| ObjectiveAnalyze the essential medicines-related papers included in the CNKI and come to understand the status of essential medicines-related research in order to lay the foundation for the development of research programs. To find out the supply and rational use of essential medicines and the economical operation in primary care health sectors, the changes in public health burden and the cognitive trust in essential medicines system of the medical stuff and outpatient, trying to understand the status and problems of implementation of essential medicines system. And then, carrying out an index "system of general evaluation by building the essential medicines system, on the basis of which, to evaluate the effect of township hospitals and community health services. The study will summarize the overall situation in the implementation of essential medicines system in Guangdong’s Primary Care Health Sectors and make recommendations to further consolidate and improve the system of essential medicines.MethodsCombined of metrological analysis and case study method, review the literature. Using stratified random sampling method to survey 120 Primary Care Health Sectors and 1200 outpatient prescriptions to know its availability and use of essential medicines, Using multi-stage stratified random sampling method to survey 658 doctors and 687 outpatient’s cognitive and trustfulness to essential medicines system. Digging out the related information from some secondary sources, such as the Guangdong Provincial Health Statistics Yearbook to know primary health care sectors amount of service, medical expenses and payments annual changes. Interview the staff of the health department, the directors of the primary health care institutions and the clinician in the form of symposium. Using the evaluation of evidence-based analysis system to extract the documentary information about the monitoring to the effect and the research of the evaluation of the essential medicine system, to conduct the evidence’s grading method, to carry out a questionnaire inquiry letter to the 25 experts by two rounds of the Delphi method, form a comprehensive evaluation index system of the effect to the implementation of the essential medicine system. Use the comprehensive evaluation methods including TOPSIS method and RSR method to carry out the comprehensive evaluation and analysis. The methods of data analysis include descriptive statistical analysis, x 2-test, Logistic regression analysis, TOPSIS method and RSR method and so on.ResultsAs of early January 2015, the papers about essential medicine research are on a total of 2860, the degree of cooperation and collaboration rate was 2.59 and 62.76%, class research papers reach 53.43%,34.00% of the thesis with the availability and use of essential medicines. The availability rate of essential medicine in township hospitals and community health services were 94.72% and 92.84%, the rate of antimicrobial drug prescribing were 64.23% and 43.57%, the average varieties of drugs per prescription were 5.08 and 3.84, the proportion of prescriptions including injections were 55.77% and 30.48%.In the terms of the operation of primary health care, the service quality of the township hospital decreased significantly, but community health center’s has steadily increased, the outpatient expenses of the two institutions has decreased, per capita hospital costs tend to smooth. The total revenue, medical income, drug income of the two institutions were significantly reduced, but the substantial increase in government revenue increased significantly. In the aspects of the basic medical staff s cognition and reliability of essential medicine system,64.29% of the basic medical staff indicated that they are familiar with the essential medicine system,87.69% considered it necessary to implement the essential medicine system, but only 13.22% of respondents felt an increase in revenue,58.81% of clinicians have a general satisfaction for the implementation of essential medicine system.9 factors, like work experience, training conditions, incentive methods, changes in income are the main factors to impact the basic medical staff s awareness of the essential medicine system. For the outpatients, Only 18.48% of respondents are familiar with the essential medicine system,61.14% of outpatients support the implementation of the essential medicine system, 57.35% of respondents felt generally satisfied for the essential medicine system.medical staff s introduction of essential medicines, the changes of the medical staff s positive, standard of culture of the patients and other factors are the main factors in the degrees of outpatients’awareness of essential medicine system. Evidence-based analysis of the comprehensive evaluation index system of the implementation effect of the essential medicine obtained 516 indexes, extracting 39 indexes of more than 21 times’citation on the total times, forming the evaluation system initially in four dimensions in availability, affordability, rational drug use, sustainability of essential medicine. Delphi method was used to advice experts, Two rounds consultation of questionnaire recovery’s rate were 83.33% and 100%, The index of the authoritative experts was 0.758, coordination coefficients of the experts’advice were statistically significant after test(P<0.05), eventually forming 4 first level indicators and 19 secondary indicators, which consist of the comprehensive evaluation index system of the implementation effect of the essential medicine. After a comprehensive evaluation, the synthesized scores on TOPSIS method in the implementation effect of the essential medicine system of township hospitals and community health services were 0.69284,0.30716, which on the RSR method were 0.82745,0.673 respectively.ConelusionThe essential medicine research has become the most noticeable area in new healthcare reform, the quality of the research is high, in terms of the method, it put an emphasis on the research, and its content is systemically. Essential Medicine List is not matching the needs of clinical medicine, which is the main problem currently. It have to adjust the method of limiting the use of the medication in grassroots, improve the essential medicine list and promote the use of medicine rationally. After the implementation of essential medicine system, the medical costs in grassroots are under control, the income-contingents of primary health care institution have been adapted and the income structure gradually optimized. The awareness trust to essential medicine system of the clinician is at the middle level, there are poor evaluation at the clinical efficacy, rational drug use, drug supply and the satisfaction of the drug demand and personal income of essential medicine. It can improve the awareness trust of the essential medicine system through increasing training and establishing checkup and stimulation. The cognitive and reliability to essential medicine of the outpatients is low, but the overall extent of the trust and satisfaction is close to a high level. The affordable feeling of the outpatient to the drug prices and medical costs is not obvious, the choice of institution is determined by convenient in the distance. It can take advantage of the role of medical personnel’s advertisement and carry essential medicine propaganda work in multi-channels to improve the cognitive and reliability of the outpatients to the essential medicine system. The evaluation index of the implementation effect to essential medicine system is more dispersed currently, the content is less systematic and operability is poor, to establish an effective and scientific evaluation system through evidence-based analysis and the Delphi method. The results are the score of township hospitals are better than community health services after the analysis of TOPSIS and RSR, the result have been validated and it is reliable, the implement effect of township hospitals is better than community health services on the availability of essential medicines and the affordable of the patient. |
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