基层医疗卫生机构慢性阻塞性肺疾病基本药物与诊断设备可获得性调查研究  

The Availability of Essential Medicines and Diagnostic Devices for Chronic Obstructive Pulmonary Disease in Primary Care

作　　者：彭博 张小娟[1] 姜骁桐 郑见立[1] 李亚子[1] PENG Bo;ZHANG Xiaojuan;JIANG Xiaotong;ZHENG Jianli;LI Yazi(Institute of Medical Information,Chinese Academy of Medical Sciences,Beijing 100020,China)

机构地区：[1]中国医学科学院医学信息研究所,北京市100020

出　　处：《中国全科医学》2022年第7期771-781,共11页Chinese General Practice

摘　　要：背景近年来,我国慢性阻塞性肺疾病(COPD)患病率明显升高,作为COPD防控的主战场,基层医疗卫生机构的诊疗能力相对薄弱。目前对基层COPD诊疗药物和诊断设备的大范围调查研究相对较少,为进一步了解基层COPD防控“短板”,弥补相关研究空白,特开展本研究。目的了解基层医疗卫生机构COPD基本药物的配备与可获得性、肺功能仪可获得性与肺功能检查开展情况。方法于2021年2—3月,采用多阶段整群抽样法,在我国31个省份选取8176家基层医疗卫生机构开展调查。根据《国家基本药物目录(2018年版)》确定COPD基本药物共16种,采用可获得率、配备率分别评价某种药品在机构的可获得情况和某家机构配备药品的品种数量情况。采用可获得率评价肺功能仪在机构的可获得情况,采用开展率评价肺功能检查在机构的应用情况。结果共7458家机构应答,应答率为91.22%。其中,乡镇卫生院5901家(79.12%)、社区卫生服务中心1557家(20.88%)。对于16种COPD基本药物,6538家(87.66%)机构配备品种数<8种,4922家(66.00%)机构配备了≥1种吸入平喘药,814家(10.91%)机构配备了长效吸入平喘药。16种COPD基本药物在基层医疗卫生机构的平均可获得率为33.30%,可获得率排在前3位的药品为氨溴索(85.28%,6360/7458)、氨茶碱(81.17%,6054/7458)、复方甘草(74.48%,5555/7458),丙酸氟替卡松(4.89%,365/7458)、噻托溴铵(6.25%,466/7458)、布地奈德福特罗(8.61%,642/7458)等吸入平喘药的可获得率较低。6种吸入平喘药在社区卫生服务中心、乡镇卫生院的平均可获得率分别为28.31%、4.81%,2种长效吸入平喘药在社区卫生服务中心、乡镇卫生院的平均可获得率分别为16.18%、5.12%。基层医疗卫生机构的肺功能仪可获得率为8.94%(667/7458),社区卫生服务中心高于乡镇卫生院〔(18.56%(289/1557)比6.41%(378/5901),P<0.05〕。基层医疗卫生机构的肺功能检查开展率为10.82Background China has seen a significantly increased prevalence of chronic obstructive pulmonary disease(COPD)recently.But primary care institutions,the main"battlefield"for containing COPD,have shown relatively weak capabilities for the diagnosis and treatment of disease.As there are relatively few large-scale investigations and studies on medicines and diagnostic devices for COPD in primary care,we conducted this study to further understand the weaknesses of current COPD containment in primary care,by which the gap in related research may be made up.Objective To understand the allocation and availability rate of essential medicines for COPD,and availability rate of spirometer as well as the implementation of pulmonary function tests in primary care.Methods From February to March 2021,a multi-stage cluster sampling was adopted to select 8176 community(township)health centers from 31 provinces of China to attend a survey.The rates of availability and allocation of each of the 16 essential medicines for COPD in the 2018 National Essential Medicines List were calculated to estimate the categories and number of these medicines in primary care institutions.The rate of availability of spirometer in these institutions was estimated.And the rate of implementation of pulmonary function tests in these institutions was estimated.Results Altogether,7458(91.22%)institutions who gave effective responses to the survey were included for analysis,including 5901(79.12%)township health centers,and 1557(20.88%)community health centers.Among the 16 essential medicines for COPD,less than 8 were available in 6538(87.66%)institutions,at least 1 inhaled antiasthmatic medicines were available in 4992(66.00%)institutions,and long-acting inhaled antiasthmatic medicines were available in 814(10.91%)institutions.The average availability rate of 16 essential medicines for COPD was 33.30%.The highest ranked three medicines in terms of availability rate were ambroxol〔85.28%(6360/7458)〕,aminophylline〔81.17%(6054/7458)〕and compound licoric

关 键 词：肺疾病 慢性阻塞性 卫生保健提供 基层医疗卫生机构 药物 必备 诊断检查服务 诊断设备 

分 类 号：R563.9[医药卫生—呼吸系统] R197.1[医药卫生—内科学]