县域医疗卫生共同体药品统一管理制度的扩散路径与机制分析  

Analysis on the diffusion path and mechanism of the unified drug management system of countywide medical communities

作　　者：郑佩瑶 高红霞[1] 胡西子 陈迎春 Zheng Peiyao;Gao Hongxia;Hu Xizi;Chen Yingchun(School of Medicine and Health Management,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Research Center for Rural Health Service,Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院医药卫生管理学院,武汉430030 [2]湖北省高校人文社科重点研究基地农村健康服务研究中心,武汉430030

出　　处：《中华医院管理杂志》2023年第2期81-86,共6页Chinese Journal of Hospital Administration

基　　金：教育部人文社科基金(21YJA630017);中央高校基本科研业务费专项基金(HUST 2021WKYXZX006)。

摘　　要：目的:分析我国县域医疗卫生共同体(以下简称县域医共体)药品统一管理制度的扩散路径和机制,为该制度的深化落实提供参考。方法:以"医共体""药品管理""县乡村一体化""中心药房"为关键词检索2017年1月1日至2022年6月30日中央政府和省级政府颁布的政策文件,运用政策扩散理论,从时间、空间、层级3个维度明确县域医共体药品统一管理制度扩散的路径,从竞争、行政指令、学习、模仿4个角度归纳该制度扩散的作用机制。结果:共收集有效政策文件36份。县域医共体药品统一管理制度的时间扩散呈"S"型曲线特征,截至2022年底,实施县域医共体药品统一管理制度的省份为30个,政策扩散进入饱和停滞阶段;空间扩散显示"邻近效应";层级扩散呈现"领导者-追随者"模式。其扩散过程中竞争机制、行政指令机制、学习机制和模仿机制共同存在,但政策扩散不同阶段的主导机制存在差异。结论:县域医共体药品统一管理制度得到了广泛扩散,建议从促进配套政策出台、优化制度考核体系、综合运用各扩散机制促进制度优化的角度着手,促进该制度的深化落实和长效运行。Objective To analyze the evolution path and diffusion mechanism of the unified drug management system of countywide medical communities in China,and provide references for the deepening implementation of the system.Methods The policy documents of the central and provincial governments were retrieved with the keywords of"medical community""drug management""county-township-village integration"and"central pharmacy".By means of the policy diffusion theory,the evolution path of the diffusion of the unified drug management system for the countywide medical communities was identified from such dimensions as time,space and hierarchy.On the other hand,the action mechanism of the diffusion of the system was summarized from such aspects as competition,administrative instruction,learning and imitation.Results A total of 36 effective policy documents were collected.The time diffusion of the drug unified management system of countywide medical communities was characterized by an"S"curve.By the end of 2022,there were 30 provinces implementing the countywide medical community drug unified management system,and the policy diffusion has entered a saturation and stagnation stage;spatial diffusion showed"proximity effect";hierarchy diffusion embodied the"leader follower"mode.In the process of policy diffusion,competition mechanism,administrative instruction mechanism,learning mechanism,and imitation mechanism coexisted,but there were difference in the dominant mechanism at different stages of policy diffusion.Conclusions The unified drug management system of the countywide medical communities has been widely disseminated.It is recommended to promote the introduction of supporting policies,optimize the system evaluation system,and comprehensively use various diffusion mechanisms to promote the optimization of the system,so as to promote the deepening and sustainable operation of the system.

关 键 词：卫生政策 政策扩散 县域医疗卫生共同体 药品管理 统一管理 

分 类 号：R95[医药卫生—药学]