中国基本药物制度对合理用药的影响: 基层医疗机构横断面研究

doi:10.5246/jcps.2019.01.006

中国药学(英文版) ›› 2019, Vol. 28 ›› Issue (1): 49-55.DOI: 10.5246/jcps.2019.01.006

• 【药事管理与临床药学专栏】 • 上一篇下一篇

中国基本药物制度对合理用药的影响: 基层医疗机构横断面研究

卢新璞¹, 郭志刚^2,3, 傅孟元⁴, 海沙尔江·吾守尔³, 史录文^3,4, 管晓东^3,4*

1. 北京大学肿瘤医院, 北京 100142
2. 北京大学口腔医院药剂科, 北京 100081
3. 北京大学医药管理国际研究中心, 北京 100191
4. 北京大学医学部药学院药事管理与临床药学系, 北京 100191

收稿日期:2018-11-09 修回日期:2018-12-15 出版日期:2019-01-27 发布日期:2018-12-20
通讯作者: Tel.: +86-010-82805019, E-mail: guanxiaodong@pku.edu.cn
基金资助:
National Natural Science Foundation of China (Grant No. 71303011, 71774005).

The impacts of national essential medicine policies on the rational use of medicines in China: A cross-sectional study in primary health care institution

Xinpu Lu¹, Zhigang Guo^2,3, Mengyuan Fu⁴, Haishaerjiang Wushouer³, Luwen Shi^3,4, Xiaodong Guan^3,4*

1. Beijing Cancer Hospital, Beijing 100142, China
2. Department of Pharmacy, Peking University Hospital of Stomatology, Beijing 100081, China
3. International Research Center for Medicinal Administration, Peking University Health Science Center, Beijing 100191, China
4. Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing 100191, China

Received:2018-11-09 Revised:2018-12-15 Online:2019-01-27 Published:2018-12-20
Contact: Tel.: +86-010-82805019, E-mail: guanxiaodong@pku.edu.cn
Supported by:
National Natural Science Foundation of China (Grant No. 71303011, 71774005).

摘要/Abstract

摘要：

不合理用药是重要的全球公共卫生问题,许多人认为国家基本药物制度会对合理用药有积极影响。目前,已有一些关于中国基本药物制度对合理用药影响的研究,但是仍缺乏证据且已有研究结论也有很大差异。本研究旨在评价中国基本药物制度对基层医疗机构合理用药的影响。研究在2010年对6个省、201个基层医疗机构进行调查,抽取各机构2010年1月–6月处方共39181张。研究对6项合理用药评价指标进行描述性统计,并采用独立样本t检验对于组间差异进行比较。基于调查结果,研究发现实施基本药物制度的基层医疗机构(实验组)每处方药品数显著高于未实施政策的机构(对照组) (3.37 vs 2.83,P<0.01), 每处方费用没有显著差异(81.43 vs 75.02)。实验组的抗菌药处方率(53.40% vs 36.48%,P<0.01)和注射剂处方率(40.54% vs 27.94%, P<0.01)较对照组显著更高,通用名药物处方率显著更低(83.71% vs 93.11%, P<0.01)。但实验组的基本药物处方率较对照组显著更高(76.12% vs 53.45%,P<0.01)。通过本研究发现,中国的基本药物制度对合理用药未产生显著的积极影响。国家仍需解决基本药物遴选效率低下、医生未能积极参与到政策实施中和患者长期以来的不合理用药习惯等问题。

关键词: 合理用药, 基层医疗机构, 基本药物制度, 医药卫生改革

Abstract:

Irrational use of medicines is a major problem worldwide, and it is believed there would be positive correlation between the National Essential Medicines Policies (NEMPs)and the level of rational use of medicines (RUMs). Though there is some early evidence on the NEMPs’ effects on RUMs in China, the evidence is scarce, and conclusions vary. In the present study, we aimed to evaluate the impacts of the NEMPs of China on the RUMs in the primary health care institutions (PHCs). A cross-sectional survey was conducted in 2010. A total of 201 PHCs from six provinces of China were selected, and 39 181 prescriptions were extracted from January to June, 2010. Six indicators were used and tested by independent-samples T test. We found that the average number of drugs per prescription in PHCs with NEMP implementation (the treatment group) was significantly higher than that of the group without NEMP implementation (the control group) (3.37 vs. 2.83, P<0.01). There was no significant difference in the average cost per prescription (81.43 vs. 75.02). The percentage of prescriptions, including an antibiotic (53.40% vs. 36.48%, P<0.01) or an injection (40.54% vs. 27.94%, P<0.01), was higher in the treatment group, and the percentage of drugs prescribed by general name was significantly lower (83.71% vs. 93.11%, P<0.01). For the percentage of drugs prescribed from essential medicines list, the treatment group exhibited the higher ratio (76.12% vs. 53.45%, P<0.01). From this study, the NEMPs were not likely to have a positive impact on RUMs. China still needed efforts to improve the selection, the absence of physicians’ active involvement, and the patients’ habits of irrational medication use.

Key words: Rational use of medicines, Primary health care institutions, National Essential Medicines Policies, Health care reforms

中图分类号:

R954

Supporting:

卢新璞, 郭志刚, 傅孟元, 海沙尔江·吾守尔, 史录文, 管晓东. 中国基本药物制度对合理用药的影响: 基层医疗机构横断面研究[J]. 中国药学(英文版), 2019, 28(1): 49-55.

Xinpu Lu, Zhigang Guo, Mengyuan Fu, Haishaerjiang Wushouer, Luwen Shi, Xiaodong Guan. The impacts of national essential medicine policies on the rational use of medicines in China: A cross-sectional study in primary health care institution[J]. Journal of Chinese Pharmaceutical Sciences, 2019, 28(1): 49-55.

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中国基本药物制度对合理用药的影响: 基层医疗机构横断面研究

The impacts of national essential medicine policies on the rational use of medicines in China: A cross-sectional study in primary health care institution

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