基于患者视角评估安徽芜湖市药品福利管理试点效果
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篇名: 基于患者视角评估安徽芜湖市药品福利管理试点效果
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摘要: 目的:评估安徽芜湖市试点实施药品福利管理(PBM)模式对患者用药依从性、健康结局、疾病经济负担及满意度的影响。方法:采用横断面研究,参照国家卫生服务调查方案进行调查问卷设计,通过整群抽样与方便抽样相结合的方式,对在芜湖市某PBM试点机构参与和未参与PBM项目的高血压患者进行问卷调查(包括主观评价调查)。采用描述性分析对两组患者的一般特征进行统计分析;采用倾向性评分匹配(PSM)对两组患者数据进行近似随机化处理以平衡基线特征;采用一元线性回归或Logistic回归分析评价患者是否加入PBM与其用药依从性、质量调整寿命年(QALY)、住院发生情况、月均慢病药品总费用、月均慢病药品自付费用等的相关性。结果:本次问卷调查共收集有效问卷755份,其中参与组共405份,未参与组共350份;两组患者在性别、年龄、教育程度、户口性质、医保类型等指标上的差异均具有统计学意义(P<0.05);参与组405例患者对PBM项目满意率约为95%。经PSM获得参与组281人、未参与组193人。回归分析结果显示,参与组患者服药依从性至少降低一个级别的概率是未参与组的0.49倍,参与组患者住院发生的概率是未参与组的0.56倍(P<0.05);而两组患者的血压控制情况 、QALY值、月均慢病药品总费用、月均慢病药品自付费用差异均无统计学意义(P>0.05)。结论:在试点地区实施PBM模式能提高患者的用药依从性、降低其住院率,患者对PBM的总体满意度较高。但PBM对患者血压控制、QALY值、医疗费用等的影响尚不明显,其长期效果还需要更多的随访研究来验证。
ABSTRACT: OBJECTIVE: To evaluate the effects of Pharmacy Benefit Management (PBM) model on drug compliance, health outcomes, economic burden and satisfaction of patients in Wuhu city of Anhui province. METHODS: In cross-sectional study, the questionnaires were designed according to the National Health Service Survey. Through cluster sampling and convenient sampling, the questionnaire survey (including subjective evaluation) was conducted among hypertensive patients who participated in or did not participate in the PBM program in pilot area of Wuhu city. Descriptive analysis was used to analyze the general characteristics of the two groups. The Propensity Score Matching (PSM) was used to approximately randomize the included data to balance the baseline characteristics. Univariate linear regression or Logistic regression analysis were used to evaluate the relationship of whether to join PBM or not with drug compliance,QALY, hospitalization probability,monthly average drug cost for chronic diseases and monthly self-paid drug cost for chronic diseases, etc. RESULTS: A total of 755 valid questionnaires were collected, including 405 in the PBM group and 350 in the non-participating group. There was statistical significance in patient’s gender, age, education degree, nature of household registration, type of medical insurance or usual visited medical institutions (P<0.05). About 95% patients (405 cases) satisfied with PBM program. 281 cases of PBM group and 193 cases of non-participating group were included through PSM. Results of regression analysis showed that lower one level at least of medication compliance in PBM group was 0.49 times as that in the non-participating group; the hospitalization probability in PBM group was 0.56 times as that in the non-participating group (P<0.05). There was no statistical significance of difference in control of blood pressure QALY, monthly average drug cost for chronic diseases and monthly self-paid drug cost for chronic diseases between two groups (P>0.05). CONCLUSIONS: The implementation of PBM model in pilot areas can improve drug compliance and reduce hospitalization rate of patients. The most patients are highly satisfied. However, the effects of PBM on patients’ control of blood pressure, QALY and medical expense are not obvious, and its long-term effect needs more follow-up studies to verify.
期刊: 2019年第30卷第6期
作者: 何丽月,王俊锋,吴晓燕,刘心怡,杨莉
AUTHORS: HE Liyue,WANG Junfeng,WU Xiaoyan,LIU Xinyi,YANG Li
关键字: 药品福利管理;用药依从性;健康结局;疾病经济负担;倾向性评分匹配;效果评价
KEYWORDS: Pharmacy Benefit Management; Drug compliance; Health outcome; Economic burden of disease; Propensity Score Matching; Effect evaluation
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