资源匮乏国家孕产妇保健基本药物合理使用的障碍与促进因素：石川框架
Barriers and facilitators to the quality use of essential medicines for maternal health in low-resource countries: An Ishikawa framework.
作者信息
Tran Dan N, Bero Lisa A
机构信息
Department of Clinical Pharmacy, University of California, San Francisco School of Pharmacy, CA, USA ; World Health Organization Collaborating Centre on Pharmaceutical Research and Science Policy, University of California, San Francisco, CA, USA.
Department of Clinical Pharmacy, University of California, San Francisco School of Pharmacy, CA, USA ; Institute for Health Policy Studies, University of California, San Francisco, CA, USA ; World Health Organization Collaborating Centre on Pharmaceutical Research and Science Policy, University of California, San Francisco, CA, USA ; Charles Perkins Centre, Faculty of Pharmacy, University of Sydney, Sydney, Australia.
出版信息
J Glob Health. 2015 Jun;5(1):010406. doi: 10.7189/jogh.05.010406.
BACKGROUND
An estimated 800 women die every day due to complications related to pregnancy or childbirth. Complications such as postpartum haemorrhage (PPH) and pre-eclampsia and eclampsia can be prevented by the appropriate use of essential medicines. The objective of this study was to identify the common barriers and facilitators to the availability and use of oxytocin, ergometrine, and magnesium sulfate (MgSO4) - essential medicines indicated for the prevention and treatment of PPH and pre-eclampsia and eclampsia.
METHODS
We analyzed seven UNFPA/WHO reports published in 2008-2010. These reports summarized country-wide rapid assessments of access to and use of essential medicines for maternal health in Mongolia, Nepal, Laos, the Democratic People's Republic of Korea (DPRK), the Philippines, Vanuatu, and the Solomon Islands. We used a "fishbone" (Ishikawa) diagram as the analytic framework to identify facilitators and barriers at four health-system levels: government/regulatory, pharmaceutical supply, health facility, and health professional.
RESULTS
Common facilitators to the quality use of essential medicines for maternal health were observed at the government/regulatory and health professional level. A majority of countries had these medicines listed in their essential medicines lists. Awareness of the medicines was generally high among health professionals. Common barriers were identified at all health-system levels. First, standard treatment guidelines were not available, updated, or standardized. Second, there was an inadequate capacity to forecast and procure medicines. Third, a required MgSO4 antidote was often not available and the storage conditions for oxytocin were deficient.
CONCLUSIONS
The "fishbone" Ishikawa diagram is a useful tool for describing the findings of rapid assessments of quality use of essential medicines for maternal health across countries. The facilitators and barriers identified should guide the development of tailored intervention programs to improve and expand the use of these life-saving medicines.
背景
据估计，每天有800名妇女死于与妊娠或分娩相关的并发症。产后出血（PPH）、先兆子痫和子痫等并发症可通过合理使用基本药物来预防。本研究的目的是确定催产素、麦角新碱和硫酸镁（MgSO4）——用于预防和治疗产后出血、先兆子痫和子痫的基本药物——在供应和使用方面的常见障碍及促进因素。
方法
我们分析了2008 - 2010年发布的七份联合国人口基金/世界卫生组织报告。这些报告总结了蒙古、尼泊尔、老挝、朝鲜民主主义人民共和国（朝鲜）、菲律宾、瓦努阿图和所罗门群岛全国范围内对孕产妇保健基本药物获取和使用情况的快速评估。我们使用“鱼骨”（石川）图作为分析框架，以确定在四个卫生系统层面（政府/监管、药品供应、医疗机构和卫生专业人员）的促进因素和障碍。
结果
在政府/监管和卫生专业人员层面观察到了孕产妇保健基本药物合理使用的常见促进因素。大多数国家将这些药物列入其基本药物清单。卫生专业人员对这些药物的知晓度普遍较高。在所有卫生系统层面都发现了常见障碍。首先，没有可用的、更新的或标准化的标准治疗指南。其次，预测和采购药品的能力不足。第三，所需的硫酸镁解毒剂往往不可用，且催产素的储存条件不足。
结论
“鱼骨”石川图是描述各国孕产妇保健基本药物合理使用快速评估结果的有用工具。所确定的促进因素和障碍应指导制定针对性的干预计划，以改善和扩大这些救命药物的使用。
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