基本药物制度对江西五所基层医疗卫生机构合理用药的影响

随机抽取江西省5家基层医疗卫生机构2009-2011年6月份的处方各100张,对其进行合理用药的分析,包括:平均处方用药数、抗生素处方使用比例、抗生素处方使用种类、注射剂处方使用比例、激素处方使用比例以及药品通用名使用比例等,通过合理用药的分析,反映基层医疗卫生机构实施基本药物制度前后合理用药的现状,为完善政策提供建议.     

实施基本药物制度对医院合理用药的影响

目的研究在医院开具处方中采取基本药物制度给临床合理用药带来的影响。方法选取2015年9月—2016年9月未实施基本用药制度的658例处方作为对照,分析2016年9月—2017年9月实施基本用药制度的658例处方,对比实施基本药物制度前后药品使用情况、药品使用费用、数量、种类。结果实施基本药物制度后处方中注射药物、抗菌药物、激素药物所占比例均低于实施前(均P0.05);处方药物数量、药物花费、药物种类均值均低于实施前(均P0.05)。结论将基本药物制度应用在临床用药中效果显著,可提升合理用药效果。     

北京市社区卫生服务中心基本药物制度实施效果

目的：对北京市基本药物制度实施效果进行分析,并就完善相关政策提供建议。方法：从基本药物可获得性、可负担性和合理用药等方面,采用定量与定性相结合的方法进行研究。结果：基本药物配备率和使用率无显著变化;药品价格变化不大,单张处方费用下降,药品可负担性有所提高;处方用药行为比较规范,但部分医务人员对基本药物仍不够熟悉。结论：进一步明确基本药物最低使用比例,保证各项相关政策衔接,提高医务人员对基本药物的认可度,合理控制药品费用的增长,提高可负担性。     

门诊基本药物处方点评与分析

目的分析我院基本药物的使用状况,为进一步提高基本药物在我院的使用率提供参考,并为基本药物的推广使用工作提供一定的理论依据;讨论分析基本药物未被优先使用的各个原因。方法利用医院电脑系统软件帮助随机抽样我院2013年11月门诊处方500张(包括:基本药物处方、非基本药物处方),按照《基本药物处方点评指南》进行处方点评,使用Excel对数据进行统计与整理。结果我院抽取的处方中基本药物处方占比44.2%,基本药物使用品种占比和基本药物销售金额占比分别为26.5%和13.5%,无正当理由未优先使用基本药物的药品比例为8.2%,处方比例为18.6%,单张处方用药品种数2.3种,单张处方使用基本药物品种数0.6种,单张处方用药金额169.4元,单张处方使用基本药物金额22.9元。结论我院使用基本药物的比率较低,对国家基本药物制度的实施需要进一步加强。     

西安市基层医疗机构实行国家基本药物制度状况分析

目的分析梳理西安市2010—2013年基层医疗机构临床用药相关数据、指标及变化,总结国家基本药物制度在基层医疗机构推行的效果和问题,为政策进一步落实和推进提供参考。方法本研究回顾了3年来西安市基层医疗机构相关统计报表、处方等资料,相关数据录入EXCEL数据库,运用SPSS17.0进行分析,研究药品配备品种数量、药品收入、药占比、处方金额、门急诊次均药品费用、住院次均药品费用、门急诊输液处方、激素使用处方、抗菌药物处方比例等。结果西安市基层医疗机构门诊人次增长25.56%、住院人次下降12.00%、医疗收入17.16%、药品收入总体增长30.51%,次均医疗费用门诊下降2.89%、住院增加15.05%,次均药品费用门诊增长6.99%、住院增长29.78%,2013年每份处方平均药物种类为2.79种,抗菌药物处方、激素处方、输液处方比例为28.80%、1.19%、21.18%,总体渐趋合理。结论国家基本药物制度实施效果初步显现,药品配备和使用渐趋合理,每处方平均药物种类、抗菌药物、激素、输液处方等指标进一步改善。建议同步推进综合医改措施、加强基层医疗机构药学学科建设、制定完善相关考核监管措施、强化培训和宣传等。     

浙江省基本药物制度对社区卫生服务中心合理用药的影响

目的：探讨浙江省基本药物制度的实施对社区卫生服务中心合理用药产生的影响。方法：随机抽取3个试点县区共9所社区卫生服务中心的1 080张处方进行分析,用统计学方法比较基本药物制度实施前后每张处方药品品种数量均数、均次处方金额,以及使用抗生素、激素、注射剂处方的比例等指标的差异。结果：基本药物制度实施前后每张处方药品品种数量均数和均次处方金额差异具有统计学意义;而使用抗生素、激素、注射剂处方比例基本药物制度实施前后差异无统计学意义。结论：基本药物制度对合理用药有促进作用,但作用有限,需要转变医患双方的用药观念和加强医务人员规范用药的培训。     

儿科门诊1200张抗菌药物处方分析

目的：对我院儿科门诊抗菌药物处方1200张进行分析.方法：随机抽取我院儿科门诊抗菌处方1200例,根据药品说明书、参考文献、抗菌药物使用相关准则对处方进行分析,对平均用药金额、抗菌药物所占处方比例、药物联合使用情况等进行统计学处理.结果：1200例处方中头孢菌素类和林可霉素使用率最高;注射类抗菌处方使用占88.25%,口服类抗菌处方占8.17%,其他方法占3.58%;结论：本院儿科门诊类用药处方基本合理,某些地方存在不足,应加强临床医师的知识培训和监督管理.     

上海市某区基本药物配备和使用情况调查分析

目的了解基本药物制度实施前后基本药物配备和使用情况。方法以问卷调查的方式收集实施基本药物制度前后上海市某区各级医疗机构基本药物的配备情况,并对社区卫生服务中心基本药物供应、医生的处方行为和合理用药情况进行分析。结果全面实施基本药物制度后,各医疗机构基本药物配备率有所增加;基本药物供应存在短缺断货现象;基本药物处方率、基本药物使用百分率及完全基本药物的处方率均大幅上升,平均每张处方用药品种数、抗生素使用百分率、二联抗生素使用百分率和注射剂使用百分率及平均处方费用均有所下降。结论基本药物制度实施有利于合理用药和减轻患者就医负担。     

四川省农村基层医疗机构基本药物制度实施效果研究

目的：分析四川省农村基层医疗机构基本药物制度实施效果,为完善基本药物制度提供实证依据与对策建议.方法：比较国家基本药物制度实施前后,样本地区农村基层医疗机构基本药物可获得性、合理用药情况、基本药物可负担性等指标的变化.结果：国家基本药物制度实施后,药品收入占医疗机构总收入比例下降,财政补助占比上升;样本医疗机构国家基本药物配备率中位数为50.81%;次均处方费用从23.95元降至21.23元,含抗生素处方率从71.06%降至68.37%,含注射剂处方比率从32.27%降至29.70%.基本药物可负担性提高,但部分仍超过了农村居民收入可负担范围.结论：基层医疗机构财政补偿机制转变;基层医疗机构＂两降两升＂效果未完全显现;基层医疗机构基本药物配备使用率不足;基本药物价格下降,可负担性仍有待提高;基层医疗机构合理用药问题仍待改善.     

成都市基层医疗机构基本药物制度初步实施效果调查

目的：评价成都市基层医疗机构基本药物可获得性及国家基本药物制度初步实施状况。方法：抽取成都市13家试点社区卫生服务中心和5家试点乡镇卫生院作为样本,采集其财务数据、药品清单,并分别抽取2009和2010年处方进行分析。结果：截至2010年5月,所调查的社区卫生服务机构和乡镇卫生院基本药物配备率分别为94.2%和62.2%;与2009年5月相比,次均处方基本药物种数比例同比增幅分别达9.6%和31.0%,次均处方基本药物费用比例同比增幅分别达57.6%和118%;而次均处方药品种数、含抗生素处方比例、含注射剂处方比例三项指标的年度变化都不明显。结论：财政补偿责任下沉,补偿存在机构间地区间差别;目录品种不能满足基层用药需求,目录遴选未与基本医疗服务挂钩;基本药物使用率提高,但对合理用药影响不明显,基本药物使用缺少激励。     

Do seniors get the medicines prescribed for them? Evidence from the 1996-1999 Medicare Current Beneficiary Survey

Using the 1996-1999 Medicare Current Beneficiary Survey, we examine trends in nonacquisition of prescribed medicines among seniors. Each year less than 3 percent of seniors reported not getting the medicines that were prescribed for them, most often for economic reasons, but they also noted reasons relating to their preferences about using medicines. The presence or absence of drug coverage and chronic disease did not appreciably change this percentage, which suggests that a Medicare drug benefit may not greatly increase seniors' acquisition of their prescribed medicines.     

Development of sample size models for national general practice surveys

Abstract: The most cost-effective method to measure the morbidity managed and treatments provided in general practice is from records of a cluster of consultations (encounters) from each general practitioner (GP) in a random sample. A cluster sampling method is proposed for future surveys for analysis of encounter-based general practice data. The sample sizes needed to measure the most common problems managed and drugs prescribed were estimated using ratio-estimator models for cluster sample surveys. Morbidity and treatment rates were estimated from the Australian Morbidity and Treatment Survey in General Practice 1990–1991 (AMTS). The 20 most common problems in the AMTS were managed at estimated rates of 1.5 to 9.5 per 100 encounters. The 20 most common drugs were prescribed at estimated rates of 0.7 to 3.6 per 100 problems. These rates were used to determine precision as a percentage of each true value for future surveys, that is, as relative precision. If we want to be 95 per cent confident that these rates will be within 5 per cent of each true rate, sample sizes of 552 to 5675 GPs are needed. If we fix the sample size at 1000 GPs, relative precision lies within 12 per cent of these rates. If the sample size is increased to 1500 GPs, relative precision improves only marginally. The differences in sample size for each of the most frequent morbidity and treatment data are largely due to their variable distributions and relatively infrequent occurrence in general practice. A sample size of 1000 GPs will enable measurement of the most common morbidity and treatments at 95 per cent confidence.     

Medicine in a multi-cultural society: the effect of cultural background on beliefs about medications

This exploratory, cross-sectional study examined the effect of self-reported cultural background on beliefs about medicines (modern pharmaceuticals) and perceptions of personal sensitivity to the adverse effects of taking medication. Using a validated questionnaire, beliefs about pharmaceutical medication were compared between 500 UK undergraduate students who identified themselves as having an Asian or European cultural background. There was a significant association between cultural background and beliefs about the benefits and dangers of medicines. Students who self-reported to have an Asian cultural background expressed more negative views about medication than those who reported a European cultural background. Students with an Asian cultural background were significantly more likely to perceive medicines as being intrinsically harmful, addictive substances that should be avoided. They were significantly less likely to endorse the benefits of modern medication. There was no significant relationship between cultural background and perceptions of personal sensitivity to medication effects or belief about how doctors use medication. In the total sample, past and present experience of taking medication was associated with a more positive orientation to medicines in general. Students who considered themselves to have a European cultural background had significantly more experience with prescribed medication than those who selected an Asian cultural background. The relationship between cultural background and beliefs about medicines in general was maintained after controlling for potential confounding variables, including chosen degree course, experience of taking prescribed medication, age, and gender. The identification of differences in beliefs about medication, between two specific cultural groups, suggests the need for a greater understanding of the effects of cultural background on medicine-usage with potential implications for the conduct of prescribing-related consultations and for the provision of patient information on medication.     

Prescribed medicines: who takes what?

The number of prescribed medicines dispensed in England and Wales increased by 21% between 1969 and 1977. Surveys carried out at the Institute for Social Studies in Medical Care have been used to compare the reported consumption of prescribed medicines in those two years. Although there were some changes in the distribution of prescribed medicines between age, sex, and social class groups, there did not appear to be an increase in the use of these medicines commensurate with the increase in the number dispensed. It is suggested that a growing proportion of people may be deciding not to take their medicines as instructed.     

Usefulness of information leaflets about drugs for hospitalized patients with chronic diseases

To know how patients perceive the information leaflets about medicines, it has been carried out a study in a sample of 65 patients admitted to a hospital for chronic respiratory or cardiac diseases. A 47.7% of patients expressed that the main information provided by the leaflet was such concerning to the purpose of the drug, whereas a 18.5% pointed out such concerning to side effects and management of unexpected circumstances. Sixty three percent of patients expressed that leaflets did not provide them new information. A relevant percentage of patients did not know the meaning of some terms frequently used in leaflets and package-inserts (80% of mistakes in the interpretation of "take the drug on an empty stomach"). It is concluded that the information leaflets can be useful in the framework of a good physician-patient relationship, as a reminder, and to reinforce the knowledge that the patient already has. It is considered that the most appropriate time for the education of chronic patients about drugs is when the treatment is prescribed for the first time.     

Improving antibiotic prescribing in Hai Phong Province, Viet Nam: the "antibiotic-dose" indicator

OBJECTIVE: To improve the use and dosage of antibiotics prescribed at Commune Health Stations in Viet Nam, and in so doing find out whether antibiotic dosage can be easily and reliably measured as a drug-use indicator. METHODS: All commune health workers from the 217 commune health stations in Hai Phong Province, Viet Nam, were enlisted over an 18-month study period during 1994-96. The study design was a longitudinal time series, with each new district baseline acting as a rolling control. Each health station was monitored monthly by district supervisors. Two formal evaluations by doctors external to the study were compared with the supervisors' results. Basic medical equipment was provided three times over nine months, conditional on improvements in prescribing practices and adequate supervision of prescribing practices. FINDINGS: The supervisors' data showed that the percentage of encounters in which a patient was prescribed an antibiotic decreased from over 65% to around 45%. When antibiotics were given, the percentage of patients who received an adequate dose increased from under 30% to 98%. These changes were stable for 17 months after the intervention stopped. CONCLUSIONS: Such initiatives require the active collaboration of health personnel and civic leaders at every level. Conditional equipment donation was shown to be effective. A simple indicator measuring adequacy of antibiotic dose can be an effective tool to improve the use of antibiotics in a sustainable way.     

社区卫生服务机构基本药物可获得性研究

应用基本药物使用率、基本药物处方率、单张处方基本药物平均个数和全是基本药物的处方率4个指标,从处方角度对我国社区卫生服务机构基本药物可获得性现状进行评估,结果发现四个指标值分别为27.97%、43.67%、0.59个和9.11%,社区卫生服务机构基本药物可获得性很低。对TOPSIS得出的最优机构进行案例分析发现,科学的药品遴选、基本药物费用合理分担、加大政府投入、有效的监督与评估和基本药物集中招标采购、统一配送、零差率销售为促进社区基本药物可获得性的良好做法。建议进一步落实基本药物制度、建立合理的补偿机制。