目的 对比新泰市中医医院药品集中带量采购前后1年的降压药相关用药数据，分析和探讨药品集采政策对基层医疗机构降压药使用的影响，为相关政策的制定提供一定参考。方法 检索医院HIS系统，并比对药品集采中选目录，筛选出目标药物，查询并确定其限定日剂量（DDD）值，采用Microsoft Excel 2019导出集采前后2个时间段内降压药相关用药信息，进行分类统计整理，计算对比用药频度（DDDs）、限定日费用（DDC）、药品价格指数（DPI）、仿制药替代率和药费节省率等评价指标。结果 纳入目标药物12个品种，涉及30个品规，中选品规的调整幅达66.67%；追踪到16个品规的价格降幅为3.6%～82.79%，最大调整差价达3.091元/片；11个品种的平均仿制药替代率高达91.19%，国产仿制药的DDDs或DDDs占比明显提高，8个品种进口原研药的DDDs降幅为13.07%～100%；所有品种共节省药费1 726 946.66元，药费总体节省率为69.37%，11个品种的DDC平均降幅为75.49%；药理类别不同的6类降压药较基期调整后的DPI范围为7.99%～56.57%；ARB、ACEI和BB类降压药的DDDs、DDDs占比都出现增长，DIU类和复合制剂的DDDs、DDDs占比都出现下降，CCB类的DDDs出现增加，而DDDs占比却出现下降。结论 药品集中采购后，基层医疗机构优先充实了中选药品，对国产仿制药的认可度和使用量大大提高，药物治疗更加贴近基层患者的高血压病特点；选择药物时更加兼顾价格因素和药理特点，确实显著地减轻了就诊患者的药费负担，也为基层医疗机构费用结构的优化提供了有力支撑。

Objective By comparing the data of antihypertensive drugs in Xintai Hospital of Traditional Chinese Medicine before and after centralized purchase of drugs in one year, the influence of centralized drug purchase policy on the use of antihypertensive drugs in primary medical institutions was analyzed and discussed, providing some reference for the formulation of related policies. Methods The hospital's HIS system was searched, and compared with the selected catalogue of centralized collection of drugs to screen out target drugs, query and determine their defined daily dose (DDD) value, and use Microsoft Excel 2019 to export the medication information related to antihypertensive drugs in two periods before and after centralized collection for classified statistical collation. DDDs, DDC, DPI, substitution rate of generic drugs and cost saving rate were calculated and compared. Results 12 varieties of target drugs were included, involving 30 drug specifications, and the adjustment amplitude of the selected drug regulations reached 66.67%. The prices of 16 specifications were tracked down to drop 3.6%-82.79%, and the maximum adjustment price difference reached 3.091 yuan for one pill. T'he average substitution rate of domestic generic drugs was as high as 91.19% for 11 varieties, and the proportion of DDDs or DDDs of domestic generic drugs increased significantly. The DDDs of imported original drugs of 8 varieties decreased 13.07%-100%. All varieties saved 1 726 946.66 yuan in total, the overall saving rate was 69.37%, and the average DDC of 11 varieties was down 75.49%. The DPI range of the six antihypertensive drugs with different pharmacological categories was 7.99%-56.57% after adjustment compared with the base period. The proportion of DDDs and DDDs of ARB, ACEI, and BB antihypertensive drugs were increased, while the proportion of DDDs and DDDs of DIU and compound preparations were decreased, the proportion of DDDs of CCB were increased, but the proportion of DDDs decreased. Conclusion After centralized procurement of drugs, basic medical institutions had given priority to enriching the selected drugs, and the recognition and use of domestic generic drugs had been greatly improved, the drug treatment was more close to the characteristics of hypertension in grassroots patients. The selection of drugs had given more consideration to price factors and pharmacological characteristics, which could significantly reduce the burden of drug costs of patients, and provided strong support for optimizing the cost structure of basic medical institutions.

R972

山东省药品临床综合评价项目(2021YZ003)