CAJ | 학술논문

目的：分析基本药物制度实施前后山东省基层医疗机构的抗生素门诊处方,为今后规范基层医务人员抗生素处方行为提供干预重点和建议。方法采用多阶段分层随机抽样方法,在山东省5市18个县(市、区)的基层医疗机构共抽取门诊处方6962张,其中实施前处方2809张,实施后处方4153张,用解剖学治疗学及化学分类系统(anatomical therapeutic chemical,ATC)对抗生素药品进行分类,分析基本药物制度实施前后山东省基层医疗机构的抗生素处方情况。结果门诊处方中抗生素使用率由实施前的54.36%降至实施后的50.66%,联合用药率由29.40%降至28.09%。村卫生室在上述2方面的比率均高于乡镇卫生院和社区卫生服务机构。基本药物制度实施前,处方中使用最多的为广谱青霉素类抗生素(12.82%)；实施后为林可酰胺类(11.24%)。基本药物制度实施前后基层医疗机构常用的前10类抗生素药品中,阿莫西林均居于首位,分别占11.45%、10.15%。结论基本药物制度的实施一定程度上促进了基层医疗机构的合理用药,但仍存在抗生素滥用及使用不当现象,村卫生室更为显著,亟待加强监管和进一步规范抗生素处方行为。
목적：분석기본약물제도실시전후산동성기층의료궤구적항생소문진처방,위금후규범기층의무인원항생소처방행위제공간예중점화건의。방법채용다계단분층수궤추양방법,재산동성5시18개현(시、구)적기층의료궤구공추취문진처방6962장,기중실시전처방2809장,실시후처방4153장,용해부학치료학급화학분류계통(anatomical therapeutic chemical,ATC)대항생소약품진행분류,분석기본약물제도실시전후산동성기층의료궤구적항생소처방정황。결과문진처방중항생소사용솔유실시전적54.36%강지실시후적50.66%,연합용약솔유29.40%강지28.09%。촌위생실재상술2방면적비솔균고우향진위생원화사구위생복무궤구。기본약물제도실시전,처방중사용최다적위엄보청매소류항생소(12.82%)；실시후위림가선알류(11.24%)。기본약물제도실시전후기층의료궤구상용적전10류항생소약품중,아막서림균거우수위,분별점11.45%、10.15%。결론기본약물제도적실시일정정도상촉진료기층의료궤구적합리용약,단잉존재항생소람용급사용불당현상,촌위생실경위현저,극대가강감관화진일보규범항생소처방행위。
Objective This article surveyed the antibiotics prescriptions at primary medical institutions before and after the implementation of the essential medicine policy in Shandong Province, and advised on intervention emphasis to regulate antibiotics use at such institutions.Methods Multi-stage stratified random sampling was called into play.A total of 6 962 outpatient prescriptions from 18 counties were sampled,in which 2 809 were made before the implementation and 4 1 53 after.The antibiotic drugs were classified using the anatomical therapeutic chemical (ATC)to study the utilization of antibiotics at primary medical institutions.Results After the implementation,the prescription rates of antibiotics of outpatient prescriptions decreased from 54.36% to 50.66%,while drug combination from 29.40% to 28.09%.The percentage of the above two at village clinics was found higher than township hospitals and community health centers.Before the implementation,antibiotics of the highest usage was broad-spectrum penicillin (12.82%),while that after the implementation was a lincosamides antibiotic (1 1.24%).Of the top ten antibiotics popular with primary medical institutions before and after the implementation,Amoxicillin always ranks the highest,accounting for 1 1.45% and 10.1 5% respectively. Conclusion The implementation of the essential medicines system has promoted rational antibiotics usage at primary medical institutions to some extent.But abuse of antibiotics is still found,especially at village clinics,which calls for further regulation and supervision.