Evidence-Based medicine in China
Evidence-Based medicine in China
复制标题
中国的循证医学
DOI：
10.1111/j.1524-4733.2008.00379.x
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发表时间：
2008-03-01
期刊：
影响因子：
4.5
通讯作者：
Wang, Li
中科院分区：
文献类型：
--
作者：
Li, Youing;Sun, Xin;Wang, Li
中国是世界上最大的国家，拥有13亿人口。人口健康一直是与经济和社会可持续发展最相关的问题之一。然而，有限的卫生服务无法满足巨大的卫生需求。2003年癌症年发病率估计为1.3%，心血管疾病50%，感染性疾病2.7%，而2004年每千人只有1.50名临床医生、1.03名护士和2.40张病床提供服务[1]。随着我国人口中传染病向慢性病的快速转移，卫生支出急剧增加。2003年全国卫生总费用达到6584.1亿元，比1995年增加了两倍[1]，而全国卫生预算从1995年的387.34亿元增加到2003年的1116.94亿元[2]，却难以科普卫生总费用的急剧攀升。如何利用有限的保健能力来保持所有人口的健康是一个巨大的挑战。另一方面，我国卫生资源的利用存在着严重的不平衡。在经济发达地区，保健服务利用不当和过度，而在经济欠发达地区，保健专业人员和技术较少。由于保健服务的利用效率低下，每年发生大量本可避免的药物不良事件，造成额外的保健资源使用，使这种情况更加复杂。自20世纪90年代初以来，这些问题在中国日益明显。尽管中央和地方政府为解决这些问题付出了巨大努力，但保健系统仍有待改善。世界卫生组织（WHO）报告[2]将中国的整体卫生服务在191个成员国中排名第144位。政策制定者和临床医生都认为有必要根据确凿的证据做出政策和临床决策。1993年，世界上出现了一个旨在提供、维护和传播最佳证据以改善医疗效果的国际组织--科克伦合作组织; 1992年，临床医学出现了一个新的领域--循证医学，其重点是改善医疗模式。这些历史事件成为推动循证医学在中国引入和发展的动因。
China is the biggest country in the world that has 1.3 billion population. The health of the population has been one of the issues most relevant to sustainable development of the economy and society. However, limited availability of health services is unable to meet the enormous health needs. The estimated annual incidence of cancers 1.3%, cardiovascular diseases 50%, infection diseases 2.7% in 2003, whereas only 1.50 clinicians, 1.03 nurses and 2.40 ward beds per thousand are available to provide services in 2004 [1]. With the rapid shift of infectious diseases to chronic diseases in the Chinese population, the health spending is increased dramatically. The national health expenditure in 2003 has been tripled to 658.41 billion Renminbi (RMB) compared to that in 1995 [1], whereas an increase of national health budget from 38.734 billion in 1995 to 111.694 billion in 2003 [2] cannot cope with the steep climbing of health expenditure. It is a big challenge to utilize the limited health-care capacity to keep all the population healthy. On the other hand, the health resource use is highly imbalanced across China. In the economically developed regions, the health-care services are improperly and excessively utilized, whereas health professionals and technologies are less available in regions with less developed economy. This situation has been further complicated by the low efficiency of utilizations of health services, on which a large number of avoidable adverse events of medications occur each year to cause additional health resource use. Since early 1990s, these problems have been increasingly evident in China. Although the central and local government paid great efforts to address these problems, the health-care system is yet to be improved. The World Health Organization (WHO) Report [2] ranked China 144th place out of 191 member countries for the overall health services. Both policymakers and clinicians feel the strong need to make policy and clinical decisions based on solid evidence. Coincidently occurred in the world was the burgeoning of the international organization in 1993—the Cochrane Collaboration—which aims to produce, maintain, and disseminate the best evidence to improve the effects of health care, and a new field in clinical medicine in 1992—EBM—that focuses on improving the health-care pattern. These historical events have become the incentives that promoted the introduction and development of EBM in China.