成都市三圈7个乡镇和社区卫生服务机构药品使用现况调查--三圈七院六站预调查报告之三  

An Investigation of Medicine Use in Rural Hospitals and Community Health Service Centers in Chengdu

作　　者：周帮旻[1] 王莉[1] 李幼平[1] 喻佳洁[1] 原志芳[1] 谭培勇[2] 李雪[3] 李鸿浩[3] 敬媛媛[1] 毛秀[1] 孟月[1] 方锐[1] 杨晓妍[1] 文进[1] 李媛媛[1] 杨伟[4] 刘军[4] 陈东明[4] 申仲华[4] 赵平[4] 李祖俊[4] 李富森[4] 

机构地区：[1]四川大学华西医院中国循证医学中心,成都610041 [2]四川大学华西临床医学院,成都610041 [3]四川大学华西药学院,成都610041 [4]成都市卫生局,成都610012

出　　处：《中国循证医学杂志》2008年第7期529-537,共9页Chinese Journal of Evidence-based Medicine

基　　金：国家自然科学基金面上资助项目(青年科学基金)(No.70503021);成都市卫生局资助项目

摘　　要：目的通过预调查了解成都市基层医疗卫生机构用药和合理用药情况,为进一步全面调查和循证制定成都市基层基本药物目录制度提供证据,促进合理用药。方法收集成都市7个城乡基层卫生机构最近一个年度的用药记录,包括药品种类、品种数、金额和使用量。采用描述性分析和ABC分类法统计药物信息,计算基层卫生机构实际用药占WHO基本药物示范目录、医保目录和国家基本药物目录的比例。结果成都市一圈乡院/中心用药品种数是二,三圈乡院的4倍,二、三圈使用品种数最多的三类西药为抗感染药、消化系统用药、维生素类药、矿物质与微量元素;使用品种数最多的中成药分别是内科类、外科类、妇科类。总金额西药约占60%,中成药占40%。乡院/中心不合理用药表现为:过度使用注射剂、过度使用药品和抗生素不合理使用。结论建议循证筛选并缩减国家基本药物目录收录的药物品种,根据不同地区的疾病负担、支付水平和用药需求制订区域性基本药物目录,再将地区目录与药品报销目录整合,有利于提高基本药物的使用率。控费重点是金额比例较高的药物。合理用药监测重点是使用频度比例较大的药物。应成都市卫生局资助项目成立药物与治疗学委员会,围绕基本药物目录的建设、使用、报销和患者满意度开展动态监测、教育、评价和持续改进。Objective The Chengdu initiative essential medicine policy is part of the Special Healthcare Program of Comprehensive Reform for Coordinated and Balanced Urban-rural Development. We aimed to investigate the current situation of medicine use in rural hospitals and community health service centers, so as to provide evidence for policy-makers to select essential medicines and facilitate rational use of medicines. Method We selected 7 township/ community health institutions from which to collect medicine use information, inc}uding medicine category, number of medicine categories, cost and consumption. Descriptive analysis and the ABC classification method were applied for statistical analysis. Resuhe The number of medicine categories used in the community health institutions was four times greater than that in the township health institutions. Traditional Chinese medicine preparations accounted for 40% of the total medicine cost. Polypharmacy, overuse of injections, and improper use of antibiotics were major manifestations of the irrational use of medicines. Conclusion The selection and use of essential medicines should be base on high quality evidence as well disease burden, the economic situation and specific demands in different areas. Drug and therapeutics committees should be set up to perform dynamic monitoring, education, evaluation and continual improvement of an essential medicines list.

关 键 词：基本药物目录 乡镇卫生院 社区卫生服务中心 合理用药 调查 循证医学 

分 类 号：R95[医药卫生—药学]