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目的 :采用模拟病人法对上海市区一、二级医院门诊药物使用的影响因素进行调查。结果 :使用累计频率在80 %左右的药物中 ,治疗心绞痛的有 11种 (累计达 80 .6 9% ) ,治疗急性胃炎的有 2 3种 (累计达 80 .2 2 % ) ,治疗急性气管—支气管炎的有 2 7种 (累计达 80 .72 % ) ;门诊医生所开治疗心绞痛、急性胃炎、急性气管—支气管炎的药物重复性分别为 0 .71%、7.6 4%和 3.13% ;心绞痛的平均药费为 5 6 .93元 ,急性胃炎的平均药费是 40 .5 7元 ,急性气管—支气管炎平均药费为 72 .70元 ;治疗心绞痛针对性差的药物占 33.5 9% ,治疗急性胃炎针对性差的药占 37.36 % ,治疗急性气管—支气管炎针对性差的药物占 31.97% ;针对性与药价无关。结论 :应加强一、二级医院医生的药物经济学等方面的培训 ,帮助其提高合理、经济、安全、高针对性地选择药物的能力 ;还应筛选出治疗效果肯定、针对性强、不良反应较小、价格合理、使用方便的基本药物作为临床常用药物 ,这样可使门诊医疗费用下降而不影响医疗保健质量。
Objective : To investigate the influencing factors of outpatient drug use in the first and second class hospitals in Shanghai using the simulated patient method. RESULTS: Of the drugs with a cumulative frequency of about 80%, 11 (80.69%) were treated for angina, 23 (32.22%) were for acute gastritis, and acute trachea was treated. - There were 27 types of bronchitis (a total of 80.72%); the drug reproducibility of angina pectoris, acute gastritis, and acute tracheal-bronchitis prescribed by outpatient doctors was 0.71%, 7.64%, and 3.13%, respectively; The average drug cost for angina was 56.93 yuan, the average drug cost for acute gastritis was 40.57 yuan, the average drug cost for acute tracheal-bronchitis was 72.70 yuan, and the poorly targeted drug for angina was 33.59%. The proportion of poorly targeted drugs for acute gastritis accounted for 37.36%, and for poorly treated patients with acute tracheo-bronchitis, 31.97% were poorly targeted drugs. Conclusion: The training of physicians in primary and secondary hospitals on pharmacoeconomics should be strengthened to help them improve their ability to select drugs rationally, economically, safely, and with a high degree of focus. It is also necessary to screen for positive, targeted, and poor outcomes. The basic drugs that are less responsive, reasonably priced, and easy to use are commonly used as clinical drugs, which can reduce outpatient medical costs without affecting the quality of healthcare.