基于内分泌科医师问卷调查结果评价武汉市胰岛素类药品集中采购分组办法的合理性及可行性

来源:用户上传      作者:胡惠子 文小桐 杨莹 毛李宁 王兆仑 罗佳 张维纯 毛宗福 崔丹

　　中D分类号 R95;R977.1+5 文献标志码 A 文章编号 1001-0408（2022）06-0666-07
　　DOI 10.6039/j.issn.1001-0408.2022.06.04
　　摘 要 目的 调查内分泌科医师对胰岛素类药品临床转换替代的态度，为完善胰岛素集中带量采购方案提供依据。方法 采用问卷调查法，以南昌市三级甲等综合医院的内分泌科医师为调查对象，从代际层面、议价组层面、通用名层面和厂牌/规格层面4个维度调查内分泌医师认可的胰岛素可转换替代比例。结果 共成功发放问卷89份，占南昌市三级甲等综合医院在岗内分泌科医师（共111名）的80.2%;回收89份问卷，其中1份为无效问卷，有效率为98.9%。调查结果显示，在代际层面，93.2%的内分泌科医师会首选胰岛素类似物。在议价组层面，医师认可的组三与组四药品间相互转换替代比例的加权平均数为63.9%。在通用名、厂牌/规格层面，医师认可的各组药品间相互转换替代比例的加权平均数均在70%以上。结论 武汉市胰岛素分组办法较为合理，能实现组内胰岛素安全临床转换替代，建议取消长效人胰岛素竞价组;组内药品间可转换替代比例的加权平均数均较高，建议提高胰岛素约定采购量，并进行“量价挂钩”谈判;受访医师选用胰岛素起始治疗方案时更注重疗效、安全等因素，故胰岛素的替换要以临床疗效、用药安全为前提。
　　关键词 胰岛素;临床转换替代;武汉;南昌;药品集中采购;内分泌科医师;分组办法;问卷调查
　　Evaluation of the rationality and feasibility of the grouping method for centralized procurement of insulin drugs in Wuhan based on the results of questionnaire survey among endocrinology physicians
　　HU Huizi1，2，3，WEN Xiaotong2，3，YANG Ying2，3，MAO Lining2，3，WANG Zhaolun2，3，LUO Jia2，3，ZHANG Weichun1，2，3，MAO Zongfu2，3，CUI Dan2，3（1. School of Management， Hubei University of Chinese Medicine， Wuhan 430065， China; 2. Global Health Institute， Wuhan University， Wuhan 430071， China; 3. School of Health Sciences， Wuhan University， Wuhan 430071， China）
　　ABSTRACT OBJECTIVE To investigate the attitude of endocrinology physicians to clinical conversion and substitution of insulin drugs， and to provide basis for improving the centralized procurement program of insulin. METHODS The proportion of convertible and substitutable insulin recognized by endocrinology physicians was investigated by questionnaire from 4 dimensions： intergenerational level， bargaining group level， common name level and brand/specification level. The subjects were endocrinology physicians in the third grade class A general hospitals in Nanchang. RESULTS A total of 89 questionnaires were successfully distributed， accounting for 80.2% of the on-the-job endocrinology physicians （111 in total） in the third grade class A general hospitals in Nanchang. Eighty-nine questionnaires were collected， one of which was invalid， and the effective rate was 98.9%. At the intergenerational level， 93.2% of endocrinology physicians preferred insulin analogues. At the bargaining group level， the weighted average of the convertible ratio between group 3 and group 4 approved by physicians was 63.9%. At the levels of common name and brand/specification， the weighted averages of convertible proportion of each group were more than 70%. CONCLUSIONS The method of insulin grouping in Wuhan is reasonable which can complete clinical conversion and substitution of insulin in the group safely. It is suggested to cancel long-acting human insulin group. The weighted average of the proportion of convertible and substitutable drugs in the group is high. It is suggested to increase the agreed purchase volume of insulin and conduct “volume price linked” negotiations. When the surveyed physicians choose the initial treatment scheme of insulin， they pay more attention to the factors such as efficacy and safety， so the replacement of insulin should be based on the clinical efficacy and drug safety.

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