Mao Wenhui, Vu Huyen, Xie Zening, Chen Wen, Tang Shenglan
School of Public Health, Fudan University, P.O. Box 187, 138 Yi Xue Yuan Road, 200032, Shanghai, China.
Duke Global Health Institute, Duke University, 310 Trent Drive, 27708, Durham, NC, USA.
PLoS One. 2015 Mar 20;10(3):e0117710. doi: 10.1371/journal.pone.0117710. eCollection 2015.
Irrational use of medicines has been an issue concerned all over the world and the outlooks in developing countries are more severe. This study aimed to assess the different patterns of irrational use of medicines and its influential factors in China and Vietnam.
A systematic review was performed on both published and grey literatures in English, Chinese and Vietnamese languages between 1993 and 2013 based on the WHO framework. Quality assessment was conducted on the basis of the Critical Appraisal Skills Programme. Key indicators were analyzed to compare the irrational use of medicines in two countries.
A total of 67 published works about China and 29 about Vietnam were included, the majority of which were cross-sectional prescription studies in both China and Vietnam. Irrational use of medicines was found in both the countries but issues with polypharmacy as well as overuse of antibiotics were more severe in Vietnam while overuse of injections was unique to China. Various patterns of irrational use were also indicated between urban and rural areas, and among different levels of hospitals. Rarely does literature focus on the analysis of influential factors of irrational use of medicines. While lack of proper knowledge from both providers and patients were the most recognized influential factors in both countries, economic incentives from pharmaceutical companies in China, and weak control and regulation over prescriptions in Vietnam were the main factors attributed to this issue.
Severe irrational use of medicines has been abundantly evidenced in both China and Vietnam, highlighting the importance of policy interventions on the issue. However, limited evidence on the appropriateness or its compliance (conformity) to guidelines of prescription has been found. In addition, convincing evidence on the underlying explanation of this issue is lacking, although economic incentives, health insurance coverage, and knowledge of service providers and users have been implied to be factors influencing irrational drug use.
药品的不合理使用一直是全球关注的问题，在发展中国家情况更为严峻。本研究旨在评估中国和越南药品不合理使用的不同模式及其影响因素。
基于世界卫生组织的框架，对1993年至2013年间以英文、中文和越南文发表的文献及灰色文献进行系统综述。依据批判性评估技能计划进行质量评估。分析关键指标以比较两国药品的不合理使用情况。
共纳入67篇关于中国的已发表作品和29篇关于越南的已发表作品，其中大部分是中国和越南的横断面处方研究。两国均存在药品不合理使用的情况，但越南的多药联用及抗生素过度使用问题更为严重，而注射剂过度使用是中国特有的问题。城乡之间以及不同级别医院之间也存在各种不合理使用模式。很少有文献关注药品不合理使用影响因素的分析。虽然医护人员和患者缺乏相关知识在两国都是最公认的影响因素，但中国制药公司的经济激励以及越南对处方的管控薄弱是导致该问题的主要因素。
中国和越南都充分证明了药品的严重不合理使用，凸显了针对该问题进行政策干预的重要性。然而，关于处方合理性或其与指南的符合程度的证据有限。此外，尽管经济激励、医疗保险覆盖范围以及医护人员和使用者的知识被认为是影响不合理用药的因素，但缺乏关于该问题根本原因的令人信服的证据。
