实施国家基本药物制度前后汕头市潮南区基层医疗卫生机构临床用药情况调查

Investigation of the Situation of Drug Use in Primary Health Care Institutions of Shantou Chaonan District before and after the Implementation of National Essential Medicine System

目的:了解实施国家基本药物制度(NEMS)后基层医疗卫生机构临床用药行为的变化,为促进NEMS在基层医疗卫生机构的顺利实施和合理用药提供参考。方法:回顾性对比分析实施NEMS前、后汕头市潮南区3家基层医疗卫生机构(卫生院A、B和1家村卫生站)患者药品费用和单病种药费等指标,通过指标变化探讨实施NEMS后用药行为的变化及对经济效益和社会效益的影响。结果:实施NEMS后,2家卫生院的用药指标均有明显改善,其中卫生院B的用药总比例由64.1%下降为37.6%,人均日住院药费由153.18元降为73.55元,下降幅度达52.0%;卫生院A、B疝修补术的药费比例下降幅度分别为47.1%和59.1%,抗菌药物费用比例下降幅度分别为50.5%和38.4%,急性阑尾炎的药费比例下降幅度分别为23.4%和30.9%,抗菌药物费用比例下降幅度分别为33.7%和23.3%。2家卫生院疝修补术抗菌药物二联使用率下降幅度分别为83.5%和80.8%,急性阑尾炎的三联使用率下降幅度分别为29.5%和25.9%。结论:NEMS的实施明显减轻了患者药费负担,也促进了合理用药。在没有药品利润收入的情况下,政府部门应尽快解决、完善补偿机制,同时基层医疗卫生机构也应加强自身改革,调动人员积极性,加大NEMS宣传力度,使NEMS真正惠及于民。

OBJECTIVE： To investigate the changes of medication behavior in primary health care institutions （PHCI） after the implementation of national essential medicine system （NEMS）, and to provide reference for the implementation of NEMS and ratio- nal drug use in PHCI. METHODS ： Drug cost and expenditure of single disease and other index in 3 PHCI of Shantou Chaonan dis- trict （hospital A and B, village health station） were analyzed retrospectively before and after the implementation of NEMS. The changes of medication behavior before and after the implementation of NEMS were investigated by above index, and the effects of NEMS on economic and social benefits were also studied. RESULTS： After implementation of NEMS, the medication indexes of 2 hospitals were improved obviously, and total proportion of medicines use decreased from 64.1% to 37.6% in hospital B and hospi- talization cost per capita decreased from 153.18 yuan to 73.55 yuan, decreasing by 52.0%. The decrease extent of medicine cost of herniorrhaphy were 47.1% and 59.1% respectively in 2 hospitals; those of antimicrobial drugs were 50.5% and 38.4% and medi- cine cost of acute appendicitis decreased by 23.4% and 30.9% ; that of antimicrobial drugs decreased by 33.7% and 23.3%. The rate of two-medicine use for herniorrhaphy decreased by 83.5% and 80.8% in 2 hospitals, and that of three-medicine use for acute appendicitis decreased by 29.5% and 25.9 %. CONCLUSIONS： Medicine cost has decreased obviously to patients after implementa- tion of NEMS, and rational use of medicines has also been improved. Government departments should fulfill quickly compensatory system without drug profits income, PHCI must also strengthen itself reformation, mobilize staff enthusiasm and enhance spreading and propaganda to make sure NEMS truly benefit people.