农村癌痛患者临终关怀直接经济负担分析

摘要

目的: 通过对简阳地区农村晚期癌痛患者实施临终关怀、癌痛规范化治疗,了解该类患者的药物需求及直接经济负担,为更好地制定预算和医疗保障提供依据.方法: 对2013 ～ 2016 年间简阳地区农村晚期癌症伴疼痛患者进行癌痛规范化治疗,现场或电话指导药物使用、剂量调整和并发症的处理,统计镇痛药和辅助用药的总金额.结果: 随机抽取的203 例患者接受临终关怀的时间跨度为4 年,平均接受关怀时间为(123. 12 ± 4. 90) 天,用于镇痛及辅助药物的总费用为952 126. 84 元,其中镇痛药895 103. 2 元(占94. 01％),人均费用为(4 530. 51 ±95. 67) 元/人[(34. 51 ± 3. 29 元)/人/天],其中肺癌(66 例,占32. 51％) 、肝癌(27 例,占13. 30％) 、直结肠癌患者(21 例,占10. 34％) 三类共占总费用57. 33％,日均用药量最大、费用最多的是骨肿瘤患者[(104. 87 ± 7. 13) 元/人/日],其次是胰腺癌患者[(56. 18 ± 0. 77) 元/人/日],第三位是肾脏及膀胱肿瘤患者[(49. 63 ± 0. 92) 元/人/日].结论: 疼痛是影响农村终末期癌症患者生活质量的主要因素,镇痛及辅助药物费用给农民造成较重的经济负担,需要完善社会保障体系给予解决.%Objective: To investigate the drug demand and analysis the direct economic burden of terminal cancer patients with pain in rural areas, providing data for budget of hospice care. Methods: Patients of terminal cancer with pain during the year 2013 and 2016 in Jianyang were selected and provided with exactly pain assessment, standardized pain-killer, morphine titration, drugs guide, dosage adjustment and management of complications in accordance to the standards of WHO. The usage of analgesics and total cost were counted and analysed through the whole period of the hospice care until all patients' death. Results: The 203 patients have been received hospice care for 4 years(123. 12 ± 4. 90 days per person). The expenditure used for analgesia and the auxiliary drug was 952 126. 84 ￥(analgesic 895 103. 2 ￥, 94. 01％), the average cost was 4 530. 51 ± 95. 67 ￥per person (34. 51 ± 3. 29 ￥per day). The largest percentage accounted for 57. 33％ of the total cost were lung cancer patients (66 cases, 32. 51％), liver cancer patients (27cases, 13. 30％) and colorectal cancer patients (21 cases, 10. 34％). The highest cost was bone tumors patients(104. 87 ± 7. 13 ￥per person per day), followed by pancreas tumor patients (56. 18 ± 0. 77 ￥per person per day), kidney and ladder tumor patients(49. 63 ± 0. 92 ￥per person per day). Conclusion: Cancerous pain is one of the main factors influencing quality of life of terminal cancer patients in rural areas, analgesia and auxiliary drug expenditure lead to heavy economic burden. The social security system should help them to overcome the problem.