基本药物制度实施前后山东省某市村卫生室抗菌药物应用情况分析

Use of Antibiotics in Village Clinics before and after the Implementation of Essential Medicine Policy in Shandong Province

目的了解基本药物制度实施前后山东省某市村卫生室抗菌药物的应用现状及存在的问题,以减少村卫生室抗菌药物的不合理使用。方法 2013年5月采用分层随机抽样方法,以山东省某市六个县区的54个村卫生室为样本,共抽取处方1 467张,其中实施前处方686张,实施后处方781张,分析抗菌药物处方率和使用率,并采用多元线性回归分析抗菌药物使用率的影响因素。结果基本药物制度实施后,抗菌药物处方率由76.4%降至64.3%;抗菌药物静脉给药处方率由63.5%降到了48.8%;头孢菌素类与其他类抗菌药物联用处方率由56.8%降低到41.0%;青霉素类抗菌药物的使用率由16.7%升高到22.7%。影响抗菌药物使用率的因素主要包括:《国家基本药物制度临床应用指南》配备情况、有关药物知识的学习情况、抗菌药物管理制度及执行效果、医务人员收入满意度以及其工作年限。结论基本药物制度的实施一定程度上促进了村卫生室的合理用药,但是仍存在抗菌药物选择档次过高、联用品种复杂、给药方式不合理等现象,亟待加强监管和进一步规范。

Objective This article analyses the present situation and existing problems of antibiotics application in village clinics in Shandong province before and after the implementation of national essential medicine system,so as to provide reference for the practice of the intervention measures to reduce the irrational use of antibiotics in village clinics.Methods Stratified random sampling method was used to determine the research objects.A total of 1 467 prescriptions chosen from 54 village clinics in 6 counties in which 686 were pre-implementations,781 were post-implementations,was extracted to analyze the prescription rate and use rate of antibiotics.Multiple linear regression analysis was used to evaluate the influence factors over antibiotics usage.Results After the implementation of national essential medicine system,the rates of antibiotic application,intravenous drip,cephalosporin class of antimicrobial agents and other types of antibacterial drug combination,dropped from 76.4％ to 64.3％,63.5％ to 48.8％,56.8％ to 41.0％ respectively; But the use rate of penicillin increased from 16.7％ to 22.7％.Multiple linear regression analysis indicated that the factors influencing antibacterial drugs use mainly included equipment of The Basic Drug System in Our Country Clinical Guidelines,relevant drug knowledge training,the management of antimicrobial agents and its implementation effect,medical workers＇ income satisfaction as well as their working years in rural place.Conclusion The implementation of essential medicines system partly promotes the rational antibiotics usage in village clinics but with some unreasonable phenomena including the selection of over high-grade drugs,complicated joint drugs and improper administration regimens which are in high need of supervision and further standardization.