CAJ | 학술논문

目的：探讨慢性病患者优先使用基本药物的影响因素，为政策优化提供科学参考与现实借鉴。方法采用多阶段分层随机抽样方法，于2012年8—12月抽取山东省5市1518户居民，其中慢性病患者516人。采用自制问卷对慢性病患者进行调查，问卷内容包括人口与社会学经济学特征、医药服务利用、医疗保障、基本药物制度认知情况及用药心理与行为。结果基本药物制度知晓率为37.6%（194/516），药品零差价政策了解率为8.9%（46/516）；慢性病分布前3位为高血压（44.2%，228/516）、糖尿病（11.2%，58/516）和心血管疾病（9.9%，51/516）；多因素Logistic逐步回归分析（α入=0.15，α出=0.20）显示，地区经济水平、慢性病常用药物在基层医疗机构可获得性、慢性病治疗药费、零差价政策了解程度、基本药物疗效、自感病情选择药店倾向及用药依从性重要性认知最终进入回归方程。结论影响慢性病患者优先使用基本药物的因素包括地区经济水平、慢性病常用药物在基层医疗机构可获得性、慢性病治疗药费、零差价政策了解程度、基本药物疗效、自感病情选择药店倾向及用药依从性重要性认知。因此，基本药物制度的制定与实施者应将关注重点放在财政投入、基本药物遴选、配送监管、政策宣传长效机制以及慢性病患者用药习惯干预制度建设等方面。
목적：탐토만성병환자우선사용기본약물적영향인소，위정책우화제공과학삼고여현실차감。방법채용다계단분층수궤추양방법，우2012년8—12월추취산동성5시1518호거민，기중만성병환자516인。채용자제문권대만성병환자진행조사，문권내용포괄인구여사회학경제학특정、의약복무이용、의료보장、기본약물제도인지정황급용약심리여행위。결과기본약물제도지효솔위37.6%（194/516），약품령차개정책료해솔위8.9%（46/516）；만성병분포전3위위고혈압（44.2%，228/516）、당뇨병（11.2%，58/516）화심혈관질병（9.9%，51/516）；다인소Logistic축보회귀분석（α입=0.15，α출=0.20）현시，지구경제수평、만성병상용약물재기층의료궤구가획득성、만성병치료약비、령차개정책료해정도、기본약물료효、자감병정선택약점경향급용약의종성중요성인지최종진입회귀방정。결론영향만성병환자우선사용기본약물적인소포괄지구경제수평、만성병상용약물재기층의료궤구가획득성、만성병치료약비、령차개정책료해정도、기본약물료효、자감병정선택약점경향급용약의종성중요성인지。인차，기본약물제도적제정여실시자응장관주중점방재재정투입、기본약물린선、배송감관、정책선전장효궤제이급만성병환자용약습관간예제도건설등방면。
Objective To investigate the influencing factors for patients with chronic diseases being given priority to use essential medicines,in order to provide scientific and realistic references for policy improvement. Methods By using multi-stage stratified random sampling method,1 518 households in five cities in Shandong Province were enrolled from August and December in 2012,among which 516 residents were with chronic diseases. Self-designed questionnaire survey was conducted on these patients,and the survey content included demographical and socioeconomic features,the utilization of medicines and services,medical security,the awareness of essential medicine system and the psychology and behavior of drug use. Results The awareness rate of essential medicine system was 37. 6%(194/516),the knowing rate of the zero-profit drug policy was 8. 9%(46/516),and the three chronic diseases with largest prevalence rate were hypertension(44. 2%,228/516),diabetes mellitus( 11. 2%,58/516 ) and cardiovascular diseases ( 9. 9%,51/516 ) . The multivariate logistic stepwise regression analysis(αinclusion =0. 15,αexclusion =0. 20)showed that a series of factors entered the regression equation,including local economy level,the availability of commonly used drugs for chronic diseases in grass-root medical settings,medicine expenses for the treatment of chronic diseases,the knowing status of the zero-profit drug policy,the efficacy of essential medicines,the propensity of drugstore choices with self - perceived illness and the awareness of the importance of medication compliance. Conclusion Influencing factors for patients with chronic diseases being given priority to use essential medicines include local economy level, the availability of commonly used drugs for chronic diseases in grass - root medical settings, medicine expenses for the treatment of chronic diseases, the knowing status of the zero - profit drug policy, the efficacy of essential medicines, the propensity of drugstore choices with self - perceived illness and the awareness of the importance of medication compliance. People in charge of the formulation and implementation of the essential medicine system should focus on the financial investment,the selection of essential medicines,the monitoring of distribution,long - term mechanism of the publicity of the policy and the intervention system of the drug use habits of patients with chronic diseases.