CAJ | 학술논문

目的：建立处方的综合评价方法，对基本药物制度实施前后山东省11县（市、区）村医处方用药的合理性做出评价。方法采用多阶段分层随机抽样方法，于2013年在山东省范围内，按经济发展水平的高、中、低抽取济南、济宁、日照3市的11县（市、区）共79个村卫生室，收集有效处方3091张，包括实施前处方1230张，实施后处方1861张。汇总抗生素使用、多重用药、注射剂使用、药品通用名以及基本药物五个方面的信息，从处方水平综合评价山东省11县（市、区）农村地区合理用药情况。结果基本药物制度实施前村医处方合理用药综合评分指数为55.51，实施后上升至60.59，但距满分100仍有很大提升空间。在综合评价系统的五个指标中，实施前、后注射剂得分（9.77、10.64）和抗生素得分（12.05、12.65）均与其满分27.27差距较大。村医处方合理用药综合评价指数满分为100。村医合理用药综合评分指数由实施前的55.51升至实施后的60.59。将基本药物制度实施后村医合理用药综合评分指数进行聚类分析，发现大部分县（市、区）合理用药水平为中等偏上。结论基本药物制度实施后村医的用药状况呈改善趋势，但还没有达到合理用药的要求。农村地区抗生素和注射剂的滥用问题尤为严峻，亟待加强监管和进一步规范。
목적：건립처방적종합평개방법，대기본약물제도실시전후산동성11현（시、구）촌의처방용약적합이성주출평개。방법채용다계단분층수궤추양방법，우2013년재산동성범위내，안경제발전수평적고、중、저추취제남、제저、일조3시적11현（시、구）공79개촌위생실，수집유효처방3091장，포괄실시전처방1230장，실시후처방1861장。회총항생소사용、다중용약、주사제사용、약품통용명이급기본약물오개방면적신식，종처방수평종합평개산동성11현（시、구）농촌지구합리용약정황。결과기본약물제도실시전촌의처방합리용약종합평분지수위55.51，실시후상승지60.59，단거만분100잉유흔대제승공간。재종합평개계통적오개지표중，실시전、후주사제득분（9.77、10.64）화항생소득분（12.05、12.65）균여기만분27.27차거교대。촌의처방합리용약종합평개지수만분위100。촌의합리용약종합평분지수유실시전적55.51승지실시후적60.59。장기본약물제도실시후촌의합리용약종합평분지수진행취류분석，발현대부분현（시、구）합리용약수평위중등편상。결론기본약물제도실시후촌의적용약상황정개선추세，단환몰유체도합리용약적요구。농촌지구항생소화주사제적람용문제우위엄준，극대가강감관화진일보규범。
Objective This article aimed to set up a comprehensive prescription evaluation method and evaluate the prescription appropriateness of village doctors in 11 counties of Shandong Province before and after the implementation of national essential medicine policy(NEMP). Methods The sample was selected using multistage stratified random sampling in 2013. 79 village clinics in 11 counties of high,medium and low economic development level in 3 cities i. e. Jinan,Jining and Rizhao of Shandong Province were selected. A total of 3 091 effective prescriptions were collected,including 1 230 prescriptions before the NEMP and 1 861 prescriptions after the NEMP. Information regarding antibiotics prescription,poly - pharmacy,injection pre-scription,common name of medicine and essential medicine were summarized,and the appropriateness of medication in the rural area of 11 counties of Shandong Province was evaluated in terms of prescription. Results The prescription appropriateness score of village doctors was 55. 51 before the implementation of NEMP,and increased to 60. 59 after the implementation of NEMP. But there was still much room for improvement from out of 100. In the five indicators of comprehensive evaluation system,injection prescription(9. 77,10. 64)and antibiotics prescription(12. 05,12. 65)score was large gap from out of 27. 27. The level of prescription appropriateness of most counties was above average, according to clustering analysis of scores after the NEMP. Conclusion The implementation of NEMP promoted the prescription appropriateness of village doctors,but the situation is not yet satisfactory. In the rural areas,abuse of antibiotics and injections are especially serious,further supervision and regula-tion are needed.