Investigation And Valuation On The Rationality Of Drug Use In Feixi Township Hospitals Under The Background Of The New Medical Reform

In December 2009, Anhui Province comprehensive primary medical and health system reform(referred to as the new medical reform) first started in whole country. The outstanding characteristics of this reform was to promote the establishment of essential medicines system.The implementation of drugs"zero profit"sales was the key for the establishment of national essential medicines system.According to the essential medicines system practices in foreign countries for many years, the success of the implementation of essential medicines policy was a close link to the level of the rational drug use. To in-depth understand the influence of the comprehensive primary medical and health system reform in pilot unit township hospitals for rational drug use, this paper investigated Feixi 8 township hospitals medication status, analyzed and evaluated their rationality of drug use in order to provide reference on further establishing the perfect essential medicines regime.Study on the specific content of this paper: 1. the investigation on medication statusAuthor surveyed 8 township hospitals from 28 township hospitals using the method of sampling, each hospitals are draw-out 100 prescriptions randomly from all electronic prescriptions in October 2009 and October 2010. Author investigated Feixi 8 township hospitals medication status including the percentage of essential medicines use, the new rural cooperative drug use, the medicare A and B drug use. The results showed that comparing with before the medical reform(in 2009), the rate of using essential medicines rose from 59.4% to 67.6% in every 100 prescriptions; the new rural cooperative drug use rate and the medicare A drug use rate had risen from 77.8%, 60.2% to 84.7%,65.4%, respectively, but the medicare B drug use rate dropped slightly from 27.5% to 24.4%.2. the investigation on the rationality of drug useOn the basis of a preliminary understanding of drug use information in Feixi township hospitals, this part investigated and analyzed the rationality of drug use. Using the method of sampling investigation, author surveyed 8 township hospitals, each hospitals are draw-out 100 prescriptions randomly from all electronic prescriptions in October 2009 and October 2010, including emergency, outpatient and inpatient prescriptions. The results were analyzed by using the part of SDUIs (Selected Drug Use Indicators) developed by WHO and the self-design indicators. The results showed that ,Totally, comparing with before the medical reform(in 2009), the average expenses dropped from 60.1 to 31.0 after the medical reform(in 2010), with significant differences (p<0.01); the drug varieties dropped from 3.8 to 3.6 in single prescription; the rate of using antibiotic drugs highly amount to 71.3% in 2009 and 69.6% in 2010 per hundred cases respectively; the rate of using essential medicines rose from59.4% to 67.6% in every 100 prescriptions; the percentage of essential medicines costs accounted for prescription medicines costs rose from 43.6% to 50.4%; the rate of using injections dropped from 56% to 46.1% per hundred cases; the rate of using proprietary Chinese medicines rose from 32.8% to 37.9% per hundred cases, the rate of using proprietary Chinese medicine injection rose from 6.1% to 7.1% per hundred cases; the rate of using hormone dropped from 24.5% to 3. the analysis on the amount and use frequency of common antibiotic drugs For further understanding the use of antibiotic drugs in the new medical reform pilot unit township hospitals, this paper analyzed antibiotic drugs varieties, sales amount and DDDs in October 2009 and October 2010, in the analysis method of amount of sorting, DDDs and defined daily cost. The results show that in October 2009 the amount of common antibiotic drugs in the top five were: Cefuroxime(parenteral), Sulbactam and Cefoperazone (parenteral), Amoxicillin(oral), Cefixime(oral), Ceftriaxone Sodium(parenteral); in October 2010 the top five were: Cefuroxime(parenteral), Cefuroxime(oral), Amoxicillin and Clavulanate Potassium(oral), Cefaclor (oral), Levofloxacin(parenteral). In October 2009 and October 2010 DDC of antibiotic drugs top five were: Cefuroxime(parenteral), Cefaclor (oral), Fosfomycin (parenteral).From the results about DDDS of antibiotic drugs, the major changes had been taken place in most of the antibiotics before and after the medical reform, in October 2009 DDDs of antibiotic drugs top five were: Amoxicillin(oral), Cefixime(oral), Lincomycin(parenteral), Cephradine(oral), Azithromycin(parenteral); October 2010 DDDs of antibiotic drugs top five were: Cefuroxime(oral), Amoxicillin and Clavulanate Potassium(oral), Levofloxacin(parenteral), Cephradine(oral), Amoxicillin(oral).The above results showed that Feixi comprehensive primary medical and health system reform was effective, the drugs prices decreased significantly, decreased rate of 48.4% after implementation of"zero profit"drugs sales, reducing the burden of the patients. But the results of the survey also showed that the phenomenon of irrational drug use in Feixi township hospitals was still more serious, mainly the rate of antibiotic drugs and injection was high, the comprehensive primary medical and health system reform should be further improved and strengthened.