| 引用本文：杨莹,沈子墨,毛宗福.门诊保障机制下老年慢性病患者药物利用特征及影响因素：以S市为例[J].中国卫生政策研究,2025,18(12):23-31 |
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| 门诊保障机制下老年慢性病患者药物利用特征及影响因素：以S市为例 |
| 投稿时间：2025-11-05 修订日期：2025-12-11 PDF全文浏览 HTML全文浏览 |
| 杨莹1，沈子墨1，毛宗福2,3 |
| 1.华中科技大学同济医学院护理学院 湖北武汉 430030;2.武汉大学董辅礽经济社会发展研究院 湖北武汉 430071;3.武汉大学全球健康研究中心 湖北武汉 430071 |
| 摘要:目的 分析门诊保障机制下老年高血压、糖尿病（简称“两病”）患者药物利用特征及影响因素。方法 通过S市医保结算纵向数据提取连续享受门诊待遇老年“两病”患者（n=101 310）为对象，以门诊用药次数、程度、结构为观测指标，采用描述性方法、潜类别轨迹模型、多因素Logit回归进行数据分析。结果 患者年均门诊用药次数、药品费用、甲类用药占比呈现随待遇享受年份增加而递增的总体趋势。潜类别轨迹模型按用药次数、程度、结构分别识别出2个、3个和2个轨迹亚组。Logit回归显示，高龄、单病、无并发症、较低医保档次、远城区患者用药频次与程度更低，而甲类用药比重更高。结论 门诊待遇连续性与档次高低是引导患者药物利用的重要因素。老年慢性病患者待遇享受及时性与稳定性存在不足，高龄、低缴费档次、偏远地区等相对弱势群体以及共病、合并并发症等人群的需求满足情况有待于深入考量。 |
| 关键词:门诊保障 药物利用 高血压 糖尿病 老年人 |
| 基金项目:国家自然科学基金（72404098）；中国博士后科学基金（2024M761028） |
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| Characteristics of drug utilization and influencing factors in elderly patients with chronic diseases under the outpatient insurance coverage： Taking S City as an example |
| YANG Ying1, SHEN Zi-mo1, MAO Zong-fu2,3 |
| 1.School of Nursing， Tongji Medical College， Huazhong University of Science and Technology， Wuhan Hubei 430030， China;2.Dong Fureng Institute of Economic and Social Development， Wuhan University， Wuhan Hubei 430071， China;3.Global Health Institute， Wuhan University， Wuhan Hubei 430071， China |
| Abstract:Objective To examine drug utilization patterns and influencing factors among elderly patients with hypertension and diabetes under outpatient insurance coverage scheme.Methods Using longitudinal insurance claims data from city S， we included elderly patients with hypertension and/or diabetes continuously enrolled in outpatient coverage （n=101，310）. Drug utilization was measured by outpatient visit frequency， cost intensity， and drug structure （proportion of Class A drugs）. Descriptive statistics， latent class trajectory model， and logistic regression were applied for data analysis.Results Annual outpatient visit frequency， drug costs， and the ratio of Class A drug consumption showed an overall upward trend with the benefit year increasing. The latent class trajectory model identified two， three， and two subgroups for the indicator of visit frequency， cost intensity， and drug structure. Logistic regression indicated that older age， single disease， no complications， lower insurance tiers， and suburban district were significantly associated with lower drug utilization frequency and intensity but a higher Class A drug use.Conclusion The continuity and level of outpatient benefits are key drivers shaping patients’ drug utilization. Timely and stable benefit access remains inadequate for elderly patients with chronic conditions. The medication needs of vulnerable groups， such as those of advanced age， enrolled in lower-tier insurance plans， residing in remote areas， and individuals with comorbidities or complications， warrant closer scrutiny and greater policy consideration. |
| Key words:Outpatient insurance coverage Drug utilization Hypertension Diabetes The elderly |
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