目的：了解基本药物制度背景下某市基层医疗机构门诊处方用药情况及其影响因素。方法于2013年对山东省某市6个县的基层医疗机构进行处方抽样，共收集有效处方3152张。运用课题组编制的合理用药评价指标体系对该市基层医疗机构门诊处方用药进行评价。采用多元回归分析、因子分析、路径分析的方法识别处方合理用药的影响因素及各因素间的相互关系。结果经帕累托图分析发现，该市基层医疗机构91.2%的医务人员处方用药合理性得分为“中”及以上。因子分析共纳入3个公因子；经多元逐步回归分析，影响处方用药合理性的因素包括患者要求因素、医生评价因素以及管理因素；路径分析显示，患者要求因素、医生评价因素以及管理因素都对基层医疗机构门诊处方用药合理性产生了直接的影响，其直接影响系数分别为-0.457、0.299和0.278。结论该市基层医疗机构门诊处方用药合理性得分总体较好，但仍有提升空间。各影响因素中，患者要求因素对门诊处方用药合理性产生的直接影响最大且为负。%Objective This article researches the outpatient prescription medication at primary medical institutions u-nit and its main influencing factors under the background of the essential medicine system. Methods By prescription sampling from the primary medical institutions in 6 counties of Shandong province,3 152 effective prescriptions were collected and evalua-ted by the self - designed rational use of medication indeX system and then identified various influencing factors and their correla-tion with each other by multiple regression analysis,factor analysis and path analysis. Results Pareto chart analysis showed that 91. 2% of the doctors at primary medical institutions scored " medium" or above in the item of rational use of prescription medi-cation. Factor analysis got three common factors in all. Multiple regression analysis showed that patientsˊ requirement,doctorsˊ e-valuation and management were the three influencing factors for the rational drug use. Path analysis showed that these three factors had direct influence and the influencing coefficients were - 0. 457,0. 299 and 0. 278 respectively. Conclusion Most of the doc-torsˊ scores in the item of rationality of outpatient medication at primary medical institutions are good,but it can still be im-proved. The element of patientsˊ requirement has the greatest direct influence and it is negative.
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