Based On The Current Situation Of Drug Procurement In Medical Institutions Under The Background Of Zero Error Rate

Objective:To grasp the proportion of essential medicine procurement in public medical institutions in Jiangxi Province and the implementation of essential medicine system in medical institutions at all levels.At the same time,we can explore the potential use of essential medicine in medical institutions in Jiangxi Province based on objective data,and provide relevant references for further exploring the space for the implementation of the essential medicine system and the corresponding measures or policies to be taken by government departments.Methods:Using the stratified cluster sampling method,and dividing all 11 cities in Jiangxi Province into five regions: southern,northern,western,central and eastern,randomly selecting one city from each region,and then surveying all 1,376 public medical institutions in these five regions for medicine procurement in 2020.Then apply the Kruskal-Wallis rank sum test to analyze the proportion of essential medicine procurement and the potential of essential medicine use in different regions and levels of medical institutions,and then use the Nemenyi method to make a two-by-two comparison.Results:(1)Current situation of medicine purchasing amount of public medical institutions in Jiangxi ProvinceThe total medicine procurement amount of the 1,376 medical institutions surveyed amounted to RMB 1,851,349 million,with 10.71%,28.05% and 61.24%of the medicine procurement amount of the first,second and third level medical institutions respectively.The five regional medical institutions in the south,north,west,central and east accounted for 22.01%,12.21%,12.44%,40.66% and 12.68%of the medicine procurement amount,respectively.(2)Procurement of essential medicinesThe total procurement amount of essential medicine in public medical institutions was RMB 693,807.1 million,and the proportion of essential medicine was 37.48%.(1)The purchase amount of essential medicine in primary,secondary and tertiary medical institutions accounted for 69.75%,45.58% and 28.12%,respectively,with significant differences among the three levels of medical institutions(H=485.53,P<0.001).(2)The procurement amount of essential medicine in 5 regions accounted for 51.64% in the west,47.74% in the east,45.74% in the north,38.89% in the south and 26.69% in the center,and the difference in the procurement amount of essential medicine in 5 regions was significant(H=222.38,P<0.001).(3)The top 5 categories of drugs in the essential medicine procurement amount in order: 54.69% of the respiratory system,vitamins/nutrition drugs/regulation of water/electrolytes and acid-base balance 48.45%,Chinese patent medicines 46.85%,anti-microbial class46.08%,blood system 46.07%;The last 5 categories in order are: 4.07% for eyes/nose/ears and skin cell growth,15.49% for antipyretic and anti-arthritic and gout,16.74% for anti-tumor,23.27% for digestive system,and 30.93% for immune system and anti-allergy.(3)Potential for substitution of essential medicine in medical institutionsThe procurement amount of non-essential medicine in the surveyed medical institutions was RMB 1,157,541.9 million,and the available alternative procurement amount of essential medicine replacement amounted to RMB 135,777.0 million,with an essential medicine substitution potential of 11.73%.(1)The potential for substitution of essential medicine in primary,secondary and tertiary medical institutions was 19.31%,15.02% and 10.03%,respectively,with significant differences among the 3 levels of medical institutions(H=58.20,P<0.001).(2)The substitutable potential of essential medicine in 5 regional medical institutions was15.42% in the west,13.33% in the east,13.23% in the north,12.63% in the south,and 9.89% in the center,with significant differences in the substitutable potential of essential medicine in different regions.(H=43.04,P<0.001).(3)The substitutable potential of 15 types of essential medicine is as follows: respiratory 52.62%,cardiovascular and cerebrovascular 18.78%,nervous 17.83%,anti-microbial 17.70%,endocrine and reproductive 16.71%,anti-tumor 13.68%,digestive system 9.73%,vitamins/nutritive drugs/regulating water,electrolyte and acid-base balance 9.19%,blood system 8.23%,Chinese patent medicine 4.88%,antipyretic/analgesic and anti-arthritis and gout 4.71%,eye/ nose/ear and affect skin cell growth 3.94%,urinary system 1.93%,effect on immune system and anti-allergy 0.60%,other types of medicine 5.35%.Conclusion:(1)In Jiangxi Province,the purchase amount of essential medicine accounted for 37.48%.From the level of medical institutions,it is advisable to strengthen the procurement of basic drugs in tertiary medical institutions.According to the results of the investigation in 5 regions,it is advisable to strengthen the procurement of essential drugs in the central and southern regions.According to the results of drug category analysis,it is appropriate to strengthen the procurement management of base drugs for eye/nose/ear and affecting skin cell growth,antipyretic,analgesic,anti-arthritis,gout and anti-tumor.(2)From the perspective of no need to change doctors’ medication habits,the substitution potential of essential medicines to replace non-essential medicines in Jiangxi Province was 11.73%.In terms of the level of medical institutions,it is advisable to strengthen the management of essential medicine use standards in primary medical institutions;In terms of regions,we should focus on the western and eastern regions to strengthen the management of standardized use of essential medicine.From the perspective of drug categories,it is appropriate to strengthen the management of the use of essential medicine for respiratory,cardiovascular and cerebrovascular drugs,nervous system drugs,endocrine and reproductive system drugs,and anti-microbial drugs to improve the utilization rate of essential drugs,so as to effectively reduce the medical costs of patients and alleviate the phenomenon of "expensive medical treatment".