李红云 苏华 芦霜 刘丽娟

摘 要 目的：建立我院儿科药品按剂量收费模式，为减少患者支出、节约医保资金、降低科室药占比提供参考。方法：自2019年6月起，我院选择12种用量大、价格高、节余多的药品建立儿科按剂量收费药品目录，将目录内药品拆分为1/2或1/5小规格药品实行按剂量收费模式;制定按剂量收费模式的相关工作流程、质量控制标准及结余（亏损）药品记录，各药房与儿科科室间协调儿科药品使用。比较2019年6-12月按剂量收费模式与按支数收费模式（同时期药品用量换算的理论值）下拆分药品的使用数量、金额和儿科科室药占比。结果：2019年6-12月，在按剂量收费模式与按支数收费模式下拆分药品的每月使用量分别为（3 346.43±734.73）支和（6 821.71±1 468.81）支，每月药品使用金额分别为（53 576.03±10 958.78）元和 （112 642.75±21 308.77）元，差异均有统计学意义（P<0.05）。4个小儿内科和1个新生儿科药占比均有不同程度降低。结论：儿科药品按剂量收费可以减少药品使用量，减少药品费用支出，节约医保资金，降低科室药占比。

关键词 儿科用药;收费模式;按剂量收费;药品节余;药品使用量;药品使用金额;药占比

ABSTRACT   OBJECTIVE： To establish charge-by-dose model for pediatric drugs in our hospital， so as to provide reference for reducing patients expenditure， saving medical insurance funds and reducing drug proportion. METHODS： Since June 2019， a total of 12 kinds of drugs with heavy usage， high price and large savings in our hospital were selected to establish pediatric charge-by-dose list. The drugs included in the list were split into 1/2 or  1/5 small-sized drug for charge-by-dose model. The process， quality control standards and surplus （loss） drug record of charge-by-dose model were formulated to coordinate the use of pediatric drugs between pharmacies and pediatric departments. The quantity and amount of drugs which were split， and the drug proportion in pediatric departments were compared between charge-by-dose model and charge-by-unit model （theoretical value of dosage conversion in the same period） during Jun.-Dec. 2019. RESULTS： From Jun. to Dec. 2019， the quantities of split drugs each month with charge-by-dose model and charge-by-unit model were （3 346.43±734.73） and （6 821.71±1 468.81）; the amounts of split drugs each month with two models were （53 576.03±10 958.78） yuan and （112 642.75±21 308.77） yuan， respectively， with statistical significance （P<0.05）. The drug proportion in four pediatric internal medicines departments and one neonatal medicine department had decreased to varying degrees. CONCLUSIONS： Pediatric drug charge by dose can reduce the use and amount of drugs， save medical insurance expenditures， decrease the drug proportion of department.

KEYWORDS   Pediatric drug use; Charge model; Charge-by-dose; Drug savings; Quantity of drug use; Amount of drug use; Drug proportion

國家食品药品监督管理总局南方医药经济研究所在《2016年儿童用药安全调查报告白皮书》中指出：全国6 000多家药厂中有1 000余家生产儿童药品，其中专门生产儿童用药的仅10余家;截至2016年6月，我国国产药品批文共176 652条，其中专用于儿童的药品批文仅3 617条[1]。市场上儿童专用药品的缺失导致患儿在临床使用中更多地使用规格较大的药品，即使是最小规格的药品也需再拆分使用，药品拼用在儿科用药中尤为常见[2]。山东第一医科大学附属聊城二院（以下简称“我院”）静脉用药集中调配中心（PIVAS）负责全院各儿科静脉用药的调配工作，实际工作中发现，药品的拼用现象突出，导致了部分药品有盘盈现象。……