The Study On The Actuality And Control Strategies Of The Out-patient Injection Expenses Of The Primary Medical Institutions In Rural Areas Of Hubei Province

ObjectiveAt present, the behaviors of exceeding out-patient injection in the primary medical institutions in rural China were overwhelming and have created enormous negative impact to both the rational allocation of health resources and the physical and mental well-being of the people in rural areas. This study has researched comprehensively the actuality of the overuse of injections in rural area of Hubei province and analyzed systematically the expenses of unreasonable prescription injections in macroscopic angle. Then the control strategies on how to inhibit the unreasonable injections behaviors of the basic institutions in rural China were put out, and which would contribute to constrain the actuality of unreasonable injections and boost the quality of medical treatment, standardize the prescription behaviors and ensure the safety, effectiveness and economy of the drugs in those areas. Also, reference on how to improve China's rural health policy will be provided.Data and MethodsOur research methods included literature study and field investigation. The information collected included: the out-patient prescriptions from the four sample medical institutions, questionnaires filled by the medical personnel of the sample medical institutions and related statistics report forms of those medical institutions. Our literature study included the research on the information documented the irrational use of injections by WHO and other studies both at home and aboard.Research contents(1)Understanding the actuality of injections use of primary medical institutions in rural areas of Hubei province, (2) Estimating the unreasonable injections expenses of primary medical institutions in rural areas of Hubei province, (3) Analyzing the reasons causing the irrational use of injections,(4) Putting out the related control strategies on how to reduce the unreasonable injections in rural areas.Results and Conclusions1. The rates of injections and infusion of the sample institutions were significantly high. (1) The infusion rate stood at 48.50%, followed by the rate of oral drugs at 36.21%. The result revealed the fact that the rate of out-patient prescriptions with injection was 59.23%, substantially higher than that with oral drugs reached, which obviously breached the clinical medication rules.2. The injections, especially the infusion significantly increased the out-patient prescription expenses. (1) Comparing the prescription expenses in different drug delivery ways: the average prescription expenses with infusion reached 44.67 Yuan, the average prescription expenses with injection was 41.69 Yuan and the average prescription expenses with oral was only 23.69 Yuan. The result showed that the average prescription expenses with infusion or injection is substantially higher than the others. (2)The differences of prescription expenses existed in different institutions: the out-patient prescription expenses of the township hospitals were lower than that of the village hospitals. The average out-patient prescription expenses of township hospitals with the infusion were 37.15Yuan compared to 43.65 Yuan in village clinics. Both the average out-patient prescription expenses of town hospital with injection and the village clinic were 41.69Yuan, implying no significant differences.3. Estimating the unreasonable expenses of the injections: based on our analysis to the literature study of World Health Organization and the results of the injections in rural China, we concluded the rational range of the use of injections, then we estimated respectively the irrational expenses of injections from this investigation and the expenses after we changed the irrational rate of injections to the oral drugs. Generally, the proportion range of the irrational expenses of infusion taking the total expenses scattered between 8% and 50%, the proportion range of the irrational expenses of injections taking the total expenses was between 7% and 48%. If the irrational infusion were replaced by the oral drugs, the proportion range we can save was between 3.11% and 20.56%.4. Analyzing the reasons causing the irrational use of injections from the view of the medical supplier, the patients, the pharmaceuticals and the health administrations. The reasons included:(1) The medical suppliers: The"drug-maintaining-medicine " model as the result of the inherent insufficient financial compensation, the technological level of the medical personnel which is low, and the lack of organization and measures which aim to supervise the rational use of drugs buried the hidden dangers to the irrantional use of injections;(2) The patients: The existence of the lack of medicine knowledge, vulnerable to media advertisements and unreasonable expectations popularized the irrational use of injections;(3) The pharmaceuticals: The business-oriented nature and no regulate marketing behaviors of the pharmaceuticals indirectly promote the irrational use of injections;(4) The health administrations: The source of the irrational use of injections is the inadequate compensation for the primary medical institutions in rural areas, regulatory vacancy, the implementation process of the essential drugs policy was disrupted, and the lack of intensity of the public education about the rational use of drugs.SuggestionsIn order to solve the problems of use injections in wrong ways in the primary medical institutions, we put out the control strategies in six aspects: 1. Enhancing the compensation proportion.The government should strengthen the compensation proportion to the rural primary medical institutions in two aspects: Firstly, the compensation mechanism should be rationalized. Secondly, the link between the income of the medical staff and the treatment methods should be weakened, so as to inhibit the behavior to abuse the injections drugs among medical staff.2. Strengthening the recruit administration of the medical staff of the primary medical institutions in rural areas.Health service is a high technical industry. The government should therefore strengthen the recruit administration of the medical staff. Only the persons with sophisticated medical skills and medical knowledge are capable of treating patients. The higher level of medical knowledge and skills can also ensure the rational use of drugs in the primary medical intuitions. The department of health should carry out plan aiming to attract the qualified medical personnel to the rural areas.3. Promoting audit to the designated medical institutions.Firstly, the office of NCMS can determine the related indexes of rational use of drugs adjusted to the local actual situations. Secondly, the office should organize personnel to spot-check the prescription of the designated medical institutions. Point out the problems in time, and ask the institutions to correct them. Moreover, motivation strategy on prompting the rational use of drugs should be realized.4.Establishing capable Pharmacy Administration Committee The primary medical institutions can establish the Pharmacy Administration Committee which includes the hospital president, pharmacy supervisor, experienced doctors, the Pharmacy Administration is responsible for the public awareness, training EDL and the clinical treatment norms, checking out the condition of use of drugs, helping doctors improve in time, controlling the impacts on the medical staff from the sales personnel, monitoring of hospital medication errors and adverse reactions and so on.5. Carrying out training and education plan for medical staff Flexible training methods, such as seminars, regular meetings of training, the development of simple and convenient medication guides could be introduced to help the township and village doctors use drugs rationally.6. Communication mechanism for healthcare personnel and patients should be established Interactive discussion group is consisted of both healthcare staff and patients. The two sides should fully communicate with each other to eliminate the gap in expectations of injections.7. Warning the harm of unreasonable injections behavior among medical students.The education of rational use of drugs should be brought into the education curriculum of the medical colleges, making the education of rational use of drugs systemized and long- termed, so as to fundamentally improve the drug application level among medical college students, foster the concept of rational use of drugs and promote the rational use of drugs. The innovations in this study included: the actuality of the overuse of injections in rural area of Hubei province was researched comprehensively, the expenses of unreasonable prescription injections were analyzed systematically in macroscopic angle, and the control strategies on how to inhibit the unreasonable injections behaviors of the basic institutions in rural China were put out. However, some drawback is unavoidable in the study: the number of the institutions I choose was only four, maybe it could not represent the actuality of Hubei province; didn't estimate the expenses of unreasonable prescription injections in disease category angle.