基于多準則決策分析的縣域醫共體藥品目錄選體系構建與實證

中圖分類號R95 文獻標志碼A 文章編號 1001-0408（2025）08-0914-06

DOI10.6039/j.issn.1001-0408.2025.08.04

Construction and empirical study of selection system for drug directory of county-level medical community based on multi-criteria decision analysis

GUO Yinan'2，YU Xiuheng2，XIE Yuqing2，XIANG Shixin2，LIN Huan'2，LONG Youqi2，ZHAO （1.School of Pharmaceutical Sciences， Chongqing Medical University， Chongqing 400o16， China； 2. Dept. of Pharmacy， University-Town Hospital of Chongqing Medical University， Chongqing 401331， China）

ABSTRCTOBJECTIVETo explorethe construction of selectionsystem fordrugdirectoryof the county-levelmedical communitybasedonmuti-criteriadecisionanalysis，and provide decision-making basisforthe selectionof drug directoryof medical community.METHODs Taking county-levelmedicalcommunity in Chonging as anexample，Delphi methodand analytic hierarchy processwereemployedtoconstructtheselectionsystem fordrug directoryof thecounty-levelmedicalcommunity. Selected drugswerequantitativelyscoredbasedontheconstructedindexsystem，andthedrugdirectorywasselectedaccordingto thedrug'comprehensive scoreTheimplementationeffectofthedirectorywasthenevaluatedthroughquestionnairesurveysone yearaftetheimplementationofthedirectoryRESULTSTheexpertauthorityceffcientsofthetworoundsofonsultationweregt; 0.8， with Kendall's W values of 0.213 and 0.196， respectively Plt;0.001 ）.Finally， the selection system for drug directory of the medical communitywasdeterminedtoincludefiveevaluationdimensionssafety，efectivenesseconomy，acessiblityand inovationalongwithightealuatiicatorsIntedugdirectelectedaccdingtotheabvemthdthepoof centrallyprocureddrugs，medicalinsurancedrugsandesentialdrugshadallincreasedcomparedtobeforetheselection；the comprehensive scoresofchemicaldrugsrangedfrom50.25to96.31scores，andthe proportionofdrugsscoringbetween70and 100 scores had increased from 78.06% before selection to 85.82% . Among them， antiparasitic drugs had the highest comprehensive scores，whiledrugsforthedigestivetractandmetabolismwerethemostnumerousTheevaluationscoresofeachindicatorandthe comprehensivescoresofdrugsinthedrugdirectoryaftertheselectionprocessincreasedsignificantlythanbeforeselection（ Plt; 0.05）.CONCLUSIONSTheselectionsystemfordrug directoryofthecounty-levelmedicalcommunityconstructedinthisstudyis scientificobjectiveandoperableThisprocessfacilitatesthepromotionofstandardizedandunifiedmanagementofdruginthe medical community.

KEYWORDcounty-levelmedicalcommunity；drug directory；drug selection；mult-criteriadecisionanalysisevaluationindexsystem；evidence-based evidence

縣域醫療衛生共同體（簡稱“縣域醫共體”）是我國深化醫藥衛生體制改革的重要舉措之一，旨在通過整合縣域內醫療資源，提升基層醫療服務能力，實現分級診療目標。2018年11月，國家衛生健康委、國家中醫藥管理局聯合發布的《關于加快藥學服務高質量發展的意見》指出，要加強藥品供應目錄的銜接，鼓勵縣域醫共體實行統一的藥品供應目錄，實施統一采購、統一配送[]。如何選出安全、有效、經濟又符合臨床需求的藥品，促進縣域醫共體藥品目錄結構優化，提高醫療資源的合理配置是目前縣域醫共體藥品管理函待解決的重要問題。

基于循證證據的藥品價值量化評價是目前藥品目錄選的主要方法。然而，醫療機構的藥品避選決策是一個牽涉多準則、多利益相關者、多價值觀的復雜問題。多準則決策分析（multi-criteria decision analysis，MCDA）是一種定量的結構化評估方法，能夠幫助決策者系統地考慮各種影響因素，已廣泛應用于包括藥品目錄篩選、藥品價值評估在內的諸多領域。本研究對重慶市某縣域醫共體采用MCDA法嘗試構建縣域醫共體藥品目錄選指標體系，并進行藥品選證研究，以期為加強醫共體的藥事管理，促進藥品的合理使用提供參考。

1資料與方法

1.1MCDA法構建縣域醫共體藥品目錄選指標體系

遵循國際藥物經濟學與成果研究學會（International Society for Pharmacoeconomics and Outcomes Re-search，ISPOR）的建議擬定基于MCDA法的藥品臨床綜合評價研究步驟：第一步，明確決策問題；第二步，選擇和構建標準；……