北京市城区全科医生基本药物处方行为的定性研究

Essential Medicine Prescribing Behaviors of Urban General Practitioners in Beijing:a Qualitative Study

背景随着我国医疗花费的不断增加,国家基本药物制度在降低医疗费用、减轻患者医疗负担上的作用也更加凸显,因此国务院办公厅明确指出要强化基本药物的使用,坚持以基本药物为主导,为基层首诊提供用药保障。目的 了解北京市城区全科医生基本药物处方行为的现状,为国家基本药物制度在基层医疗卫生机构的实施和推广提供参考。方法 于2020年1—3月,采用目的抽样法选取北京市城区17家基层医疗卫生机构的17名全科医生作为研究对象,通过微信语音的形式分别对其进行个人深入访谈,访谈时间控制在30 min以内。通过内容分析法对访谈资料进行分析。结果 14例(82.3%)全科医生基本药物处方比例为50%~60%。对访谈资料进行分析后共提炼出6个访谈主题:全科医生对基本药物制度的了解程度普遍偏低;基层医疗机构药品供应不及时;缺乏对基本药物有效性和安全性的监测随访;基本药物无法完全满足全科医生的临床用药需求;基本药物与原研药医保报销比例无差异,不利于基本药物的推广;患者对基本药物的选择偏好较低。结论 目前北京市城区全科医生基本药物处方比例不高,基本药物制度实施过程存在不足,因此完善基本药物制度的相关政策、提高全科医生及居民对基本药物的认知程度是进一步提高全科医生基本药物处方行为的有效措施。

Background The role of China's national essential medicine system(NEMS)has been highlighted by its implementation effects on easing patient burden of healthcare costs via reducing the increased medical expenses.The General Office of the State Council of the People's Republic of China,clearly stated that the determined functions of essential medicines shall be strengthened,priority shall be given to the use of essential medicines for drug treatment,and the provision of essential medicines for initial treatment in primary care shall be ensured.Objective To investigate essential medicine prescribing behaviors in urban general practitioners(GPs)in Beijing,to provide a reference for the implementation and promotion of the NEMS in primary care.Methods Purposive sampling was used to select 17 GPs from 17 urban community health centers in Beijing from January to March 2020.Individual in-depth interviews were conducted with voice call in WeChat,and each interview was kept under 30 minutes.The interview data were analyzed through content analysis.Results In all,82.3%(14/17)of the GPs said that essential medicines prescriptions accounted for 50%-60%of the total prescriptions written by them.Six themes were identified:GPs had a low level of understanding of the NEMS;The supply of medicines in primary care was not timely;There was a lack of surveillance and follow-up for effectiveness and safety of essential medicines;The available essential medicines could not fully meet the clinical needs in primary care;The health insurance reimbursement for cost of essential medicines was similar to that for the cost of originally developed medicines,negatively affecting the promotion of the use ofessential medicines;Patients showed a low preference for essential medicines.Conclusion In Beijing,the proportion of essential medicine prescriptions written by urban GPs was not high,and the implementation of the NEMS needs to be improved.To further improve essential medicine prescribing behaviors of GPs,it is suggested to modify the policies related to the NEMS,and enhance the awareness levels of GPs and residents.