The impact of China's national essential medicine system on improving rational drug use in primary health care facilities: an empirical study in four provinces.
The impact of China's national essential medicine system on improving rational drug use in primary health care facilities: an empirical study in four provinces.
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DOI：
10.1186/s12913-014-0507-3
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发表时间：
2014-10-25
影响因子：
2.8
通讯作者：
Yin A
中科院分区：
文献类型：
--
作者：
Song Y;Bian Y;Petzold M;Li L;Yin A
国家基本药物制度（NEMS）是中国于2009年推出的一项新政策，旨在改善药物的合理使用。本研究旨在检验NEMS目标在中国基层医疗机构合理用药方面的结果。通过2010-2011年的实地调查，从中国四个省的146个乡镇卫生院收集了28，651张处方。使用前/后设计提取并比较合理用药指标，然后根据世界卫生组织（WHO）标准指南和之前研究的数据进行评估。2009年至2010年，每张处方的平均药物数量从3.64种下降到3.46种（p < 0.01）。NEMS对每张处方的平均抗菌药物使用量影响不大，但含抗菌药物处方的比例从60.26%下降到58.48%（P < 0.01）。注射剂或肾上腺皮质类固醇的处方也有所减少，分别占所有处方的40.31%和11.16%。2011年也记录了所有这些积极的问题。然而，上述每一个数值仍然高于世卫组织的标准。实施国家基本药物管理制度后，从基本药物目录中处方的药物比例增加（p < 0.01）。在现有数据允许评估成本变化的情况下，平均每张处方的费用显著增加，从25.77元增加到27.09元（p < 0.01）。NEMS有效地促进了中国的合理用药。然而，多种药物以及过度使用抗生素和注射剂的现象仍然很普遍。仍有大量未完成的议程需要政策改进。治疗指南、强化支持监督以及对专业人员和消费者的持续培训是需要采取的基本行动。
The National Essential Medicine System (NEMS) is a new policy in China launched in 2009 to improve the appropriate use of medications. This study aims to examine the outcomes of the NEMS objectives in terms of the rational use of medicines in primary health care facilities in China. A total of 28,651 prescriptions were collected from 146 township health centers in four provinces of China by means of a field survey conducted in 2010–2011. Indicators of rational drug use were extracted and compared using a pre/post design and then evaluated with regard to the World Health Organization (WHO) Standard Guidelines and data from previous research. The average number of drugs per prescription decreased from 3.64 to 3.46 (p < 0.01) between 2009 and 2010. Little effect was found for the NEMS on the average number of antibiotics per prescription, but the percentage of prescriptions including antibiotics decreased from 60.26 to 58.48% (p < 0.01). Prescriptions for injections or adrenal corticosteroids also decreased, to 40.31 and 11.16% of all prescriptions, respectively. All these positive issues were also recorded in 2011. However, each of the above values remained higher than WHO standards. The percentage of drugs prescribed from the Essential Drug List increased after the implementation of the NEMS (p < 0.01). Where the available data allowed changes in costs to be assessed, the average expense per prescription increased significantly, from 25.77 to 27.09 yuan (p < 0.01). The NEMS effectively improved rational medicine use in China. However, polypharmacy and the over-prescription of antibiotics and injections remain common. There is still a large unfinished agenda requiring policy improvements. Treatment guidelines, intensive support supervision, and continuing training for both professionals and consumers are the essential actions that need to be taken.
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影响因子：
3.3
作者：
Reynolds, Lucy;McKee, Martin
通讯作者：
McKee, Martin
影响因子：
2.8
作者：
Desalegn AA
通讯作者：
Desalegn AA
影响因子：
2.8
作者：
Jiang Q;Yu BN;Ying G;Liao J;Gan H;Blanchard J;Zhang J
通讯作者：
Zhang J
国家基本药物政策对湖北省基层医疗机构处方行为的影响
影响因子：
3.2
作者：
Yang, Lianping;Liu, Chaojie;Zhang, Xinping
通讯作者：
Zhang, Xinping
影响因子：
3.3
作者：
Pavin, M;Nurgozhin, T;Laing, R
通讯作者：
Laing, R