县级公立医院基本药物目录实施及相关问题研究

Study on Implementation of National Essential Medicines in Public Hospitals at County Level and Related Problems

目的评价县级公立医院两版《国家基本药物目录》实施前后相关监测指标的变化,研究患者是否在改革中受益,为深化基本药物制度改革提供参考。方法选择6家县级公立医院,比较2009年和2012年两版《国家基本药物目录》实施前后的四大项目14个监测指标的变化。结果实施前后,药品结构变化显著,基本药物占比6家医院都显著提高、抗菌药物占比和药品占比分别有4家和2医院显著下降,差异均有统计学意义(P<0.05)。抗菌药物应用管理4项指标都得到了较好控制,除住院患者抗菌药物使用强度下降差异无统计学意义外,其余3项指标均有2-3家医院显著下降,差异有统计学意义(P<0.05)。不合格处方占全部处方比例5家医院明显下降,其中3家差异有统计学意义(P<0.05)。患者负担的4项费用指标都有不同程度的上升,门诊和住院病人的均次药品费虽变化不大,但病人均次费用6家医院全部上升,分别各有4家和3家医院显著升高,差异有统计学意义(P<0.05)。结论 2012年版目录实施对县级公立医院改变用药结构、促进合理用药产生了较大的影响,但对减轻患者医疗负担作用不大。

Objective To evaluate the changes of monitoring indicators before and after the implementation of new national essential medicines list in public hospitals at county level and whether patients had benefited from the reform so as to provide reference for further reform of the essential medicines system. Method Compared 14 monitoring indicators before and after the implementation of the national essential medicines list （2009 and 2012 version） in the six public hospitals at county level. Results After the reform, there was a significant change in drug use structure. There has been a significant increase of the essential drug use proportion in six hospitals, which was of statistical difference （P〈0.05）. The antibiotics use proportion decreased significantly in four hospitals and drug cost proportion declined significantly in two hospitals with statistical difference （P〈0.05）. Four monitoring indicators of antimicrobial drug management had been well controlled. Except antibiotic use intensity of inpatients, the other three monitoring indicators had declined significantly in two or three hospitals, which was of statistical difference （P〈0.05）. The unqualified prescriptions in five hospitals had declined significantly and three out of five had statistical difference （P〈0.05）. Although the average drug expense had little changed in outpatients and inpatients, the average medical expense in six hospitals had raised. The outpatient medical expense of four hospitals and inpatient medical expense of three hospitals increased significantly, which was of statistical difference （P〈0.05）. Conclusion The implementation of national essential medicines list 2012 had changed the drug use structure and promoted rational use of medicines. However, it had little effect on reducing patients＇ medical expense.