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药物处方诱导需求的主要因素:一项定性研究。

The Main Factors of Induced Demand for Medicine Prescription: A Qualitative Study.

作者信息

Mohamadloo Azam, Zarein-Dolab Saeed, Ramezankhani Ali, Jamshid Jamshid

机构信息

School of Public Health, Shahid Beheshti University of Medical Science, Tehran, Iran.

School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran.

出版信息

Iran J Pharm Res. 2019 Winter;18(1):479-487.

Abstract

Inappropriate request for health care services which are considered to be unnecessary for the patients has long been addressed by several writers The hypothesis supplier induced demand refers to the induced demand initiated by the supplier who acts in his own economic self-interest rather than patient best interest. The purpose of the present qualitative study was to explore about induced demand and the relevant motivating factors associated with unnecessary prescriptions of medicine. In-depth interviews were used for data generation with a purposive sample of 20 participants who were selected according to their experience. The interviews were transcribed and analyzed. The key themes were identified, named and coded with a sample of quotation. In general, 24 sub-themes or factors were identified and classified into personal, community and institutional themes. Some important factors are asymmetric information, patient expectation, patient poor health literacy, physician›s inadequate knowledge in medicine, neglecting patient rights, financial incentives, barriers in health insurance companies, reimbursement mechanism, marketing and advertising by pharmaceutical companies, Poor financial condition of pharmacies and social interactions. Our results showed that the induced demand for medicine is multifactorial in a health system. Addressing these factors could lead to decrease unnecessary prescription of medicine by a multi-faceted strategy, including curriculum revision, health promotion, and policy making.

摘要

对于患者而言被认为不必要的医疗服务的不当需求,长期以来一直受到多位作者的关注。“供方诱导需求”假说指的是由供方发起的诱导需求,供方是出于自身经济利益而非患者的最佳利益行事。本定性研究的目的是探讨诱导需求以及与不必要药物处方相关的激励因素。采用深度访谈来收集数据,从根据经验挑选出的20名参与者中选取了有目的的样本。访谈内容被转录并进行了分析。通过引用样本确定、命名并编码了关键主题。总体而言,确定了24个次主题或因素,并将其分为个人、社区和机构主题。一些重要因素包括信息不对称、患者期望、患者健康素养低下、医生医学知识不足、忽视患者权利、经济激励、保险公司的障碍、报销机制、制药公司的营销与广告、药房财务状况不佳以及社会互动。我们的结果表明,在卫生系统中,药物的诱导需求是多因素的。解决这些因素可以通过多方面的策略减少不必要的药物处方,包括课程修订、健康促进和政策制定。

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