Xie Xuefeng, Jin Xu, Zhang Ling, Sun Huihui, Shen Aizong, Huang Xiaohui, Sun Yehuan
Department of Basic and Clinical Pharmacology, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, 230032, Anhui, China.
Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China.
BMC Health Serv Res. 2018 Oct 23;18(1):812. doi: 10.1186/s12913-018-3614-8.
Changes in the national drug policy always have impact on the drug utilization. In the context of China health care reform, what changes had happened in the trend of drug utilization in public hospitals? Has this change met the expectations of policy design? This study was conducted to explore the trend of medicine consumption in county public hospitals before and after health care reform, and to provide real-world evidence to help assess the effectiveness of national drug policy.
A cross-sectional study was performed to investigate the drug utilization trends of 6 county public hospitals in Anhui Province, which is the first pilot area of China health care reform. Data were collected before and after the implementation of the China National Essential Medicine Policy (NEMP) to analyse the drug utilization indicators, such as the drug utilization constituent ratio, the rate of essential medicine usage and the rate of antibiotic consumption.
Chemicals are used most frequently and account for 60%~ 70%, followed by oral agents of proprietary Chinese medicine. The results also show increased consumption of Chinese medicine injections (χ = 28.428, P < 0.01). The top 3 chemical medicines consumed were anti-infective drugs (12.92%), cardiovascular system drugs (11.61%), and digestive system drugs (8.42%). For Chinese traditional medicine, the top 3 drugs consumed were internal medicine drugs (66.03%), surgical drugs (8.45%), and gynaecological drugs (7.70%). The total sales amounts of drugs covered by medical insurance are at a high level (all above 80%), whereas essential medicines are less than 50% at almost all county-level medical institutions.
This study uncovered the changing tendency of medicine usage under the implementation of the reform. Chinese medicine injections and anti-infective drugs have always been a sustained concern of pharmacovigilance. It is noteworthy that although essential medicines are advocated for as a priority for use in the government-run hospital, the consumption proportion of these medicines is lower than expected.
国家药品政策的变化总会对药品使用产生影响。在中国医疗卫生体制改革的背景下，公立医院的药品使用趋势发生了哪些变化？这种变化是否符合政策设计的预期？本研究旨在探讨医改前后县级公立医院的药品消费趋势，并提供真实世界证据以帮助评估国家药品政策的有效性。
开展一项横断面研究，调查中国医疗卫生体制改革首个试点地区安徽省的6家县级公立医院的药品使用趋势。在实施国家基本药物政策（NEMP）前后收集数据，以分析药品使用指标，如药品使用构成比、基本药物使用率和抗生素消费率。
化学药品使用最为频繁，占60%~70%，其次是中成药口服制剂。结果还显示中药注射剂的消费量有所增加（χ=28.428，P<0.01）。消费排名前3的化学药品是抗感染药物（12.92%）、心血管系统药物（11.61%）和消化系统药物（8.42%）。对于中药，消费排名前3的药物是内科用药（66.03%）、外科用药（8.45%）和妇科用药（7.70%）。医保覆盖药品的销售总额处于较高水平（均高于80%），而在几乎所有县级医疗机构中，基本药物的销售占比均低于50%。
本研究揭示了改革实施过程中药品使用的变化趋势。中药注射剂和抗感染药物一直是药物警戒持续关注的对象。值得注意的是，尽管政府办医院提倡优先使用基本药物，但这些药物的消费占比低于预期。
