陕西省基层医疗卫生机构基本药物制度实施效果评估研究

摘要

目的：分析陕西省基层医疗机构基本药物制度实施情况，为完善相关政策提供实证依据与对策建议。方法采用分层抽样的方法选取陕西省基层医疗机构样本，监测陕西省2012年基层医疗机构基本药物制度实施情况，具体指标包括样本医疗机构基本药物的配备、采购、缺断货、中标情况以及合理用药等。结果陕西省基层医疗机构基本药物的配备率为100%。所配备的基本药物中，按品种计，国家基本药物、陕西省增补基本药物和陕西省县区增补的基本药物所占的比例依次为67.2%、26.0%、6.8%；陕西省基层医疗机构基本药物采购金额中，国家基本药物、陕西省增补基本药物和陕西省县区增补基本药物所占的比例依次为67.5%、23.5%、9.0%；80%的样本机构存在不同程度的药品缺(断)货情况；基本药物招标尚存在一些问题。陕西省基层医疗机构合理用药的各项指标情况：注射类药物处方率为27%，二联及以上抗菌药物处方率为12%，激素类药物的处方率为6%。结论陕西省基层医疗机构基本药物的采购和配备情况良好，但是多数机构存在不同程度的药品缺(断)货现象，合理用药水平还需进一步提高。建议不断加强药品供应监督管理，做好药品招标采购和缺(断)货的管理工作，加大基本药物宣传力度，提高基层医疗机构合理用药水平，促进基本药物制度的不断巩固和完善，使其更加惠及百姓。%Objective To analyze the implementation of Essential Medicine Policy in grassroots medical institutions in Shaanxi Province,and to provide empirical evidence and suggestions to improve relevant policies.Methods Stratified random sampling method was used to choose the institution samples, and questionnaire survey was conducted to study the implementation of Essential Medicine Policy in 2012. Indicators included the variety and amount of essential medicines procured, the medicine shortage condition and the rate of winning the bid for essential medicine and more information about rational drug use.Results In the sample grassroots medical institutions,the rate of essential medcines equipping amounted to 100%.As for the variety of essential medicines, national, provincial and county-level essential medicines accounted for 67.2%, 26.0% and 6.8%, respectively;the percentages of procurement amount of national essential medicines, provincial and county-level essential medicines were 67.5%, 23.5% and 9.0%, respectively.Totally 80% of grassroots medical institutions faced the shortage of medicines in different extent. There were 35 kinds of essential drugs in urgent needs that were out of bid;the ratios of injection prescriptions, prescriptions with two or more combined use of antibiotics and steroids prescriptions in all prescriptions were 27%, 12% and 6%,respectively.Conclusion The medicine supply and procurement in grassroots medical institutions are in good condition,however,more attention needs to be paid to medicine shortage and rational drug use.We should take measurements to strengthen supervision and management of drug supply and increase publicity of rational drug use and essential medicines in grassroots medical institutions to improve the implementation of Essential Medicine Policy which will finally benefit people.