Chuc N T, Tomson G
Department of Public Health Sciences, Division of International Health Care Research, Karolinska Institutet, Stockholm, Sweden.
Eur J Clin Pharmacol. 1999 Jun;55(4):325-32. doi: 10.1007/s002280050636.
Vietnam, a developing country, has had comparatively good health and human survival at low cost. The economic reform changed the health care system, and private pharmacies during the last 5 years have taken over a majority of the drug distribution. Problems include weaknesses in drug regulation and reported increases in antibiotic resistance. This case study, a purposive sample of two private pharmacies in Hanoi, explored management, including dispensing, inventory and financing, using the concept of triangulation. Observations and interviews of customers were complemented by stock inventory and interviews of the pharmacy staff. Drugs were classified according to the ATC code and the essential drug list of Vietnam. Pretested protocols were used. In all 1833 encounters were studied during the 2 weeks, out of which 286 were children. Less than 1% of customers came with prescriptions and 94.9% decided by themselves which drugs to buy. Antibiotics represented 17%, of which 90% were broad spectrum. Ampicillin dominated, both in children and adults. Some 50% of the antibiotics were given for 2.5 days or less. Less than 50% of the drugs were essential drugs (ED) on dispensing and even less on inventory. Antibiotics and vitamins were the most commonly sold drugs and, overall, brand names dominated. Little if any drug information was observed. Antibiotics were said to represent the most profitable drugs, according to the pharmacy staff. More than 20% of all products were combination drugs, including irrational and popular products with antibiotics and corticosteroids and combinations of aspirin, phenacetin and caffeine. This study shows an unexpectedly high proportion of customers, being "Tu Lam Bac Sy" (their own doctors), deciding themselves which drugs to buy. Although the "Doi moi" renovation has led to much improved drug availability, at least in urban setting, our case study highlights major problems in need of urgent actions. In particular the prevailing practices regarding antibiotics and combination drugs need to be seriously scrutinized and drug regulatory mechanisms should be enforced.
越南作为一个发展中国家，以低成本实现了相对良好的健康状况和人类生存水平。经济改革改变了医疗保健系统，在过去五年中，私人药店已接管了大部分药品分销业务。问题包括药品监管薄弱以及报道的抗生素耐药性增加。本案例研究以河内两家私人药店为有目的的样本，运用三角测量法探讨了管理情况，包括配药、库存和融资。对顾客的观察和访谈辅以库存盘点和对药店工作人员的访谈。药品根据解剖学治疗学及化学分类代码和越南基本药物清单进行分类。使用了预先测试的方案。在两周内共研究了1833次购药情况，其中286次涉及儿童。不到1%的顾客持处方购药，94.9%的顾客自行决定购买哪种药品。抗生素占17%，其中90%为广谱抗生素。氨苄西林在儿童和成人中都占主导地位。约50%的抗生素给药时间为2.5天或更短。配药时不到50%的药品为基本药物，库存中的比例更低。抗生素和维生素是最常销售的药品，总体而言，品牌药占主导。几乎没有观察到任何药品信息。据药店工作人员称，抗生素被认为是最赚钱的药品。所有产品中有超过20%是复方制剂，包括不合理的以及含抗生素和皮质类固醇的常用产品，还有阿司匹林、非那西丁和咖啡因的复方制剂。本研究显示，自行决定购买药品的顾客比例高得出乎意料，他们就像“自己的医生”。尽管“革新开放”带来了药品可及性的大幅改善，至少在城市地区是这样，但我们的案例研究凸显了亟需采取紧急行动的重大问题。特别是关于抗生素和复方制剂的普遍做法需要受到严格审查，药品监管机制应得到加强。
