医保目录内慢性阻塞性肺疾病治疗用支气管舒张药物在上海市社区卫生服务中心可获得情况分析

Analysis of the availability of bronchodilators listed in the medical insurance catalog for treatment of chronic obstructive pulmonary disease in community health service centers in Shanghai

  • 摘要:
    目的 了解上海市社区卫生服务中心慢性阻塞性肺疾病(简称“慢阻肺”)治疗用支气管舒张药物的可获得情况。
    方法 在前期研究的基础上更新问卷,于2023年4—5月对上海市各社区卫生服务中心展开调查,重点关注慢阻肺治疗药物的配置情况。根据《国家基本医疗保险、工伤保险和生育保险药品目录(2023 年版)》确定慢阻肺治疗用支气管舒张药物共24种,通过可获得率评估某种药物在社区卫生服务中心的可获得情况,通过配备率评估社区卫生服务中心配备药品的品种数量情况。
    结果 共248家社区卫生服务中心应答,应答率为100.0%。232家(93.5%)社区卫生服务中心配备了支气管舒张药物。在可获得率方面,β2受体激动剂的可获得率为86.3%,抗胆碱能药物的可获得率为52.4%,复合制剂的可获得率为52.4%,黄嘌呤类的可获得率为85.1%。分区域来看,沙丁胺醇/左沙丁胺醇和布地奈德福莫特罗在远郊的可获得率低,异丙托溴铵在市区社区卫生服务中心可获得率低,氨茶碱在远郊的可获得率高。在配备率方面,24种慢阻肺治疗用支气管舒张药物在全市社区卫生服务中心的配备品种数量的中位数为5种,200家社区卫生服务中心(80.6%)配备的支气管舒张药物种数不足7种。
    结论 上海市社区卫生服务中心配备慢阻肺治疗用支气管舒张药物的比例较高,但存在药物配备品种数量不多,不同药物可获得性差异较大,不同区域药物配备不平衡的问题。为更好完成慢阻肺患者规范诊疗和管理工作,建议加强社区卫生服务中心的慢阻肺治疗药物配备。

     

    Abstract:
    Objective To assess the availability of bronchodilators for treatment of chronic obstructive pulmonary disease (COPD) in community health service centers (CHCs) in Shanghai.
    Methods On the basis of previous research, the questionnaire was updated, and surveys were conducted from April to May 2023 in CHCs in Shanghai, with a focus on the availability of medications for COPD treatment. According to the National Basic Medical Insurance, Work Injury Insurance, and Maternity Insurance Drug List (2023 Edition), a total of 24 types of bronchodilators for COPD treatment were identified. The availability rates were used to assess the accessibility of specific drugs in CHCs, and the dispensing rates were used to evaluate the variety of these medications in CHCs.
    Results A total of 248 CHCs responded, with a response rate of 100.0%. Among them, a total of 232 CHCs (93.5%) were equipped with bronchodilators. In terms of availability rates, the availability rates for β2 adrenoreceptor agonists, muscarinic antagonists, combination drugs, and xanthines drugs were 86.3%, 52.0%, 52.4%, and 85.1%, respectively. Regional differences were observed, in that salbutamol/levalbuterol and budesonide-formoterol were less available in suburban CHCs, ipratropium bromide had lower availability in urban CHCs, and aminophylline was more available in suburban CHCs. Regarding the dispensing rates of the 24 types of bronchodilators for COPD treatment, the median of types equipped by CHCs was 5, with a total of 200 CHCs (80.6%) equipped with fewer than 7 types of bronchodilator drugs.
    Conclusion The proportion of CHCs in Shanghai equipped with bronchodilators for COPD is relatively high. However, there exist problems such as limited variety of stocked medications, significant differences in the availability of different drugs, and regional imbalances in drug stocking. To improve the standardized diagnosis, treatment, and management of COPD patients, it is recommended to enhance the availability of COPD treatment medications in CHCs.

     

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