乡村一体化制度下基层医疗机构药品使用现状分析

Utilization of Essential Medicines at Primary Medical Institutions under the Regime of Rural Integration

目的通过对基层医疗机构药物使用现状的调查,了解基本药物制度实施以来基层医疗机构药物使用存在的问题与不足,为健全药物使用提供建议。方法选取辽宁省、河北省共8家基层医疗机构(包括2家县医院、4家乡镇卫生院及2家村卫生室)2010—2012年度药品购销详细目录、3家卫生局的相关政策文件进行分析。具体分析指标有基本药物使用率、药品年均销售量、年均销售额、常用剂型等。同时,对这11家医疗卫生机构的相关人员进行访谈。结果县医院、乡镇卫生院及村卫生室基本药物使用率分别为36.8%、89.8%、89.2%。调研对象普遍认为,基本药物目录中常用药品少、低价位药品少、知名药品少等。目前只有县级医疗机构存在药品加价率,县级医疗机构药品的年均利润占总销售额的25.3%,各院间加价标准未统一,调研对象普遍认为药品加价率的差异与县级医疗机构药品加价率未制定统一标准关系密切。三级医疗机构药品销售量前十名中,注射剂销售种类所占比例分别为70.0%、50.0%及90.0%,抗微生物药物销售种类所占比例分别为10.0%、40.0%、30.0%。结论基本药物目录与基层医疗机构的临床需求存在差异,应改善基本药物的遴选;各地药品价格、补偿机制实施混乱,应完善药品价格及补偿机制;药物使用存在不合理使用抗生素及注射液的问题,应规范医生处方行为,提高基本药物宣传力度。

Objective To study the usage of essential medicines at primary medical institutions and find out the eXist-ing problems and insufficiency after the implementation of essential medicine system so as to provide a reference for improvement of the usage of medicine. Methods Detailed buying and selling catalogue of medications during 2010-2012 of 8 primary medical institutions in Liaoning and Hebei provinces and relevant documents and policies of 3 health institutions were selected for statistical analysis of the usage rate of essential drugs,average annual sale volume and average annual sales and the commonly used drug formulation. At the same time,the relevant personnel in the 11 health institutions were interviewed. Results The usage rate of essential medicines in county hospitals,township hospitals and village clinics were 36. 8% ,89. 8% and 89. 2% respective-ly. The subjects investigated generally thought that common medicines,low priced medicines and well - known medicines were in little proportion of the essential medicine in the catalogue. Only county hospitals had the phenomenon of drug price addition and the annual profit of medicines accounted for 25. 3% of the total but without unified addition standard,which,according to the subjects who were investigated,brought about the difference of addition rate. The proportion of the usage of injections and antibi-otics were 70. 0% ,50. 0% ,90. 0% and 10. 0% ,40. 0% ,30. 0% respectively in the top ten sales of drugs in the tertiary medical institutes. Conclusion The essential medicines listed in the catalogue cannot satisfy clinical needs and the tender selec-tion of essential medicines needs improvement. Drug price and compensation mechanism are in chaos from region to region,so it also needs improvement. Because of the eXisting unreasonable use of antibiotics and injections,we should normalize doctorsˊ pre-scription behavior and improve propaganda of essential medicines.