| ObjectiveTo investigate the implementation of the National Drug Centralized Procurement Policy(hereinafter referred to as the “National Centralized Procurement Policy ”)in Qingdao,we selected the first batch medication including 25 medicines,then analyze the distribution of the usage and affected factors.This can provide scientific basis for the relevant departments of national intensive purchasing in Qingdao to optimize the implementation plan and promote the implementation of national intensive purchasing policy.Methods1.Multi-stage and sub-survey method was adopted,and questionnaires were filled out and collected face to face by the questionnaire star platform.Convenient sampling method was used to carry out a survey among doctors,pharmacists and consumers about national collective drugs,and one-way ANOVA was used to analyze the significant differences.Objective sampling method was used to conduct in-depth interviews about attitudes of customer towards national centralized drug collection.The convenience sampling method was used to investigate customer’ willingness to use the selected drugs.All questionnaires were assessed anonymously.2.Based on the theory of planned behavior and the results of the questionnaire,the structural equation model of consumers’ willingness to use national collective purchasing drugs in Qingdao was constructed.Four dimensions of attitude,subjective norm,perceived behavioral norm and perceived risk were set by the national drug intention test model of Qingdao consumers.Validity and reliability tests and exploratory factor analysis were conducted by SPSS26.0.According to the results of the test model,the formal structural equation model of consumers’ willingness to use national collective drugs in Qingdao was optimized,and the fitting degree test and path analysis of the structural equation model were completed through AMOS23.0.3.Using cross-sectional study method,the overall use of 25 selected drugs collected by Qingdao and the use of different levels of medical institutions were investigated.Cluster stratified sampling and intention sampling were adopted to select 85 unclassified medical institutions,including 10 unclassified medical institutions,42 first-level medical institutions,14 second-level medical institutions and 19 third-level medical institutions.Descriptive statistical analysis was conducted on the preset procurement amount,actual consumption amount,selected replacement rate and independent procurement of each medical institution.Result1.The difference of awareness degree among pharmacists,doctors and consumers to the national collective purchasing policy was statistically significant(P<0.05).The awareness among pharmacists,doctors and consumers was 86.43%,67.90% and 31.32%respectively.In addition,the recognition degree from them s was statistically significant difference(P<0.05),the recognition degree of the pharmacists,doctors and consumers was 98.40%,65.43% and 87.35%,respectively.2.A total of 443 questionnaires were collected,including 92 test model questionnaires and 351 formal model questionnaires.Based on the theory of planned behavior,the structural equation model of consumers’ willingness to use national collective purchasing drugs in Qingdao has a good fitting degree,which can explain the research problem.The indexes of fit degree were Chi/DF=2.592,GFI=0.909,AGFI=0.876,RMSEA=0.067,NFI=0.937,IFI=0.903,CFI=0.938.The results showed that the subjective norms positively affected the use intention,and the path influence coefficient was 1.15(P<0.05).The perceived risk negatively affected the actual action,and the path coefficient was 0.52(P<0.05).Willingness to use can be effectively translated into action,and the path coefficient is 0.60(P<0.05).Social media affected consumers’ subjective norms,and the path coefficient was 2.03.The path coefficients of consumers’ concern about the quality and efficacy of selected drugs were 1.63 and 1.77,respectively.3.In Qingdao,25 varieties were selected from the national collective collection.Among them24 varieties were completed the preset purchase amount in the first year,but fosinopril sodium tablets were not completed.Gefitinib and imatinib tablets were 52.66 times and 22.65 times than the preset amount.The replacement rates were 98.06% and98.01%,respectively.The top three in total consumption were atorvastatin calcium tablet,amlodipine besylate tablet and rosuvastatin calcium tablet,which were 1.10,1.34 and1.86 times of the agreed purchase amount,and the selected replacement rates were70.61%,69.96% and 72.49%,respectively.The replacement rates of irbesartan hydrochlorothiazide tablets and clopidogrel bisulfate tablets were 93.54% and 96.20%,higher than other cardiovascularmedication.The replacement rate of cefuroxime axetil tablets was 96.60%,and that of montmorillonite powder was 93.48%.The replacement rates of levetiracetam and risperidone tablets were 46.71% and 67.26% respectively.4.The survey on the replacement rate of 85 medical institutions at different levels showed that the percentage of replacement varieties was different.There were 4 unrated medical institutions,5 first-level medical institutions,8 second-level medical institutions and 0 third-level medical institutions.Primary medication which the basic institutions independently purchase are atorvastatin calcium tablets,montmorillonite powder,cefuroxime,etc.Conclusion:1.The recommendation of doctors and pharmacists to national collective medicines is an important factor affecting consumers’ willingness to use.Pharmacists have a higher awareness rate of national collective purchasing policy and a higher recognition rate of selected drugs than doctors,which is more likely to play a positive role in consumers’ willingness to use.2.The top three in total use were atorvastatin calcium tablets,amlodipine besylate tablets and rosuvastatin calcium tablets.The replacement rates were all lower than consumers’ recognition of the selected drugs.Consumers’ high perceived risks to the efficacy,quality and safety of selected drugs block their actual purchasing behavior.3.Consumers’ willingness to use selected drugs is affected by many factors such as cognition and medication experience.Medical staff’s recommendation,media publicity and medication experience can affect consumers’ willingness to use.Adverse use experience increases consumers’ perceived risk of the selected drugs and may directly block consumers’ re-purchase and use behavior.The improvement of consumers’ willingness to use is beneficial to improve the actual use behavior and the replacement rate.4.Qingdao carried out well on the national intensive purchasing policy and basically completed the task of national intensive purchasing.The substitution rate of the selected original drugs was higher than that of the selected generic drugs.The substitution rate of drugs for common diseases was higher than that for chronic diseases,such as cefuroxime tablets.Montmorillonite powder was significantly higher than that for atorvastatin calcium tablets and rosuvastatin besylate calcium tablets.Due to the particularity of the disease,there are safety risks in the process of drug replacement of antipsychotics,and the replacement rate is lower than that of other drugs.5.It was found that the replacement rate in primary medical institutions was higher than that in tertiary hospitals.Drugs independently procured by primary-level medical institutions are mainly drugs for chronic diseases and common diseases.Procurement tasks can be set stratified according to the levels of medical institutions.6.For some drugs with high coefficient of variation and narrow treatment window,the suitability of substitution of selected drugs for drugs with doubtful safety should be further verified. |
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