Zhang Tao, Liu Chaojie, Ren Jianping, Wang Sheng, Huang Xianhong, Guo Qing
School of Medicine, Hangzhou Normal University, Hangzhou, China.
School of Management, Hubei University of Chinese Medicine, Wuhan, China.
BMJ Open. 2017 Jul 10;7(7):e014621. doi: 10.1136/bmjopen-2016-014621.
This study aimed to investigate the perceptions of primary care workers about the impacts of the national essential medicines policy (NEMP).
A cross-sectional questionnaire survey was undertaken in 42 urban community health centres randomly selected from four provinces in China.
791 primary care workers rated the impacts of the NEMP on a 5-point Likert scale.
An average score for the impacts of the NEMP on four aspects (the practice of health workers, interactions of patients with health workers, operations of health centres and provision of medicines) was calculated, each ranging from 0 to 100. A higher score indicates a more positive rating. Linear regression models were established to determine the sociodemographic characteristics (region, age, gender, profession, training, income) that were associated with the ratings.
The respondents gave an average rating score of 65.61±11.76, 63.17±13.62, 66.35±13.02 and 67.26±11.60 for the impacts of the NEMP on health workers, patients, health centres and provision of medicines, respectively. Respondents from the central region rated the NEMP higher than those from the eastern and western regions. The pharmacists (β=5.4577.558, p<0.001) and nurses (β=2.6123.107, p<0.05) gave a more positive rating on the NEMP than their physician counterparts. A higher income was found to be associated with a decrease in the NEMP ratings. Repetitive training was a predictor of higher ratings.
The NEMP has significant impacts (as perceived by the health workers) on health services delivery in primary care settings. However, the impacts of the NEMP vary by region, professional practice and the income level of health workers. It is important to maintain support from physicians through income subsidies (to compensate for potential loss) and training.
本研究旨在调查基层医疗工作者对国家基本药物政策（NEMP）影响的看法。
在中国四个省份随机选取42家城市社区卫生中心进行横断面问卷调查。
791名基层医疗工作者采用5点李克特量表对NEMP的影响进行评分。
计算NEMP在四个方面（卫生工作者的实践、患者与卫生工作者的互动、卫生中心的运营和药品供应）影响的平均得分，每项得分范围为0至100分。得分越高表明评价越积极。建立线性回归模型以确定与评分相关的社会人口学特征（地区、年龄、性别、职业、培训、收入）。
受访者对NEMP对卫生工作者、患者、卫生中心和药品供应影响的平均评分分别为65.61±11.76、63.17±13.62、66.35±13.02和67.26±11.60。中部地区的受访者对NEMP的评分高于东部和西部地区。药剂师（β=5.4577.558，p<0.001）和护士（β=2.6123.107，p<0.05）对NEMP的评价比医生更积极。发现收入越高，NEMP评分越低。重复培训是评分较高的一个预测因素。
NEMP（卫生工作者所感知）对基层医疗环境中的卫生服务提供有显著影响。然而，NEMP的影响因地区、专业实践和卫生工作者的收入水平而异。通过收入补贴（以补偿潜在损失）和培训来维持医生的支持很重要。
