| Objective:The objective of this research is to analyze the type, severity and influencing factors of irrational drug use by estimating drug use in the three levels of medical institutions and the knowledge and drug use of rural residents in Shandong Province and Ningxia Autonomous Region. The research will provide policy advice on the promotion of rational drug use, the improvement of people's health and the reduction of the disease burden.Subject and Methodology:This research is a part of the EU project: which aims to bring health care to the vulnerable by developing equitable and sustainable rural health insurance in China and Vietnam.Three project counties were investigated in Shandong province and Ningxia Autonomous Region respectively. In each of the project counties, three townships were sampled, according to economic status and geographic distribution, and six villages (economic status: 2 good, 2 average, 2 poor) were sampled in each township. Using a stratified sampling method, 3000 outpatient prescriptions of the past year were randomly chosen from nine village health posts, three township health centers and three county hospitals in Shandong and Ningxia province. Combined with this investigation, the calculation of indicators referred to the methods of analyzes the rational use of drug in developing countries, which is designed by WHO/INRUD. In-depth individual interviews were conducted with doctors and pharmacists from the sampled medical institutions.A household questionnaire survey about the medical knowledge, drug purchases and usage, existence of spare drugs in the home, and medication compliance was conducted on 30 residents from each sampled village.After collection and input, Microsoft Excel and SPSS 11.5 were used to conduct data analysis, including t-tests, variance,χ~2 tests and multiple regression analysis.Results:1. The rationality of drug use in three-level medical institutions should be further strengthened.1.1 The survey indicated the existence of overmedication in rural medical institutions: In Shandong Province, the lower levels of the rural medical institutions, prescribed the more drugs. In the village health posts, town hospitals and county hospitals of Shandong Province, the average number of drugs prescribed was 4.55, 3.10 and 2.09, respectively. For upper respiratory tract infections (URTI), the average number of prescripions was 4.95, 3.05 and 2.06, while for hypertension these numbers were 3.68, 3.11 and 2.46. Of all the prescriptions sampled from village health posts in Shandong Province, 30.3% contained more than five kinds of drugs. In Ningxia, prescriptions at the township health centers had the most drugs per prescription-an average of 3.13. The average number of drugs per prescription in Ningxia's village health posts, township hospitals and county hospitals was 2.97, 3.12 and 2.81 for URTIs, and 2.24, 3.30 and 2.19 for hypertension. In both Shandong and Ningxia, the prescription fee increased with the level of medical institutions. The county hospitals had the highest fees, averaging 72.3 RMB and 64.2 RMB respectively. Within this, the average fees for hypertensions prescriptions were 82.4 RMB and 50.5 RMB. In the three levels of medical institutions in Shandong, 22.7%, 8.0% and 3.8% of the prescriptions sampled were over 100 RMB, while in Ningxia county hospitals 19.3% of prescriptions sampled exceeded 100 RMB.1.2. Drug abuse is serious: In the rural medical institutions of both provinces over one third of the top ten drugs prescribed were antibiotics. Of all prescriptions sampled, 66.1% (Shandong) and 65.7% (Ningxia) contained at least one type of antibiotics, much higher than WHO guidelines recommend. Of prescriptions for URTI 89.3% (Shandong) and 76.7% (Ningxia) contained antibiotics. In both provinces, nearly 50% of prescriptions use injections. Analyzed of URTI prescriptions, indicates that over 50% of the prescriptions in village health posts and town hospitals in Shandong and 78.6% and 62.0% of those in county and town hospitals in Ningxia included injections. These figures are all well above the WHO criteria. In both provinces, the drugs prescribed were mainly Western medicine, although Ningxia had higher rates of prescribing traditional Chinese medicine. In Shandong, about twenty out of every hundred prescriptions included Chinese medicines, while in Ningxia 31.1% (town hospitals) and 41.8% (village health posts) of prescriptions contained traditional Chinese medicine. For URTI prescriptions in Ningxia, these figures were similar, at 31.5% (town hospitals) and 46.8% (village health posts). Of all the prescriptions sampled in the two provinces, about 7% contained 3 or more kinds of proprietary Chinese medicines.2. More attention should be paid to irrational drug use among rural residents.2.1 Residents in rural areas lack drug knowledge: Rural residents in both Shandong and Ningxia have little basic drug knowledge on such topics as prescription and nonprescription drug and drug resistance. Of all the residents investigated, 91.2% (Shandong) and 86.3% (Ningxia) thought injection was safer and more effective than oral medications, while 55.1% (Shandong) and 42.7% (Ningxia) thought that more expensive drugs were more effective.2.2 Drug abuse exists in rural residents: Of the residents who self-medicated more than 40% used antibiotics, while more than 80% of URTI patients used antibiotics. Residents who used Chinese medicines accounted for 38% (Shandong) and 47.8% (Ningxia) with over 10% of all selt-medicators using three of more Chinese medicines each time.The ratio of Chinese medicines to western medicines were close to 1:1 in Ningxia.2.3 Rural residents have poor medication compliance: Of the patients who used drugs in the four weeks preceding the survey, 5.1% and 7.8% always forgot their medication, 25.3% and 36.1% occasionally forgot their medication, and 54.6% and 60% changed the dosage when their symptoms changed in Shandong and Ningxia respectively. Self-medicators had higher rates of forgetting their medication and changing their dosage than did patients who sought formal treatment. Hypertension patients were more likely to forget their medication than URTI patients, while URTI patients had higher rates of drug withdrawal and changing their dosage.Suggestions:The survey suggests the existence of irrational drug use on both the supply (provider) and demand (patient) sides in Shandong Province and Ningxia Autonomous Region. We offer the following suggestions to promote rational drug use.1. Strengthen legislation and improve drug regulatory system. Complete drug-related laws and regulations. Establish nationally suitable evaluation mechanisms for rational drug use.2. Teach medical workers about rational drug use. Establish a system of continuing education on rational drug use for doctors, nurses and pharmacists.3. Carry out public education campaigns on rational drug use. Disseminate information to the public through TV, radio, newspapers, magazines, posters and other mass media.4. Regulate retail pharmacies and prescription medications. Rationally distribute the pharmacies. Keep record of drugs purchased by every resident and randomly check purchase and sale records of prescription drugs in retail pharmacy.
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