Outpatient prescription practices in rural township health centers in Sichuan Province, China.
Outpatient prescription practices in rural township health centers in Sichuan Province, China.
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DOI：
10.1186/1472-6963-12-324
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发表时间：
2012-09-18
影响因子：
2.8
通讯作者：
Zhang J
中科院分区：
文献类型：
--
作者：
Jiang Q;Yu BN;Ying G;Liao J;Gan H;Blanchard J;Zhang J
四川省是中国西部的农业省和经济发展省。了解农村乡镇卫生院门诊用药的做法，对于我省及西部地区农村医疗卫生事业的发展具有重要意义。这是一项基于第四次全国卫生服务调查数据的观察性研究。共收集分析了四川省30个乡镇卫生院的3059张处方。分析中采用了七个指标来表征处方实践。它们是疾病分布、每次就诊的平均费用、每次就诊的药物数量、抗生素的使用百分比、糖皮质激素的使用百分比、糖皮质激素和抗生素联合使用的百分比以及注射的使用百分比。每次就诊的平均药物费用为 16.30 元（2.59 美元）。约60%的处方含有中成药（CPM），几乎所有处方（98.07%）含有西药。 85.18%的处方中含有抗生素，其中24.98%含有两种及以上抗生素；糖皮质激素处方比例为19.99%；同时使用糖皮质激素和抗生素的处方比例为16.67%； 51.40%的处方中包含注射剂，其中39.90%包含两次及以上注射剂。本研究的结果表明，四川省农村乡镇卫生院门诊患者存在抗生素、糖皮质激素和注射剂的不合理用药。造成不合理用药的原因不仅是乡镇卫生院追求效益最大化，更可能是由于乡村医生缺乏合理用药的医学知识以及乡镇卫生院缺乏诊断疾病的医疗器械。本研究的政策含义是加强乡村医生合理用药专业培训、改善乡镇卫生院硬件设施、加强农村居民健康教育、建立乡镇卫生院处方行为监测公开报告制度等。
Sichuan Province is an agricultural and economically developing province in western China. To understand practices of prescribing medications for outpatients in rural township health centers is important for the development of the rural medical and health services in this province and western China. This is an observational study based on data from the 4th National Health Services Survey of China. A total of 3,059 prescriptions from 30 township health centers in Sichuan Province were collected and analyzed. Seven indicators were employed in the analyses to characterize the prescription practices. They are disease distribution, average cost per encounter, number of medications per encounter, percentage of encounters with antibiotics, percentage of encounters with glucocorticoids, percentage of encounters with combined glucocorticoids and antibiotics, and percentage of encounters with injections. The average medication cost per encounter was 16.30 Yuan ($2.59). About 60% of the prescriptions contained Chinese patent medicine (CPM), and almost all prescriptions (98.07%) contained western medicine. 85.18% of the prescriptions contained antibiotics, of which, 24.98% contained two or more types of antibiotics; the percentage of prescriptions with glucocorticoids was 19.99%; the percentage of prescriptions with both glucocorticoids and antibiotics was 16.67%; 51.40% of the prescriptions included injections, of which, 39.90% included two or more injections. The findings from this study demonstrated irrational medication uses of antibiotics, glucocorticoids and injections prescribed for outpatients in the rural township health centers in Sichuan Province. The reasons for irrational medication uses are not only solely due to the pursuit of maximizing benefits in the township health centers, but also more likely attributable to the lack of medical knowledge of rational medication uses among rural doctors and the lack of medical devices for disease diagnosis in those township health centers. The policy implication from this study is to enhance professional training in rational medication uses for rural doctors, improve hardware facilities for township health centers, promote health education to rural residents and establish a public reporting system to monitor prescription practices in rural township health centers, etc.
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