中国国家基本药物制度对改善基层医疗卫生机构合理用药的影响：一项在四个省份开展的实证研究
The impact of China's national essential medicine system on improving rational drug use in primary health care facilities: an empirical study in four provinces.
作者信息
Song Yan, Bian Ying, Petzold Max, Li Lingui, Yin Aitian
机构信息
State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Av. Padre Tomás Pereira Taipa, Macau, China.
Sahlgrenska Academy, University of Gothenburg, Box 100, S-405 30, Gothenburg, Sweden.
出版信息
BMC Health Serv Res. 2014 Oct 25;14:507. doi: 10.1186/s12913-014-0507-3.
BACKGROUND
The National Essential Medicine System (NEMS) is a new policy in China launched in 2009 to improve the appropriate use of medications. This study aims to examine the outcomes of the NEMS objectives in terms of the rational use of medicines in primary health care facilities in China.
METHODS
A total of 28,651 prescriptions were collected from 146 township health centers in four provinces of China by means of a field survey conducted in 2010-2011. Indicators of rational drug use were extracted and compared using a pre/post design and then evaluated with regard to the World Health Organization (WHO) Standard Guidelines and data from previous research.
RESULTS
The average number of drugs per prescription decreased from 3.64 to 3.46 (p < 0.01) between 2009 and 2010. Little effect was found for the NEMS on the average number of antibiotics per prescription, but the percentage of prescriptions including antibiotics decreased from 60.26 to 58.48% (p < 0.01). Prescriptions for injections or adrenal corticosteroids also decreased, to 40.31 and 11.16% of all prescriptions, respectively. All these positive issues were also recorded in 2011. However, each of the above values remained higher than WHO standards. The percentage of drugs prescribed from the Essential Drug List increased after the implementation of the NEMS (p < 0.01). Where the available data allowed changes in costs to be assessed, the average expense per prescription increased significantly, from 25.77 to 27.09 yuan (p < 0.01).
CONCLUSIONS
The NEMS effectively improved rational medicine use in China. However, polypharmacy and the over-prescription of antibiotics and injections remain common. There is still a large unfinished agenda requiring policy improvements. Treatment guidelines, intensive support supervision, and continuing training for both professionals and consumers are the essential actions that need to be taken.
背景
国家基本药物制度（NEMS）是中国2009年推出的一项新政策，旨在改善药物的合理使用。本研究旨在考察中国基层医疗卫生机构在合理用药方面国家基本药物制度目标的实施效果。
方法
2010 - 2011年通过实地调查从中国四个省份的146个乡镇卫生院收集了总共28651张处方。采用前后设计提取并比较合理用药指标，然后根据世界卫生组织（WHO）标准指南和以往研究数据进行评估。
结果
2009年至2010年期间，每张处方的平均用药数量从3.64降至3.46（p < 0.01）。国家基本药物制度对每张处方的抗生素平均数量影响不大，但包含抗生素的处方比例从60.26%降至58.48%（p < 0.01）。注射剂或肾上腺皮质激素的处方也有所减少，分别降至所有处方的40.31%和11.16%。2011年也记录到了所有这些积极变化。然而，上述各项数值均仍高于世界卫生组织标准。实施国家基本药物制度后，基本药物目录中所列药物的处方比例有所增加（p < 0.01）。在可评估成本变化的可用数据方面，每张处方的平均费用显著增加，从25.77元增至27.09元（p < 0.01）。
结论
国家基本药物制度有效改善了中国的合理用药情况。然而，多药联用以及抗生素和注射剂的过度处方仍然普遍。仍有大量未完成的议程需要政策改进。治疗指南、强化支持监督以及针对专业人员和消费者的持续培训是需要采取的关键行动。
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