West China School of Public Health, Sichuan University, No,17 Section 3 South Renmin Road, Chengdu, Sichuan, China.
BMC Health Serv Res. 2012 Sep 18;12:324. doi: 10.1186/1472-6963-12-324.
Sichuan Province is an agricultural and economically developing province in western China. To understand practices of prescribing medications for outpatients in rural township health centers is important for the development of the rural medical and health services in this province and western China.
This is an observational study based on data from the 4th National Health Services Survey of China. A total of 3,059 prescriptions from 30 township health centers in Sichuan Province were collected and analyzed. Seven indicators were employed in the analyses to characterize the prescription practices. They are disease distribution, average cost per encounter, number of medications per encounter, percentage of encounters with antibiotics, percentage of encounters with glucocorticoids, percentage of encounters with combined glucocorticoids and antibiotics, and percentage of encounters with injections.
The average medication cost per encounter was 16.30 Yuan ($2.59). About 60% of the prescriptions contained Chinese patent medicine (CPM), and almost all prescriptions (98.07%) contained western medicine. 85.18% of the prescriptions contained antibiotics, of which, 24.98% contained two or more types of antibiotics; the percentage of prescriptions with glucocorticoids was 19.99%; the percentage of prescriptions with both glucocorticoids and antibiotics was 16.67%; 51.40% of the prescriptions included injections, of which, 39.90% included two or more injections.
The findings from this study demonstrated irrational medication uses of antibiotics, glucocorticoids and injections prescribed for outpatients in the rural township health centers in Sichuan Province. The reasons for irrational medication uses are not only solely due to the pursuit of maximizing benefits in the township health centers, but also more likely attributable to the lack of medical knowledge of rational medication uses among rural doctors and the lack of medical devices for disease diagnosis in those township health centers. The policy implication from this study is to enhance professional training in rational medication uses for rural doctors, improve hardware facilities for township health centers, promote health education to rural residents and establish a public reporting system to monitor prescription practices in rural township health centers, etc.
四川省是中国西部的一个农业和经济发展省份。了解农村乡镇卫生院门诊用药情况，对该省乃至中国西部农村医疗卫生事业的发展具有重要意义。
本研究基于中国第四次国家卫生服务调查数据，共收集四川省 30 个乡镇卫生院的 3059 张处方进行分析。采用 7 项指标描述处方行为，分别为疾病分布、每次就诊平均费用、每次就诊用药品种数、抗生素使用率、糖皮质激素使用率、联合使用糖皮质激素和抗生素的处方比例、注射剂使用率。
每次就诊的平均药物费用为 16.30 元（2.59 美元）。约 60%的处方含有中药（CPM），几乎所有处方（98.07%）均含有西药。85.18%的处方含有抗生素，其中 24.98%含有两种或两种以上类型的抗生素；糖皮质激素处方比例为 19.99%；同时使用糖皮质激素和抗生素的处方比例为 16.67%；51.40%的处方包含注射剂，其中 39.90%包含两种或两种以上注射剂。
本研究结果表明，四川省农村乡镇卫生院门诊患者抗生素、糖皮质激素和注射剂的使用不合理。不合理用药的原因不仅是乡镇卫生院追求利益最大化，还可能是由于农村医生缺乏合理用药知识，乡镇卫生院缺乏疾病诊断的医疗设备。本研究的政策意义在于加强农村医生合理用药的专业培训，改善乡镇卫生院的硬件设施，向农村居民开展健康教育，建立乡镇卫生院处方行为监测的公开报告制度等。
