聊城市乡镇卫生院抗菌药物不合理使用原因研究

Study on Causes of Inappropriate Use of Antibacterials in Township Health Centers in Liaocheng

目的:分析聊城市乡镇卫生院抗菌药物不合理使用的原因,为制定合理的抗菌药物管理措施提供参考。方法:采用分层抽样法抽取18位聊城市乡镇卫生院的医务人员进行半结构式访谈。结果:导致乡镇卫生院抗菌药物不合理使用的因素包含组织、规制、劝服和筹资4个方面。在组织方面,药事管理委员会未完全发挥作用,乡镇卫生院基础建设落后;在规制方面,处方点评制度未规范实施,抗菌药物分级管理政策未落实;在劝服方面,缺乏抗菌药物合理使用的培训,已有培训内容与现实需求存在差距;在筹资方面,血常规检查项目医保报销比例较低。结论:聊城市乡镇卫生院抗菌药物不合理使用的原因主要集中在组织、规制、劝服和筹资方面,应建立或完善药事管理委员会制度,保证处方点评制度规范实施,合理定制医生的培训计划,同时应加强乡镇卫生院的基础建设以辅助医生诊疗。

Objective:To analyze the causes of inappropriate use of antibacterials in township health centers in Liaocheng,so as to provide references for formulating the reasonable antibacterials stewardship.Methods:The semi-structured interviews were conducted among 18 medical staff in township health centers in Liaocheng by using stratified sampling.Results:The factors causing the inappropriate use of antimicrobials were comprised of organization,regulation,persuasion and financing.In terms of organization,the pharmaceutical management committee did not play its role completely and the basic construction of township health centers was backward.In terms of regulation,the implementation of prescription comment system was not standardized and the antimi-crobial classification management policy was not put into effect.In terms of persuasion,there was lack of training for the rational use of antibacterials and there was a gap between the existing training content and the actual demand.In terms of financing,the proportion of medical insurance reimbursement for blood routine examination items was low.Conclusion:The main causes of inappropriate use of antibacterials in township health centers in Liaocheng include organization,regulation,persuasion and financing.It is recommended to establish or improve the system of pharmaceutical management committee,implement the prescription comment system in a standard way and reasonably customize the training plans of doctors.In addition,the infrastructure of township health centers should be strengthened to assist doctors in diagnosis and treatment.