基于医生网络的中国县域医生合理用药水平提升策略研究

保障医疗服务质量、提升医生药品合理使用是实现“健康中国2030”的重要议题。全世界有超过一半药品使用不合理，中国情况更加严峻。医生之间的知识交流和由此产生的同群效应是医生获取信息、更新知识、提升合理用药的重要信息来源。同群效应是指一个人的行为或者行为结果受到同伴群体的影响。虽然医师进修制度等已有实践体现了同群效应对提升医生知识水平的重要作用，但理论上尚不清楚同群效应对提升药品合理使用的效果和影响机制。本课题基于社会网络分析开展以下研究:（1）基于“共诊患者”构建医生网络的理论模型、界定医生网络关系，通过医保数据和调查问卷分析并优化模型；（2）建立医生同群效应的量化分析方法，评价医生药品合理使用，探究同群效应对医生合理用药的影响机制；（3）通过前瞻性干预试验为策略转化提供证据，以应用为导向为“基于医生同群效应的合理用药整体提升策略”提供支持。

Ensuring the quality of medical services and improving drug appropriate use is one of the most prominent issues to achieve “Health China 2030”. More than half of drugs were used irrationally around the world and the situation in China is even worse. Communications and peer effects among doctors are essential source for doctors to receive information, update knowledge and improve drug use. Peer effects exist when a person’s behavior is affected by his or her interaction with one or more other people. Practices like continuing education system for doctors and the counterpart support have already reflected the impact of peer effects on improving doctors’ knowledge. However, the mechanism is still unclear about the impact of peer effects on drug rational use. Hence, based on social network analysis, our research includes: (1) a theoretical model of doctor professional relation network will be built based on “patient sharing” and the model will be validated and optimized through medical insurance data and questionnaire survey; (2) quantitative analysis methods will be established for doctor peer effects to evaluate the rationality of drug use and explore the mechanism; (3) based on the mechanism, strategy of promoting drug appropriate use will be studied and improved by a prospective intervention trial. Policy proposals will be put forward in order to provide theoretical support and practice guide for improving drug appropriate use.