西部农村基层医疗机构门诊处方中成药使用现状

Analysis of outpatients' prescriptions utilization of Chinese Patent Medicines in primary health institutions from rural western China

目的:通过分析西部农村基层医疗机构门诊处方数据,揭示中成药在农村地区使用中呈现的规律和问题。方法:选取2011年西部七个省(自治区)农村地区132家医疗机构的14 336张中成药处方数据,描述中成药使用的整体情况,比较不同级别和不同地域医疗机构对中成药使用的差异。结果:中成药处方占农村基层医疗机构处方总数的62.47%,县、乡、村级医疗机构这一比例分别为49.76%、56.96%和71.51%。县、乡、村级医疗机构单张处方使用中成药的品种数分别为1.38、1.91和2.54种,处方平均药费金额分别为52.20元、21.89元和19.37元,中成药基药使用率分别为37.25%、32.14%和25.79%。所有中成药处方中,86.84%由西医师开具,仅13.16%出自中医师,且中医师处方诊断存在西医化现象。结论:我国西部农村各级医疗机构中成药使用情况存在差异,随着医疗机构级别降低,使用中成药的品种数逐渐增多;县级医疗机构平均每张处方药费金额高于乡、村两级医疗机构。基层医疗机构中成药基药使用率低。中成药处方存在西医化现象。相关部门应根据农村各级医疗机构的具体需求和特点,完善中成药处方管理和质量控制。

Objective： This study aims to analyze the outpatient prescriptions in primary rural health institutions in western China to reveal the feature and disadvantages of utilization of Chinese patent medicines in rural areas. Methods： A total of 14336 prescriptions were selected from 132 health institutions in rural areas of 7 provinces in western China in 2011. The utilization of Chinese patent medicines is described and compared to the health institu- tions in different levels and different provinces/autonomous regions. Results： The prescriptions of Chinese patent medicines accounted for 62.47% of the total prescriptions in rural health facilities. The proportion of county, town- ship and village medical institutions was 49.76%, 56.96% and 71.51% respectively. 86.84% of the Chinese patent medicines prescriptions were prescribed by physicians without traditional Chinese medicine background, while only 13. 16% of them were traditional Chinese medicine physicians. The number of varieties of Chinese patent medicines in a single prescription in county, township and village health institutions were 1.38, 1.91 and 2.54, respectively and the average drug costs of every prescription in these health institutions were 52.20 yuan, 21.89 yuan and 19.37 yuan, re- spectively. Conclusions： There are ＇differences in the utilization of Chinese patent medicines in outpatient prescriptions of rural health institutions in western China. The hospitals in higher medical level use more Chinese patent medicines. The drug cost of the prescription of county health institutions is higher than that of township and village hospitals. Thisstudy suggests that health policy should be adjusted based on the specific needs and characteristics of rural health insti- tutions at a different level and should be implemented in the management of prescription in quality control.