| Objective: To summarize the current situation of the shortage of national essential medicines(NEMS)in our country,the progress of the implementation of relevant policies,analyze the causes of drug shortage and provide reference for the future comprehensive reform of drug supply in medical institutions and the guarantee of China’s drug supply.Hefei three hospitals to understand the status of drug shortage,analysis of the reasons leading to drug shortage.According to the above research results,this paper puts forward some suggestions on how to promote the comprehensive reform of drug supply in medical institutions.Methods: This study is divided into two parts: The first part of the systematic search Wanfang,CNKI,VIP database and Pubmed for the period from August 2009 to August2017 China NEM shortage related literature.Through the literature review,analysis,statistics NEM shortage status and the reasons.After reviewing the relevant government websites in our country,since the statistical analysis of the essential drug system,China has promulgated relevant policies to solve the shortage of medicines.Finally,with the analysis results to complete the design of the interview outline.The second part,from August,2017 to November,2017,according to the distribution of different regions in Hefei city.A qualitative interview was conducted with the hospital key personnel faceto-face interview to understand the Hospital shortage of drugs and the reasons for the shortage in seven tertiary level general hospital.At the same time,access to the hospital from January 1,2016 to June 30,2017 shortage of drug records,the data obtained in accordance with the previously designed form to extract.Using Excel 2007 to collect the data for statistical analysis,the statistical description of the count data using the constituent ratio indicators.Qualitative interview data using Colaizzi seven-step data analysis of the scene recording data analysis,combined with the field notes in accordance with the purpose of the study summarized.Results: Review of the literature:(1)Since the implementation of the essential drug system in our country,a total of 192 kinds of NEM have been in short supply,including177 kinds of chemical and biological medicines and 15 kinds of proprietary Chinese medicines.Shortage chemical medicines mainly concentrate on anti-infective drugs and cardiovascular system Drugs,shortages of proprietary Chinese medicines are mainly concentrated in the medical treatment;reports of comprehensive literature,leading to NEM shortage causes of eight main reasons are the shortage or price rise of raw materials,drug quality problems caused by drug recalls,GMP issues,drugs Low profit or loss,the characteristics of the drug itself and other reasons,the clinical demand is small,the lack of supply company and the drug delivery market or not bid.(3)In recent years,China has tackled the shortage of medicines mainly by establishing a shortage drug monitoring system,implementing fixed-point drug production at short supply points,cracking down on the monopoly of raw drug substances,phasing out the drug additions,implementing the drug distribution system reform and accelerating the shortage of emergency medicine Production approval and so on.Site survey:(1)The survey found that there were 68 kinds of drugs in 7 tertiary hospitals in Hefei.There are a total of 68 kinds of drugs,which are classified according to the categories of essential medicines: 38 kinds of national essential medicines and 48 kinds of provincial essential medicines;Classified by the properties of medicines: Chemistry and Biology There are58 kinds of medicine,10 kinds of middle-level medicine.According to pharmacological effects classification: a total of 17 pharmacological effects of the shortage of drugs,including eight kinds of circulatory system medication,eight kinds of medical use,six hormones and regulatory endocrine function drugs,six kinds of antimicrobial drugs, five kinds of specialist medication,five kinds of digestion Four kinds of antineoplastic drugs,four kinds of nervous system drugs,four kinds of detoxification drugs,four kinds of respiratory system drugs,three kinds of anti-allergy drugs,two kinds of diagnostic drugs,two kinds of blood system drugs,two kinds of surgical drugs,two kinds Vitamins and minerals deficiency drugs,two antipyretic and analgesic and non-steroidal anti-inflammatory drugs,a regulation of water,electrolytes and acid-base balance of drugs.(2)According to the investigation of the supply of 3 kinds of fixed-point drugs in2016,only one of the 7 sampling sites resumed the supply of digoxin oral solution,and the other samples were replaced by digoxin tablet;Oxyzole injection were not resumed supply,with its tablet replacement;sodium salicylate injection,the sample points in recent years did not use this drug medication plan.The main reasons leading to drug shortage are: shortage of raw materials,prices continue to rise,manufacturers terminate or discontinue production,distribution companies can not meet the "two-vote system" requirements,manufacturers lack of productivity,drug peak caused by shortage,drug recall,GMP problems,quantitative Supply,the reasons for the development of their own manufacturers,exclusive supply,productivity and other reasons.Conclusion: In recent years,there are many shortages of drugs in our country and the reasons for the shortage are complicated.Relevant policies aimed at solving drug shortage are still at an exploratory stage.At present,there are still more serious drug shortage problems in the tertiary general hospitals in Hefei.The reasons for the shortage of medicines are quite complicated.The implementation of related medical policies is also the reason for the shortage of some medicines.Therefore,our country needs to further explore solutions to drug shortage and set up a framework for resolving the drug shortage problem.From a shortage alert,we explore influencing factors,formulate a reasonable pricing mechanism and a scientific compensation mechanism,and further promote the policy of fixed-point manufacturing of drugs. |
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