Yao Qiang, Liu Chaojie, Ferrier J Adamm, Liu Zhiyong, Sun Ju
School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei, 430072, China.
School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia.
Int J Equity Health. 2015 Jul 30;14:58. doi: 10.1186/s12939-015-0186-7.
To assess the impact of the National Essential Medicines Scheme (NEMS) with respect to urban-rural inequalities regarding drug prescriptions in primary care facilities.
A stratified two-stage random sampling strategy was used to sample 23,040 prescriptions from 192 primary care facilities from 2009 to 2010. Difference-in-Difference (DID) analyses were performed to test the association between NEMS and urban-rural gaps in prescription patterns. Between-Group Variance and Theil Index were calculated to measure urban-rural absolute and relative disparities in drug prescriptions.
The use of the Essential Medicines List (EML) achieved a compliance rate of up to 90% in both urban and rural facilities. An overall reduction of average prescription cost improved economic access to drugs for patients in both areas. However, we observed an increased urban-rural disparity in average expenditure per prescription. The rate of antibiotics and glucocorticoids prescription remained high, despite a reduced disparity between urban and rural facilities. The average incidence of antibiotic prescription increased slightly in urban facilities (62 to 63%) and reduced in rural facilities (67% to 66%). The urban-rural disparity in the use of parenteral administration (injections and infusions) increased, albeit at a high level in both areas (44%-52%).
NEMS interventions are effective in reducing the overall average prescription costs. Despite the increased use of the EML, indicator performances with respect to rational drug prescribing and use remain poor and exceed the WHO/INRUD recommended cutoff values and worldwide benchmarks. There is an increased gap between urban and rural areas in the use of parenteral administration and expenditure per prescription.
评估国家基本药物制度（NEMS）对基层医疗机构药物处方城乡不平等的影响。
采用分层两阶段随机抽样策略，从2009年至2010年的192个基层医疗机构中抽取23,040份处方。进行了差分分析（DID）以检验NEMS与处方模式城乡差距之间的关联。计算组间方差和泰尔指数以衡量药物处方的城乡绝对和相对差距。
基本药物目录（EML）的使用在城乡医疗机构中均达到了高达90%的合规率。平均处方成本的总体降低改善了两个地区患者获得药物的经济可及性。然而，我们观察到每张处方平均支出的城乡差距有所增加。尽管城乡医疗机构之间的差距有所缩小，但抗生素和糖皮质激素的处方率仍然很高。城市医疗机构中抗生素处方的平均发生率略有上升（从62%升至63%），而农村医疗机构中则有所下降（从67%降至66%）。肠外给药（注射和输液）使用方面的城乡差距有所增加，尽管两个地区的这一差距都处于较高水平（44%-52%）。
NEMS干预措施在降低总体平均处方成本方面是有效的。尽管EML的使用有所增加，但在合理用药处方和使用方面的指标表现仍然较差，超过了世界卫生组织/国际合理用药网络（WHO/INRUD）推荐的临界值和全球基准。在肠外给药的使用和每张处方的支出方面，城乡差距有所增加。
