湖北省县、乡级公立医疗机构药物采购和配送现状研究

Study on the Current Status of Medicine Purchase and Distribution of County,Township Public Medical Institutions in Hubei Province

目的:分析湖北省县、乡级公立医疗机构药物采购与配送环节现状及存在的问题,提出相应政策建议。方法:采用分层典型抽样的方法,抽取湖北省3个县的3家县级医疗机构和40家乡级医疗机构2015年5月-2016年4月县卫生和计划生育委员会药物招标采购平台和医疗机构医院信息系统(HIS)的药物数据,分析各级别医疗卫生机构药物采购与配送总体情况及配送率;基本药物、中成药及注射药物采购和配送情况,采购金额排序前十的药物基本情况。结果:各乡级医疗机构院均采购与配送金额均低于县级医疗机构,但药物采购与配送总金额、药物整体配送率均高于县级医疗机构;基本药物采购金额约占采购总金额的3/4(其中乡级占比为90.6%、县级占比为48.4%),中成药采购金额约占采购总金额的1/4(其中乡级占比为35.4%,县级占比为15.4%);注射药物采购金额占采购总金额近一半(其中乡级占比为34.6%,县级占比为59.3%);乡级医疗机构基本药物、中成药和注射药物的配送率分别为93.0%、93.3%、93.2%,县级医疗机构分别为81.8%、78.6%、79.6%,乡级医疗机构药物配送率高于县级医疗机构;采购金额排序前十的药物中抗菌药物有6种,排序前五的药物中注射药物有2种。结论:湖北省基本药物采购政策落实较好,采购率符合省政策要求(40%~50%),但从注射药物采购比例反映出注射药物使用量较大,提示可能存在注射药物滥用的情况,同时,中成药采购成为药物采购中不可或缺的一部分。此外,药物配送仍存在不到位的情况,但乡级医疗机构药品配送情况优于县级医疗机构。

OBJECTIVE：To analyze the current status and problems of medicine purchase and distribution of county,township public medical institutions in Hubei province,and to propose targeted policy recommendations. METHODS：By stratified typical sampling,medicine data of 3 county medical institutions and 40 township medical institutions in 3 counties of Hubei province were collected from medicine bidding and purchasing platform of county health and family planning bureau and hospital information system（HIS）. Medicine purchase and distribution,distribution rate,purchase and distribution of essential medicine,Chinese patent medicine and injection,general information of top 10 medicines in the list of purchase amount were analyzed in different levels of medical institutions. RESULTS：The medicine purchase and distribution amount of the township medical institutions were lower than those of county medical institutions,but the total amount and distribution rate were higher than county medical institutions. The purchase amount of essential medicine accounted for nearly 3/4 of the total amount（90.6% of the township medical institutions,and 48.4% of the county medical institutions）;the purchase amount of Chinese patent medicine accounted for about 1/4 of the total amount（35.4% of the township medical institutions,15.4% of the county medical institutions）;purchase amount of injection accounted for nearly half（34.6% of the township medical institutions,and 59.3% of the county medical institutions）. The distribution rates of essential medicine,Chinese patent medicine and injection were 93.0%,93.3%,and 93.2%in township medical institutions,and 81.8%,78.6% and 79.6% in county medical institutions,respectively. The rate of medicine distribution of township medical institutions was higher than that of the county medical institutions. The top 10 medicines in the list of purchase amount included 6 kinds of antibiotics,and the top 5 medicines included 2 kinds of injection. CONCLUSIONS：The policy of essential medicine purchase is well implemented in Hubei province,and purchase rate of essential medicine meet the policy requirements（40%-50%）;but the proportion of injection purchase can partly reflect the high usage of injection,which may indicate the abuse of injection, and Chinese patent medicine has become an integral part of medicine purchase. Moreover,medicines still have the status of distribution untimely,and medicine distribution of the township medical institutions is better than that of county medical institutions.