基于结构方程模型的我国县级以上医疗机构实施基本药物制度的影响因素研究  

Studying on the Factors to Influence the Implementation of Essential Medicines System in and Above the County Medical Institutions Based on Structural Equation model

作　　者：刘菲[1] 吴江玥[1] 肖洁[1] 胡明[1] 

机构地区：[1]四川大学华西药学院,四川成都610041

出　　处：《中国卫生事业管理》2017年第7期521-523,536,共4页Chinese Health Service Management

基　　金：国家自然科学基金"新医改多重政策实施背景下基本药物可及性评价:指标及方法的建立与实证"(编号:71473170)

摘　　要：目的:分析影响基本药物制度实施的影响因素及潜在原因、各因素间关系及影响力度,针对各影响因素提出完善县级以上医疗机构实施基本药物制度的措施与建议。方法:在文献内容分析法的基础上对县级以上医疗机构相关人员发放调查问卷;采用最大似然法的结构方程模型对影响因素进行分析以得出影响因素之间相互关系及影响力度。结果:结构方程模型分析结果显示,从县级以上医疗机构视角出发,现有基本药物目录对制度实施的结果评价影响不显著;招标采购机制通过影响配送供应从而间接对结果评价产生作用;另外,制度保障措施一方面对结果评价存在直接影响,另一方面通过影响医务人员实施制度的主观意愿从而间接影响结果评价。结论与建议:(1)结合实际情况,分级别制定适合县级以上医疗机构的基本药物目录;(2)完善基本药物招标采购与配送供应机制,考虑将基本药物部分与非基本药物部分相互衔接;(3)尽快制定并落实针对县级以上医疗机构的财政补偿方案,定期对二三级公立医疗机构医务人员进行宣传培训和绩效评价工作。Objective To analyze the factors to influence the implementation of Essential Medicines System and its potential causes- and put forward countermeasures for improving it. Methods Based on literature content analysis, staffs in and above the county medical institutions were surveyed with questionnaire. And its influencing factors were analyzed with structural equation modeling of maximum likelihood method. Results Structural equation modeling analysis showed that the existing essential medicine had insignificant influence on evaluation of policy implementation in view of medical institutions. Bidding mechanism had indirect effect on evaluation by directly influencing the medicine supply and distribution. In addition, system guarantee measures can di- rectly influence the evaluation of results, and indirectly influence the evaluation by influencing the medical staffs＇ subjective intention. Conclusion It is suggested to develop appropriate essential medicine list for county medical institutions and above, perfect medicine bidding, supply and distribution system, implement financial compensation and propaganda and performance evaluation.

关 键 词：基本药物制度 县级以上医疗机构 影响因素 结构方程模型 调查问卷 

分 类 号：R951[医药卫生—药学]