Study On Evaluation Of Interventions And Strategies To Improve Use Of Drugs In Rural Areas Of China

Object:More and more people pay attention to irrational use of drugs in rural areas. In order to eliminate it and reduce unnecessary waste of medicine resource, we have done many intervention researches. There are many effective interventions and useful experience. This study summarized the experience in rural areas, especially in Health 8 project areas. This study provided some suggestions on how to improve rational use of drugs in rural areas and ensure the ration use of drugs (RUD) policy be effective in a sustainable way.Data and Methods:Literature review, field investigation, expert consultation and statistical method were used in this study. The data included: (1) literatures of rational use of drugs in home and abroad. (2) the data of Health 8 experimental counties, including: documents, reports of Health 8 experimental counties; interview data of 31 person of 21 Health 8 experimental counties, including managers in health management department and health facilities and health workers; data of drug management in health facilities in rural townships; prescription data in health facilities.(3) the data of New-type rural cooperative medical system (CMS) experimental province, including the data of interventions in the province and inpatient medical record of Appendicitis of 8 health facilities in 4 project counties from 2003 to 2005.This study content included: (1) study on values of common evaluation indicators of RUD in rural areas, (2) evaluation of the effect of interventions in investigated areas, (3) study on strategies to apply interventions.Results and Conclusions:1. By reviewing and summarizing the literatures, analyzing the frequency, min, max, mean and median of every indicator, the researcher found common indicators used by researchers were average number of drugs per encounter, average expenditure per encounter, percentage of encounters with an antibiotic prescribed, percentage of antibiotics, percentage of encounters with cortex hormone prescribed, percentage of encounters with an injection prescribed. They are all prescribing indicators. The value of percentage of encounters with cortex hormone prescribed should be lower in China. The value of percentage of essential drugs should be higher in China. Reference values were calculated by referring the optimal value suggested by international expert and the range between min (or max) and mean (or median).Reference values were 1.77-3.875, 4.86%-11.46%, 22.97%-48.14%, 18.32%-25.22%, 0%-9.95%, 1.86%-43.3%. Percentage of essential drugs was 62.83%-74.22%.2. Interventions in investigated areas have some rational effect, such us standard treatment guideline (STG), essential drug list (EDL). Average number of drugs per encounter was 2.72-4.54, percentage of antibiotics was 21.27%-31.87%, percentage of encounters with cortex hormone prescribed was 6.20%-50%, percentage of injections was 11.29%-99.02%, percentage of drugs prescribed by generic name was 88.71%-99.33%, percentage of essential drugs was 72.37%-98.23%. Average expenditure of intervention group was lower than contrast group in Anhui province. Average expenditure of intervention group was a little lower than contrast group in CMS province. Average number of drugs per encounter, percentage of antibiotics , percentage of encounters with cortex hormone prescribed,percentage of injections of intervention groups was lower than contrast groups. But the use of antibiotics was aggravating in CMS areas. The abuse of cortex hormone was not been controlled. Health workers in Health 8 areas have much rational change in concept, knowledge, and behavior on use of drugs. 76.88 percent of investigated people have rational concept, 85.95 percent of investigated have rational knowledge and 73.42 percent of investigated pay more attention to RUD.3. There was much difference in different areas. The intervention group was more rational than the contrast group in AnHui province. It was more rational than other areas.4. The Two-week Non-visit Rate of outpatient service of rural people was 45.8% in China. The Non-visit Rate of inpatient service of rural people was 30.3% in China. People in rural areas make use of health service insufficiently, and may make use of drugs insufficiently. But researchers in our country do not pay attention to this problem.5. Evaluating the effect of interventions by prescribing indicators alone is not appropriate. We must develop all-round indicators including concept, knowledge and behavior change.6. The cause of irrational use of drugs in rural areas is complex, including health workers'poor knowledge, insufficient budget, appropriate health facility commercialization, insufficient health insurance, fake drug advertisement, patient's improper inducement, improper drug price, etal.7. The relation between new-type rural cooperative medical system and RUD policy is interactive. We can mak use of the combination of two policy.Suggestions:In order to improve RUD in rural areas of China and RUD researches, the researcher suggested:1.Pay more attention to the manager's impact on improving RUD and make use of its paradigm and leading impact.2.Apply ten core interventions including STG and EDL. They are applying STG, applying EDL, developing a drug management department and perfecting its function, educating health workers, supervising and checking up the use of drugs, developing independent drug information system, carrying out public education, economic interventions, improving the work rate of drug use and health workers by ensuring sufficient budget.3. Make use the pressure of applying the new-type CMS and apply many types of interventions to improve RUD in rural areas.4. Many departments improve RUD cooperatively, including: management department of CMS and MA, health department, department of drug administration, department of industrial and commercial administration, commodity price department and media department.5. Pay attention to the problem of insufficient use of drugs in rural areas, develop valid evaluation hypothesis.6. Constitute proper evaluation indicators of impact on interventions and study standard values. Structural indicators are used to evaluate the drug management in health facilities, process indicators are used to evaluate concept, knowledge and behavior change; outcome indicators are used to evaluate the behavior outcome include prescribing indicators, patient care indicators and economic indicators.