Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, Shandong, China.
Glob Health Res Policy. 2024 Sep 5;9(1):32. doi: 10.1186/s41256-024-00374-x.
With the aging population, the increasing prevalence of chronic non-communicable diseases, and the diversified needs for primary health care (PHC) medicines, it is necessary to rethink the functional role of the supply of PHC medicines. This study aims to evaluate the supply of PHC medicines and the status of meeting PHC medicine needs.
The mixed-methods study was conducted to evaluate the supply of PHC medicines in Shandong Province. In the quantitative study, survey questionnaires were distributed to county hospitals, township hospitals, and patients, and a prescription review was performed in township hospitals. In the qualitative study, semi-structured interviews were conducted with the pharmacy managers, physicians, and patients in county hospitals, township hospitals, and village clinics. A senior pharmacist from a tertiary hospital who has rich experience on the indications for medicine use, accompanied us on a visit to inspect the PHC pharmacies to survey medicine equipment with a professional perspective.
Quantitative analysis revealed that 211 county hospitals and 1,581 township hospitals participated in the survey, revealing the median annual frequency of medicine shortages of 5.0 times for county hospitals and 2.0 times for township hospitals. Of the 6,323 patient medication surveys, after excluding 152 patients not involved in medication use, 945 (15.3%) indicated medicine shortages, with half of these attributable to institutions lacking required medicines (52.8%). On average, the prescription qualified rate of 37 township hospitals was 72.2%. Four final themes emerged during the qualitative data analysis: (1) Supply of PHC medicines; (2) Solutions to the shortage of off-list medicines; (3) Appropriateness of PHC medicines list; (4) Pharmacist workforce development and pharmacy services.
The discrepancy between patients' need for PHC medicine and present medicine supply is noteworthy. It is suggested that governments should optimize the existing lists to adequately meet patient medicine needs and prioritize medicines for chronic diseases, which is also particularly important for developing countries. Integrated health care may be a novel strategy to establish unified medicines list and achieve uniform pharmaceutical services in PHC.
随着人口老龄化、慢性非传染性疾病患病率的增加以及对初级卫生保健（PHC）药物多样化需求的出现，有必要重新思考 PHC 药物供应的功能作用。本研究旨在评估 PHC 药物的供应情况和满足 PHC 药物需求的现状。
采用混合方法研究评估山东省 PHC 药物供应情况。在定量研究中，向县级医院、乡镇卫生院和患者发放调查问卷，并对乡镇卫生院进行处方审查。在定性研究中，对县级医院、乡镇卫生院和村诊所的药剂师、医生和患者进行半结构化访谈。一位来自三级医院的资深药剂师，具有丰富的药物使用适应症经验，陪同我们从专业角度视察 PHC 药房，调查药物设备。
定量分析显示，有 211 家县级医院和 1581 家乡镇卫生院参与了调查，揭示了县级医院每年平均缺药 5.0 次，乡镇医院每年平均缺药 2.0 次。在对 6323 名患者用药调查进行剔除未参与用药的 152 名患者后，有 945 名（15.3%）患者表示缺药，其中一半是由于机构缺乏所需药物（52.8%）所致。37 家乡镇卫生院的处方合格率平均为 72.2%。定性数据分析得出了 4 个最终主题：（1）PHC 药物供应；（2）解决非目录药物短缺的办法；（3）PHC 药物目录的适宜性；（4）药剂师队伍发展和药房服务。
患者对 PHC 药物的需求与现有药物供应之间存在差距，值得关注。建议政府优化现有目录，以充分满足患者的药物需求，并优先考虑慢性病药物，这对发展中国家尤为重要。综合卫生保健可能是一种新的策略，可以建立统一的药物目录，并在 PHC 中实现统一的药物服务。
