The Research On Transparency Mechanism And Its Effect Of Medicine Use In Health Facilities

[Background] The situation of irrational medicine use in health facilities is worrying, and the lack of transparency is one of the main causes for corruption and low efficiency in medicine use fields, the research on transparency mechanism is the important basis to solve the irrational medicine use problems. In2012, Zhejiang province started the "Sunshine Medicine Project", it’s a good practice for transparency regulation of medicine use in our country, but its operation mechanism and the implementation effect are not clear, and need further study.[Objective] To establish the transparency regulation model and operating mechanism based on the information disclosure, analysis, dissemination and sanction; with the perspective of medication behaviors, verify the effects and existing problems of the transparency mechanism, and optimize the regulatory strategy.[Methods] Through literature review, focus group discussion and logical reasoning method for defining the relevant concepts of transparency mechanism, constructing the framework of transparency mechanism of medicine use in health facilities, and identifying the promoting and limiting factors. Clear the transparency status of medicine information in Zhejiang provincial hospitals by content analysis. Use the medicine monitoring data disclosure by Zhejiang province, and through statistical analysis, generalized estimating equations (GEE), TOPSIS method to verify the effect of transparency mechanism and the medicine use behavior change trend of the health facilities.[Results](1) The medicine use information in Zhejiang provincial hospitals including Service process, inform patients and health education, price policy, medicine expenditure and medicine use quality. Among them, medicine expenditure and medicine use quality information accounted for the highest proportion of the total frequency (27.18%); followed by the service process information, is26.70%; the lowest is price policy information (7.77%). From the hospital categories, the information in the different types of hospitals was not statistically significant. From the geographical location, the service process, inform patients and health education, price policy of the hospitals located in Hangzhou city and Wenzhou city were no significant difference; and there were significant differences in medicine expenditure (X2=33.758, P=0.000) and medicine use quality (x2=33.758, P=0.000)(2) In this study, combined with the characteristics of medicine use regulatory in health facilities in china, we established the framework of transparency mechanism of medicine use in health facilities based on DADS, which requires health facilities to disclose information of medicine use, the competent department of the government or the third party agencies to analyze information, and disseminate it to the public regularly; after the dissemination, the health facilities will feel pressure, so they may take the initiative to improve medication behavior; the government would impose sanctions on the health facilities that do not comply with medication prescribed, forcing them to regulate the medication behavior; then the health facilities have to disclose the improved medicine information. The key elements of transparency mechanism of medicine use in health facilities include the information of medicine use, health facilities and government departments; the key link including medicine information disclosure, analysis, dissemination and organizational sanctions; the running environment and security conditions of transparency mechanism including social environment, institutional environment, organizational construction and information management of the hospital. Based on the above, we have carried out the research combined with the actual situation of the provincial hospitals of Zhejiang province. The results showed that there are some places need to improve in transparency mechanism of medicine use in Zhejiang provincial hospitals:no unified standard in information disclosure, and it’s not reached the public’s needs and the relevant standards; in the information analysis, the analysis results of the government department is too simple, and it’s not entirely practical and useful for the public; the time, frequency and channels of the medication information dissemination need to be improved; lack of public participation and social influence in the regulatory, and the social foundation need to strengthen.(3) The empirical results showed that the medicine utilization indexes of the16hospitals have improved significantly with the passage of time. The results of GEE analysis showed, percentage of unqualified prescriptions (Wald χ2=39.094, P<0.001), percentage of drugs prescribed from EML (Wald χ2=370.066, P<0.001), percentage of patients with antibiotic prescribed (Wald χ2=32.542, P<0.001), percentage of outpatients with antibiotic medicines prescribed (Wal dχ2=57.871, P<0.001), percentage of medicine income in medical income (Wald χ2=27.948, P<0.001), percentage of medicine income in outpatient medical income (Wald χ2=26.441,P<0.001) and percentage of medicine income in inpatient medical income (Wald χ2=32.319, P<0.001) were significantly difference at different time points, only average expenditure per prescription (Wald χ2=4.095, P=0.664) is not significant difference at different time point.Further analysis found that, the better than expected hospital group has had a relatively worse trend in measurement indicators, while the worse than expected hospital group has had a relatively better trend. Among them, from the point of view of frequency, The total frequency of medicine use indicators of the better than expected hospital group (A group), as expected hospital group (B group) and the worse than expected hospital group (C group) improved respectively16,34and30, and respectively accounted for40%,70.8%and75%of the total frequency in each group. The improved effect of A group is the worst, the level of rational use of medicines was decreased in most indicators, B group is better, some indicators improved, while C group improved effect is the best, most indicators have improved. By chi square test, There were significant differences among the three groups in general; there were no significant difference between B group and C group, and the other groups showed significant differences. From the point of view of margin, A group has four indicators getting greater deteriorate magnitude than improvement magnitude, only half of the total; B group has six, accounting for75%of the total; and C group has seven, accounting for87.5%of the total. The comprehensive ranking results of TOPSIS showed that the relative medication behavior of the hospitals showing a trend of diversification.[Conclusion](1) There was a positive effect of transparency mechanism to the health facilities, but the specific medication behavior of the health facilities need to further standardize.(2) Recommendations:first, to ensure the quality of the information of medicine use, and make disclosure and dissemination more effectively, which is the basis of transparency regulation; second, strengthening the lateral governance, and encourage the hospitals, the public, research institutions and other social sectors to involved, it will expand its influence and reduce the cost of regulation, third, Insist on ongoing supervision, to detect and control the adverse trends of medicine use in health facilities in time.