Zhussupova Gulzira, Aiypkhanova Ainur, Zhaldybayeva Saule, Satmbekova Dinara, Akhayeva Tamila, Kaliyeva Sholpan
Center for the Development of Scientific and Research Activities, Astana Medical University, 47 Abay Ave, Astana, 010000, Kazakhstan.
"Sanat" National Education Development Science Center, 13, Dostyk St, Astana, 010000, Kazakhstan.
BMC Health Serv Res. 2025 Jan 9;25(1):49. doi: 10.1186/s12913-024-12172-9.
Kazakhstan inherited the Semashko health system model, known for the centralized adoption of rules at the Ministry of Health (MoH) level that regulate the healthcare system. In 2019 MoH established a national framework with indicators aimed at collecting qualitative and quantitative data from healthcare organizations as part of their annual self-evaluation, and biannual external evaluation by the National Research Center for Health Development (NRCHD). The purpose of this study was to pilot the MoH framework on rational use of medicines and evaluate its effects on medicine use practices in health care organizations and at the national level.
This cross-sectional study was conducted from October to December 2019 at 22 state-owned primary health care organizations (polyclinics) serving adults and children in Astana, Kazakhstan. Data were collected by trained surveyors visiting each organization. Data were converted to numeric values to arrive at compliance scores for each organization and analyzed to assess each organization's compliance with set indicators.
The evaluation showed the rational use of medicines was assessed as "excellent" (90% < compliant) in 2 organizations (9% of the sample), "good" (75-89% compliant) in 7 organizations (32%), and "satisfactory" (50-74% compliant) in 13 organizations (59%), with an average compliance rate of 71% across the sample. 22 organization-specific evaluation reports were developed by the evaluator (NRCHD) and sent to health care organizations for corrective actions. Evaluation data triggered two improvements at the national level: correction of the default setting for trade names to international nonproprietary names within the physician ordering feature of the national health information system for medicines, and adoption of a national policy that allowed the exchange of unused stocks of medicines between polyclinics.
Using the national framework allowed the evaluator agency and healthcare organizations to identify organization-specific gaps and triggered improvements in the use of medicines.
哈萨克斯坦继承了谢马什科卫生系统模式，该模式以卫生部层面集中采用规范医疗体系的规则而闻名。2019年，卫生部建立了一个包含指标的国家框架，旨在从医疗机构收集定性和定量数据，作为其年度自我评估以及国家卫生发展研究中心（NRCHD）每半年进行的外部评估的一部分。本研究的目的是试行卫生部关于合理用药的框架，并评估其对医疗机构和国家层面用药实践的影响。
这项横断面研究于2019年10月至12月在哈萨克斯坦阿斯塔纳的22家为成人和儿童服务的国有初级卫生保健机构（综合诊所）进行。数据由经过培训的调查员走访每个机构收集。数据被转换为数值，以得出每个机构的合规分数，并进行分析以评估每个机构对既定指标的遵守情况。
评估显示，2家机构（占样本的9%）的合理用药被评为“优秀”（合规率>90%），7家机构（32%）被评为“良好”（合规率75 - 89%），13家机构（59%）被评为“满意”（合规率50 - 74%），整个样本的平均合规率为71%。评估者（NRCHD）编写了22份针对各机构的评估报告，并发送给医疗机构以采取纠正措施。评估数据在国家层面引发了两项改进：在国家药品卫生信息系统的医生开单功能中，将商品名的默认设置更正为国际非专利名；通过一项国家政策，允许综合诊所之间交换未使用的药品库存。
使用国家框架使评估机构和医疗机构能够识别各机构特有的差距，并推动了用药方面的改进。
