反应调节药(占17.98%)、靶向治疗类药物(占11.91%,以单克隆抗体药和酪氨酸激酶抑制药为主)、辅助用药(占28.06%,其中造血生长因子占比最高)、采购金额最高的前十类药物(累计占比48.12%)都是合理用药和费用控制的关键点;从临床使用情况看,三级医院(处方数量占比70.32%,平均处方费用为1110.46元)、40岁及以上中老年患者(处方数量占比90.20%,40~49岁区间人群的平均处方费用最高,为1370.00元)、自费患者(平均处方费用为1603.15元)都是处方使用的重点干预机构或人群,其中恶性淋巴瘤(3818.31元/张处方)、肺恶性肿瘤(2997.52元/张处方)、胰腺恶性肿瘤(2737.62元/张处方)的处方费用较高.结论:基于上海市抗肿瘤药物采购端和使用端的数据分析结果,建议在限定医疗机构抗肿瘤药物和辅助用药品种品规数量、定期开展抗肿瘤药物重点品种使用的监测与评价、落实抗肿瘤药物和辅助用药的处方点评及公示制度等方面进行关键点控制.

Objective:To analyze the current situation of drug use of patients with diabetes in Shanghai,and evaluate the drug use rationality among all levels of medical institutions.Methods:Using the indicators of defined daily doses(DDDs) and defined daily consumption(DDDc) recommended by the World Health Organization(WHO),it conducted statistical analysis on the amount,price,dose of the antidiabetic drugs purchased from November 2013 to October 2014 in the Pharmaceutical Bidding Database of Shanghai.Results:The research on the top drug composition showed that the DDDs in different medical institutions of Shanghai was sulfonylureas(53.84％),followed by insulin and metformin.The analysis of the purchase amount shows that,the amount of antidiabetic drugs purchased by the primary,secondary and tertiary medical institutions were 573 million,322 million and 339 million respectively.Additionally,it sorted the DDDs by generic name and found the most frequently used antidiabetic drugs were gliclazide,glimepiride and recombinant human insulin,etc.The average level of medical institutions consistency for antidiabetic drug was 68.69％.Conclusion:Patients with diabetes primarily purchased the drug prescribed in the community health centers in Shanghai,DDDc was rational.Sulfonylureas,insulin and metformin were the most frequently used antidiabetic drugs,while sulfonylureas was used more frequently.It was closed in the primary and secondary medical institutions.

Objective:To comparatively analyze the rationality and diversity of outpatient prescription behavior among medical institutions at all levels,and to explore the influencing factors on storing up and using drugs in community health service centers where chronic disease patients get initial visiting. Methods:Based on cluster sampling,medical prescription of hypertension and diabetes in May and November of 2014 were used to analyze the rationality of prescription. Anatomical therapeutic chemical and defined daily dose(ATC/DDD)was used to analyze drug utilization. Results:The prescription charges for outpatients with hypertension or diabetes in secondary and tertiary medical institutions were significantly higher than that in community health service centers. Patients with hypertension and diabetes got medicine mostly from community health service centers. There was a slight difference among drug category between community health service centers and other medical institutions. Medical institutions had poor consistency on purchase of hypertension and diabetes drugs. Conclusion:The fundamental method to alleviate or solve the phenomenon of “hard to get related medicine in community health service centers”is to keep consistency among community health service centers,secondary medical institutions and tertiary medical institutions. It is recommended to open the range of chronic disease medicine in the communities appropriately and the control line of health insurance as well as prescription duration.

目的:基于上海市ACEI和ARB两类药品的采购费用分析情况,结合典型地区的经济学评价结果和数据模拟的预算影响分析,以明确两者相对的经济学价值,为临床降压药物的合理有效使用提供数据支持.方法:选择一个社区卫生服务中心和一定区域范围的医疗机构作为典型抽样机构,分析ACEI或ARB单药治疗轻中度原发性高血压患者的直接医疗费用,分析指标包括人均年治疗总费用和次均治疗费用等,选择成本最小化分析方法开展药物经济学评价研究.基于上述研究结果和药品招标采购平台数据库,模拟在完全规范高血压管理情况下比较ACEI和ARB类药物的总费用,并进行预算影响分析.结果:从卫生服务提供者的角度考虑,基于典型地区直接医疗费用数据分析结果,ACEI类药品在次均治疗费用上相对ARB类药品具有成本优势;通过预算影响分析,在假定完全规范高血压管理情况下,ACEI类药品对ARB类药品的替换具有节约费用的作用,若完全替代,可为上海医保支出节约1.5～2.4亿元.结论:从医保基金的高效使用以及病人的经济负担角度,建议各级医疗机构优先使用ACEI类药品.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的:了解上海市各级医疗机构的就医人员对基本药物的认知和使用基本药物的意愿。方法:按上海市高、中、低经济水平采用分层整群随机抽样的方法选择三个区,每个区3家社区卫生服务中心,1家二级医疗机构,1家三级医疗机构,共15家医疗机构,对各抽样医疗机构的就医人员采取问卷调查,对1125份有效问卷进行统计分析。结果:就医人员对基本药物的知晓率较低,存在认知偏差,社区基本药物配备基本满足用药需求,医务人员在引导患者使用基本药物中起着较大的作用。结论:上海市还需加强基本药物知识的宣传,发挥医务人员的引导作用,推进基本药物制度的实施。</span>

1 新加坡医疗行业概况 新加坡是一个城市化的岛国,2006年全部人口为448万人,其中常住人口360万.全国共有公立医疗机构13家,医生3505人,护士11 574人;私立医疗机构16家,医生2 966人,护士6 109人.医生总数与总人口比例为1:646.医院的床位总数11 840张,其中公立8 813张,私立3 027张.新加坡国家医疗支出占国民生产总值的极小部分,据2001年5月31日统计,为国民生产总值的3.0%,但新加坡的期望寿命(男:78.O岁,女:81.8岁)、婴儿死亡率(2.6‰)、产妇死亡率(10/10万)都居世界前列,卫生投入效率非常高.而同期美国的医疗支出高达13.0%.这固然与新加坡年轻人口比例大、经济发展快速有关,但其保健系统的建设也是一个不容忽视的原因.