中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
22期
2652-2656
,共5页
孙寂晗%张相苏%张合华%赵玉虹
孫寂晗%張相囌%張閤華%趙玉虹
손적함%장상소%장합화%조옥홍
乡村一体化%基层医疗机构%基本药物%药品使用
鄉村一體化%基層醫療機構%基本藥物%藥品使用
향촌일체화%기층의료궤구%기본약물%약품사용
Rural integration%Primary medical institutions%Essential medicines%Drug application
目的：通过对基层医疗机构药物使用现状的调查，了解基本药物制度实施以来基层医疗机构药物使用存在的问题与不足，为健全药物使用提供建议。方法选取辽宁省、河北省共8家基层医疗机构（包括2家县医院、4家乡镇卫生院及2家村卫生室）2010-2012年度药品购销详细目录、3家卫生局的相关政策文件进行分析。具体分析指标有基本药物使用率、药品年均销售量、年均销售额、常用剂型等。同时，对这11家医疗卫生机构的相关人员进行访谈。结果县医院、乡镇卫生院及村卫生室基本药物使用率分别为36.8%、89.8%、89.2%。调研对象普遍认为，基本药物目录中常用药品少、低价位药品少、知名药品少等。目前只有县级医疗机构存在药品加价率，县级医疗机构药品的年均利润占总销售额的25.3%，各院间加价标准未统一，调研对象普遍认为药品加价率的差异与县级医疗机构药品加价率未制定统一标准关系密切。三级医疗机构药品销售量前十名中，注射剂销售种类所占比例分别为70.0%、50.0%及90.0%，抗微生物药物销售种类所占比例分别为10.0%、40.0%、30.0%。结论基本药物目录与基层医疗机构的临床需求存在差异，应改善基本药物的遴选；各地药品价格、补偿机制实施混乱，应完善药品价格及补偿机制；药物使用存在不合理使用抗生素及注射液的问题，应规范医生处方行为，提高基本药物宣传力度。
目的：通過對基層醫療機構藥物使用現狀的調查，瞭解基本藥物製度實施以來基層醫療機構藥物使用存在的問題與不足，為健全藥物使用提供建議。方法選取遼寧省、河北省共8傢基層醫療機構（包括2傢縣醫院、4傢鄉鎮衛生院及2傢村衛生室）2010-2012年度藥品購銷詳細目錄、3傢衛生跼的相關政策文件進行分析。具體分析指標有基本藥物使用率、藥品年均銷售量、年均銷售額、常用劑型等。同時，對這11傢醫療衛生機構的相關人員進行訪談。結果縣醫院、鄉鎮衛生院及村衛生室基本藥物使用率分彆為36.8%、89.8%、89.2%。調研對象普遍認為，基本藥物目錄中常用藥品少、低價位藥品少、知名藥品少等。目前隻有縣級醫療機構存在藥品加價率，縣級醫療機構藥品的年均利潤佔總銷售額的25.3%，各院間加價標準未統一，調研對象普遍認為藥品加價率的差異與縣級醫療機構藥品加價率未製定統一標準關繫密切。三級醫療機構藥品銷售量前十名中，註射劑銷售種類所佔比例分彆為70.0%、50.0%及90.0%，抗微生物藥物銷售種類所佔比例分彆為10.0%、40.0%、30.0%。結論基本藥物目錄與基層醫療機構的臨床需求存在差異，應改善基本藥物的遴選；各地藥品價格、補償機製實施混亂，應完善藥品價格及補償機製；藥物使用存在不閤理使用抗生素及註射液的問題，應規範醫生處方行為，提高基本藥物宣傳力度。
목적：통과대기층의료궤구약물사용현상적조사，료해기본약물제도실시이래기층의료궤구약물사용존재적문제여불족，위건전약물사용제공건의。방법선취요녕성、하북성공8가기층의료궤구（포괄2가현의원、4가향진위생원급2가촌위생실）2010-2012년도약품구소상세목록、3가위생국적상관정책문건진행분석。구체분석지표유기본약물사용솔、약품년균소수량、년균소수액、상용제형등。동시，대저11가의료위생궤구적상관인원진행방담。결과현의원、향진위생원급촌위생실기본약물사용솔분별위36.8%、89.8%、89.2%。조연대상보편인위，기본약물목록중상용약품소、저개위약품소、지명약품소등。목전지유현급의료궤구존재약품가개솔，현급의료궤구약품적년균리윤점총소수액적25.3%，각원간가개표준미통일，조연대상보편인위약품가개솔적차이여현급의료궤구약품가개솔미제정통일표준관계밀절。삼급의료궤구약품소수량전십명중，주사제소수충류소점비례분별위70.0%、50.0%급90.0%，항미생물약물소수충류소점비례분별위10.0%、40.0%、30.0%。결론기본약물목록여기층의료궤구적림상수구존재차이，응개선기본약물적린선；각지약품개격、보상궤제실시혼란，응완선약품개격급보상궤제；약물사용존재불합리사용항생소급주사액적문제，응규범의생처방행위，제고기본약물선전력도。
Objective To study the usage of essential medicines at primary medical institutions and find out the eXist-ing problems and insufficiency after the implementation of essential medicine system so as to provide a reference for improvement of the usage of medicine. Methods Detailed buying and selling catalogue of medications during 2010-2012 of 8 primary medical institutions in Liaoning and Hebei provinces and relevant documents and policies of 3 health institutions were selected for statistical analysis of the usage rate of essential drugs,average annual sale volume and average annual sales and the commonly used drug formulation. At the same time,the relevant personnel in the 11 health institutions were interviewed. Results The usage rate of essential medicines in county hospitals,township hospitals and village clinics were 36. 8% ,89. 8% and 89. 2% respective-ly. The subjects investigated generally thought that common medicines,low priced medicines and well - known medicines were in little proportion of the essential medicine in the catalogue. Only county hospitals had the phenomenon of drug price addition and the annual profit of medicines accounted for 25. 3% of the total but without unified addition standard,which,according to the subjects who were investigated,brought about the difference of addition rate. The proportion of the usage of injections and antibi-otics were 70. 0% ,50. 0% ,90. 0% and 10. 0% ,40. 0% ,30. 0% respectively in the top ten sales of drugs in the tertiary medical institutes. Conclusion The essential medicines listed in the catalogue cannot satisfy clinical needs and the tender selec-tion of essential medicines needs improvement. Drug price and compensation mechanism are in chaos from region to region,so it also needs improvement. Because of the eXisting unreasonable use of antibiotics and injections,we should normalize doctorsˊ pre-scription behavior and improve propaganda of essential medicines.
