| BackgroundFor a long period of time, China suffers with sever problem of irrational medicines use, especially in western rural area in terms of polypharmacy, antibiotics and injection overuse. International intervention experience includes four categories: educational, management, economic and administrative measures. The most effective intervention methods are usually comprehensive. In face with the situation, China has begun to establish its national essential medicines policies (EMP) with a cluster of measures since2009, setting the rational medicines use as one of the key policy objectives.Prompt policy evaluation during the implementation provides important evidence for policy adjustment and revision. However, there is few intervention evaluation concerned with national EMP in China, and most of them provide virtually no evidence of policy effect due to uncontrolled, cross-sectional designs. As a result, a well designed evaluation of national EMP impact on rational medicines use in reasonable design has great significance to enhance the policy.ObjectivesThis study aims to investigate and analyze the indicators of rational medicines use (INRUD) in primary care before and after EMP implementation, identifyt problems and assess intervention effect of current policy measures on the issue with the reference to key factors affecting prescription habits. Policy suggestions will be made to improve national medicines use and EMP measures.ContentsThe contents of the thesis includes policy analysis of national EMP and its relevant measures on rational medicines use, INRUD indicators comparison in primary care before and after EMP implementation, investigation of key factors affecting prescription habits and analysis on current effect and impact of China EMP measures. MethodsSummarize international and national issues, interventions and their effects through literature review; extensively collect national and regional policy documents of EMP measures for policy analysis; and understand difficulties and problems in policy implementation from informant interview and group discussion participated by stakeholders. Investigation has been carried out to obtain indicator data of rational medicines use and prescription affecting factors. Base on the4th National Health Services Survey in2008, the investigation is composed with surveys on primary health institutions, prescriptions, doctors and patients covering94counties in31provinces of China. Finally8233prescriptions from83primary institutions which have counterparts in the the survey2008are analyzed.4266doctors and790patients provided feedback. The research uses a controlled, comparison design. Statistics analysis of indicators comparison includes T test for parameter variables meeting the criteria and Mann-Whitney U for non-parameter ones. A difference in difference analysis is applied to evaluate net intervention effect.Results and key findings1. Among measures of EMP, essential medicines (EM) list selection, EM bidding, procurement, distribution and supply, as well as specific control program of antibiotics use are classified into administrative intervention; EM pricing, zero-mark up, insurance reimbursement and fiscal compensation into economic intervention; performance assessment for institutions and physicians, institutional pharmacy administration into management interventions; and physician training course on guidelines and patients promotion into educational interventions.2. The direct policy impact may be reflected, while most prescription problems are not effectively solved. There is no significant net effect contributed by EMP measures. Main issues concerning irrational medicines use include unreasonable disease prescription, medicines use disparity between urban and rural areas, limited institutional condition to ensure rational use, and the lack of medicines knowledge and prescription compliance of patients.3. Prescription affecting factors reflect the limited cognition of physicians on EM and rational use with unmet reasonable income expectation, the lack of patient education, and changes in primary institution service and operation. 4. The cause of insignificant EMP measures effect on rational medicines use may partly explained by limited implementation period of the new policy. On the other hand, however, the issue also reflects policy problems in list selection, EM supply, zero-mark up requirement, institutional fiscal compensation, and education for both physicians and patients.SuggestionsMain suggestions include:the policy focus should transit from ensuring medicines supply to improving rational medicines use; facilitating physicians’recognition and compliance on EM list and guidelines; enhancing patients’education in order to avert incorrect perception, and establishing management and administrative mechanism for rational medicines use in primary care. |
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