中国基本药物制度对合理用药的影响:基层医疗机构横断面研究

摘要

Irrational use of medicines is a major problem worldwide,and it is believed there would be positive correlation between the National Essential Medicines Policies (NEMPs) and the level of rational use of medicines (RUMs).Though there is some early evidence on the NEMPs' effects on RUMs in China,the evidence is scarce,and conclusions vary.In the present study,we aimed to evaluate the impacts of the NEMPs of China on the RUMs in the primary health care institutions (PHCs).A cross-sectional survey was conducted in 2010.A total of 201 PHCs from six provinces of China were selected,and 39 181 prescriptions were extracted from January to June,2010.Six indicators were used and tested by independent-samples T test.We found that the average number of drugs per prescription in PHCs with NEMP implementation (the treatment group) was significantly higher than that of the group without NEMP implementation (the control group) (3.37 vs.2.83,P＜0.01).There was no significant difference in the average cost per prescription (81.43 vs.75.02).The percentage of prescriptions,including an antibiotic (53.40％ vs.36.48％,P＜0.01) or an injection (40.54％ vs.27.94％,P＜0.01),was higher in the treatment group,and the percentage of drugs prescribed by general name was significantly lower (83.71％ vs.93.11％,P＜0.01).For the percentage of drugs prescribed from essential medicines list,the treatment group exhibited the higher ratio (76.12％ vs.53.45％,P＜0.01).From this study,the NEMPs were not likely to have a positive impact on RUMs.China still needed efforts to improve the selection,the absence of physicians' active involvement,and the patients' habits of irrational medication use.%不合理用药是重要的全球公共卫生问题,许多人认为国家基本药物制度会对合理用药有积极影响.目前,已有一些关于中国基本药物制度对合理用药影响的研究,但是仍缺乏证据且已有研究结论也有很大差异.本研究旨在评价中国基本药物制度对基层医疗机构合理用药的影响.研究在2010年对6个省、201个基层医疗机构进行调查,抽取各机构2010年1月-6月处方共39181张.研究对6项合理用药评价指标进行描述性统计,并采用独立样本t检验对于组间差异进行比较.基于调查结果,研究发现实施基本药物制度的基层医疗机构(实验组)每处方药品数显著高于未实施政策的机构(对照组)(3.37 vs 2.83,P＜0.01),每处方费用没有显著差异(81.43 vs 75.02).实验组的抗菌药处方率(53.40％ vs 36.48％,P＜0.01)和注射剂处方率(40.54％ vs 27.94％,P＜0.01)较对照组显著更高,通用名药物处方率显著更低(83.71％vs 93.11％,P＜0.01).但实验组的基本药物处方率较对照组显著更高(76.12％ vs 53.45％,P＜0.01).通过本研究发现,中国的基本药物制度对合理用药未产生显著的积极影响.国家仍需解决基本药物遴选效率低下、医生未能积极参与到政策实施中和患者长期以来的不合理用药习惯等问题.