医院卫生技术评估在药品管理中的应用现状与发展思路(1)
摘 要 目的：为我国药品的循证管理与评价体系的建立提供参考。方法：通过文献研究与医药新政策解读，追溯国内外医院卫生技术评估的发展历程及其在药品管理中的应用，探讨医院卫生技术评估在我国医院药品管理中的发展前景。结果与结论：医院卫生技术评估可对医疗技术的准入、使用等过程进行科学评价，从而优化医院资源配置、保证医疗质量。国外已将医院卫生技术评估用于协助医院决策制定，而我国的医院卫生技术评估尚在起步阶段，与国际领先水平存在差距。医院卫生技术评估作为能够有效控制成本和提高质量的手段，应尽快应用到药品管理评价体系中，努力探索合适的药品评价模式(如大使模式、迷你-卫生技术评估模式、内部委员会模式、医院卫生技术评估单元模式)，加强药品卫生技术评估人才培养，构建药品卫生技术评估方法学(如迷你-卫生技术评估模式的评估工具包括概要，基本信息，一般方法，多结构的评估结果，讨论、结论和推荐意见)，加强重视程度并促进成果转化，最终尽快探索出适合我国国情的发展道路，实现医院药品循证管理的目标。
关键词 医院卫生技术评估;药品管理;合理用药
ABSTRACT OBJECTIVE： To provide reference for establishing evidence-based pharmaceutical management and assessment system in China. METHODS： Through literature study and new medical policy interpretation， the development course of hospital-based health technology assessment (HB-HTA) and its application in pharmaceutical management at home and abroad were traced; the development prospect of HB-HTA in China’s hospital drug management was discussed. RESULTS & CONCLUSIONS： The HB-HTA makes scientific evaluation on the process of access and use of medical technology， so as to optimize the allocation of hospital resources and ensure the quality of medical treatment. Foreign countries have used HB-HTA to assist the decision-making of hospitals. China’s HB-HTA is still in its initial stage and lags behind the international leading level. As effective means for cost control and quality improvement， HB-HTA should be applied in drug management and assessment system as soon as possible; it is necessary to explore suitable drug assessment mode (i.g. ambassaclor mode， Mini-HTA mode， internal committee mode， HB-HTA unit mode)， strengthen HTA personnel training， establish HTA methodology (such as Mini-HTA mode assessment tool included outline， general information， general methods， multi-structure evaluation results， discussion， conclusions and recommendations)， pay more attention to it and promote the transformation of achievements.
KEYWORDS Hospital-based health technology assessment; Pharmaceutical management; Rational drug use
衛生技术评估(Health technology assessment，HTA)即对卫生技术(药品、设备、耗材、诊治程序或医疗服务项目)的安全性、有效性、经济性、社会法律伦理适宜性进行的综合评价，以支持医药技术监管、配置、采购、定价、合理应用和支付决策，为卫生决策者提供循证依据[1]。医院卫生技术评估(Hospital-based HTA，HB-HTA)即在医院环境中开展HTA，根据各医院实际情况建立运行模式，对医院技术在引入、使用、调整环节进行系统评价，为医院管理层提供决策依据[2]。药品是医疗体系的重要卫生技术之一，也是医院管理的重点环节。在公立医院药品“零加成”的背景下，HB-HTA能帮助医院基于循证证据作出符合本院情况的药品采购和使用决策，从而促进药物合理使用、缓解医保经费压力。因此，利用HB-HTA进行药品管理与评价十分必要。本文以“Health technology assessment”“Hospital-based HTA”“卫生技术评估”“医院卫生技术评估”等为关键词检索PubMed、中国期刊全文数据库(CNKI)、维普网、国家卫生健康委员会官方网站等，检索时限为各数据库建立之日起至2019年8月，通过回顾国内外文献资料，了解HB-HTA的发展历程及其在药品管理中的应用，同时结合国内医药新政，探讨HB-HTA在医院药品管理中的应用现状与发展趋势，为建立基于HB-HTA的医院药品管理与评价体系提供思路与参考，以期加强合理用药、提高药物疗效、促进药品相关的循证决策转化。, http://www.100md.com(王庆 张蓉)
关键词 医院卫生技术评估;药品管理;合理用药
ABSTRACT OBJECTIVE： To provide reference for establishing evidence-based pharmaceutical management and assessment system in China. METHODS： Through literature study and new medical policy interpretation， the development course of hospital-based health technology assessment (HB-HTA) and its application in pharmaceutical management at home and abroad were traced; the development prospect of HB-HTA in China’s hospital drug management was discussed. RESULTS & CONCLUSIONS： The HB-HTA makes scientific evaluation on the process of access and use of medical technology， so as to optimize the allocation of hospital resources and ensure the quality of medical treatment. Foreign countries have used HB-HTA to assist the decision-making of hospitals. China’s HB-HTA is still in its initial stage and lags behind the international leading level. As effective means for cost control and quality improvement， HB-HTA should be applied in drug management and assessment system as soon as possible; it is necessary to explore suitable drug assessment mode (i.g. ambassaclor mode， Mini-HTA mode， internal committee mode， HB-HTA unit mode)， strengthen HTA personnel training， establish HTA methodology (such as Mini-HTA mode assessment tool included outline， general information， general methods， multi-structure evaluation results， discussion， conclusions and recommendations)， pay more attention to it and promote the transformation of achievements.
KEYWORDS Hospital-based health technology assessment; Pharmaceutical management; Rational drug use
衛生技术评估(Health technology assessment，HTA)即对卫生技术(药品、设备、耗材、诊治程序或医疗服务项目)的安全性、有效性、经济性、社会法律伦理适宜性进行的综合评价，以支持医药技术监管、配置、采购、定价、合理应用和支付决策，为卫生决策者提供循证依据[1]。医院卫生技术评估(Hospital-based HTA，HB-HTA)即在医院环境中开展HTA，根据各医院实际情况建立运行模式，对医院技术在引入、使用、调整环节进行系统评价，为医院管理层提供决策依据[2]。药品是医疗体系的重要卫生技术之一，也是医院管理的重点环节。在公立医院药品“零加成”的背景下，HB-HTA能帮助医院基于循证证据作出符合本院情况的药品采购和使用决策，从而促进药物合理使用、缓解医保经费压力。因此，利用HB-HTA进行药品管理与评价十分必要。本文以“Health technology assessment”“Hospital-based HTA”“卫生技术评估”“医院卫生技术评估”等为关键词检索PubMed、中国期刊全文数据库(CNKI)、维普网、国家卫生健康委员会官方网站等，检索时限为各数据库建立之日起至2019年8月，通过回顾国内外文献资料，了解HB-HTA的发展历程及其在药品管理中的应用，同时结合国内医药新政，探讨HB-HTA在医院药品管理中的应用现状与发展趋势，为建立基于HB-HTA的医院药品管理与评价体系提供思路与参考，以期加强合理用药、提高药物疗效、促进药品相关的循证决策转化。, http://www.100md.com(王庆 张蓉)