乡村医生新型农村合作医疗处方行为研究

Study the Prescription Behavior of Rural Doctors in New Rural Cooperative Medical System

目的提高乡村医疗机构合理用药水平。方法采取等距抽样的方式抽取2005、2006年昆明市新型农村合作医疗开展门诊减免的富民县及未开展门诊减免的石林县乡村卫生室处方,每月10张,共抽取480张,进行统计学分析。结果在经济条件相似的2个县中,就诊人次使用药品种类、抗生素种类及药品总费用等,实行门诊减免的富民县高于没有实行门诊减免的石林县,而激素种类的比例为富民县小于石林县(P均<0.05);处方总费用、药品费用呈现经济条件较好的乡高于经济较差的乡(P<0.05);新农合减免费用为经济较差的乡高于经济较好的乡(P<0.05)。结论新农合门诊减免的开展,在一定程度上体现了其开展的初衷。但是农村地区还存在一定的不合理用药现象。新农合的实施一定程度上加剧了农村不合理用药现象,并引起医疗费用的增加。为此,应加强对乡村医生处方行为的监管,规范其用药行为,保证农民以较低的价格获得安全、有效的医疗服务。

Objective Improving the level of reasonable prescription behavior. Method Use the equal--distance sampling to collect the prescriptions in village sanitation room from 2005 to 2006 in two counties of Kunming, and the total number is 480 pieces with 10 pieces per month. Then analyse the data. Results In two counties with the similar economic condition, the Fumin county is higher than the Shilin county in the drugs type, antibiotics type, the expense of drugs and the total expense of prescriptions, but for the steroids type, Shilin county is higher than the Fumin county （P d0.05）. In the better economic condition area, the charge of prescription and Drugs are higher than the commonly area, but the charge of NRCMS is opposite {P〈0.05 }. Conclusions The development of NRCMS showed original intention. There are some unreasonable drug-- using phenomenon in rural area, especially in the NRCMSI s area. So we should strengthen the management of the prescription behavior of rural doctors, and make the behavior criterion , and guarantee the lower price and safer medical service to peasants.