Study On Essential Drugs Policy And Rational Drugs Use In Community Health Service Institutions

Research purposesTo learn the content of national essential drugs policy implemented in community health service (CHS) institutions. To research the rational drugs use and the distribution of prescription costs of CHS institutions, and to analyze the influence factors of prescription medicines and costs, emphasis on the influence of essential drugs policy. To supply the theoretical basis and policy suggestions for the national essential drugs policy putting into effect, increasing the level of rational drugs use, reducing the prescription costs of CHS, and practically solving the problem of overly expensive medical services for citizenry.Research methodsThis study used some qualitative and quantitative research methods. Literature research was used to learn the national essential drugs policy. Seleting the CHS institutions in key contact cities and prescription samples as research object, the method of"one institution, one questionnaire"was used to survey the fundamental state of CHS institutions and theirs prescription information and analyze the influence factors of prescription medicines and costs. SWOT analysis was conducted to learn the strengths, weaknesses, opportunities and threats of the essential drugs policy carried out in CHS institutions. The main data analysis methods were descriptive analysis, nonparametric test, generalized linear regression method. EPIDATA 3.0 was used to set up databases, SAS9.0 was for statistical analysis, and SPSS15.0 and Excel were for making charts.Results1. The national essential drugs policy carried out in CHS institutions include: the essential medicine lists policy, two lines management mechanism of receipts and expenditure policy,"without added profit"drugs policy, separation of drug and medicine policy, drugs purchased and distributed by government uniformly etc. 2. Research of prescription drugs: the average total number of drugs per 100 prescription is 250.3, slightly higher than the standard of WHO; Average times of using intravenous drip per 100 prescription is 35.2, basically according with the national standards; Average times of using antibiotic per 100 prescription is 43.7, obviously higher than the WHO standard; Average times of using antibiotics for more than one type per 100 prescription is 12.3, exceeding the national standard unobviously; Average times of using hormone per 100 prescription is 7.6, most institutions among the national standard range.3. Research of prescription costs: the arithmetic mean of prescription costs of all the random institutions is 53.31 yuan, and the median is 44.20 yuan. The average of CHS centers is 54.44 yuan, that of station is 52.14 yuan. The prescription costs appear left skewed distribution significantly, and the logarithm prescription costs conform for normal distribution.4. The analysis of the influence factors of prescription costs showed that: many factors have significant role in average prescription costs, generally including regional difference, population situation, institution holders, the business income of institutions and drugs categories, the doctors'degree; the variables reflecting the rational use of drugs, including prescription medication, the use of antibiotics, hormone and intravenous; the variable reflecting the implementing of the national drugs policy.5. The analysis of the influence factors of prescription medication showed that: the variables having significant role in each 100 prescription medication include: the regional difference, 60 years old and above population situation; the business income of institutions and drugs categories, doctors'degree variables, the variables reflecting the implementing of the national drugs policy and average prescription cost.6. The analysis of the impact of essential drugs policy on rational drugs use showed that: the community essential medicine lists making and carrying out, two lines management mechanism of receipts and expenditure policy,"without added profit"drugs policy and separation of drug and medicine policy have had significant role in reducing the prescription costs and increasing the level of rational drugs use of CHS institutions.Conclusions and SuggestionsBased on the results of the study, conclusions were drawn as the following: (1) Essential drugs policise of CHS were being implemented progressively, and the implementing situation in each district is different, still needing to further strengthen the implementation. (2) Rational drugs use in CHS institutions still had some problems, needing to strengthen and improve the medication management. (3) Some CHS institutions aiso had"high price prescription", control of the prescription costs still needed to further strengthen. (4) The national essential drugs policy implemented in CHS institutions effectively improved the level of rational drugs use, reduced the prescription costs, and alleviated the pressure of residents in medical treatment. (5) In the eastern, central and western urban the development of community health is not balanced, and the eastern urban had the highest number of prescription medication and prescription costs. (6) The prescription costs of CHS institution by different holders had significant difference, the institutions holded by government were highest, and by social organizations or individuals were lowest. (7) The regional population composition also had a certain degree of influence on the prescription medication and costs. (8) CHS institutions with relatively good drugs equipped condition were more likely to have irrational drugs use and "high price prescription" phenomenon. (9) With high technology level of the doctors in CHS institutions, the prescription medication and costs were higher. (10) Prescription medication directly affected the prescription costs, improving the level of rational drugs use is an important measure for controlling the prescription costs.Policy suggestions: (1) To intensify the legal status of essential drugs policy and strengthen the executive power of essential drugs policy. (2) To strengthen the cooperation between the relevant departments and jointly promote the implementation of the essential drugs policy. (3) To increase government attention and investment on CHS and perfect the compensation mechanism of community medical institutions. (4) To encourage regions to develop the community essential medicine lists based on their conditions and actual situation. (5) To reduce costs of medicines circulation and improve drugs centralized bid procurement. (6) To ensure the supply of essential drugs and avoid the shortage of essential drugs. (7) To utilize various channels to strengthen the publicity and training of essential drugs policy. (8) To strengthen prescription management, improve the quality of CHS, and reduce the drugs expenses. (9) To develop diversification of CHS institutions holders and encourage social entities to engage in holding CHS institutions.