基本药物制度实施前后山东省基层医疗机构抗生素处方分析

Analysis of antibiotics prescriptions at primary medical institutions before and after the implementation of essential medicine policy in Shandong province

目的：分析基本药物制度实施前后山东省基层医疗机构的抗生素门诊处方,为今后规范基层医务人员抗生素处方行为提供干预重点和建议。方法采用多阶段分层随机抽样方法,在山东省5市18个县（市、区）的基层医疗机构共抽取门诊处方6962张,其中实施前处方2809张,实施后处方4153张,用解剖学治疗学及化学分类系统（anatomical therapeutic chemical,ATC）对抗生素药品进行分类,分析基本药物制度实施前后山东省基层医疗机构的抗生素处方情况。结果门诊处方中抗生素使用率由实施前的54.36%降至实施后的50.66%,联合用药率由29.40%降至28.09%。村卫生室在上述2方面的比率均高于乡镇卫生院和社区卫生服务机构。基本药物制度实施前,处方中使用最多的为广谱青霉素类抗生素（12.82%）；实施后为林可酰胺类（11.24%）。基本药物制度实施前后基层医疗机构常用的前10类抗生素药品中,阿莫西林均居于首位,分别占11.45%、10.15%。结论基本药物制度的实施一定程度上促进了基层医疗机构的合理用药,但仍存在抗生素滥用及使用不当现象,村卫生室更为显著,亟待加强监管和进一步规范抗生素处方行为。

Objective This article surveyed the antibiotics prescriptions at primary medical institutions before and after the implementation of the essential medicine policy in Shandong Province, and advised on intervention emphasis to regulate antibiotics use at such institutions.Methods Multi-stage stratified random sampling was called into play.A total of 6 962 outpatient prescriptions from 18 counties were sampled,in which 2 809 were made before the implementation and 4 1 53 after.The antibiotic drugs were classified using the anatomical therapeutic chemical （ATC）to study the utilization of antibiotics at primary medical institutions.Results After the implementation,the prescription rates of antibiotics of outpatient prescriptions decreased from 54.36% to 50.66%,while drug combination from 29.40% to 28.09%.The percentage of the above two at village clinics was found higher than township hospitals and community health centers.Before the implementation,antibiotics of the highest usage was broad-spectrum penicillin （12.82%）,while that after the implementation was a lincosamides antibiotic （1 1.24%）.Of the top ten antibiotics popular with primary medical institutions before and after the implementation,Amoxicillin always ranks the highest,accounting for 1 1.45% and 10.1 5% respectively. Conclusion The implementation of the essential medicines system has promoted rational antibiotics usage at primary medical institutions to some extent.But abuse of antibiotics is still found,especially at village clinics,which calls for further regulation and supervision.