The Impact Of The Implementation Of The Basic Drug System To Community Residents’ Drug Use Behaviors

The original intention of national essential drug system is to reduce people’smedical burden. The main purpose is to change the residents’ medication behavior byreducing drug prices, including more use of basic drugs、common chronic diseases incommunity medical treatment、so as to change the patient flow and alleviate the"difficult and expensive" medical problem. Since the zero slip policy, it has been threeyeas. How was the implementation effect? Whether the drug use behaviors of residentshad changed and what had changed? What affect t the drug use behaviors of residents?Discussion of these problems is contributed to the evaluation of long-term effects of thepolicy as to provide a reference for the formulation and implementation of relevantpolicies.ObjectiveBy consulting the related literature at home and abroad and searching outpatients’awareness of the essential drug system and drug use behaviors in community healthservice institutions to learn the status of implementation of the essential drug systemand whether the situation significantly changed to policy makers’ expectation after theimplementation of essential drugs system.Analyze profoundly the problems existing in the implementation process of thebasic drug system and the deficiencies exposed in the system through the fieldinvestigation and in-depth interviews, to propose targeted strategies and providereference to improve the basic drug system and related policies.Method1. Used a combination of qualitative and quantitative methods. By using stratifiedrandom sampling method and self-made questionnaire on the effects of basic medicinesystem on drug use behavior of community residents, randomly selected sample13community health service stations as the surveyed units in Suzhou.1552patients wererandomly selected in all and1492valid questionnaires were recovered. Then input the data to database and analyze. Used the statistical software EpiData3.02and SPSS17.0and combined related health statistical methods such as a general description、chi-square test and Multinomial variable logistic regression method and so on toanalyze the change of the community residents’ medication behavior after theimplementation of the essential drug system in Suzhou.2. Used the non-probability sampling----purposive sampling method and selectedthe staff with a better understanding of the implementation of the basic drug systemfrom different health departments for interview. Interviews mainly included: practicalimplementation of the system of essential drugs for primary health care sector, problemsof implementation encountered in the process, the attitude of staff and patients of themedical institutions to the basic drug system and so on.ResultsThe survey results showed that74.73%of the respondents heard of the basic drugsystem or "zero-slip" policy. They learned the policy mainly through communityphysicians, television and community posters. After the implementation of the essentialdrug system,65.82%thought that the drug prices declined.79.22%of the patientssupported the policy.The analysis of medicines location convenience showed that72.52%of thepatients thought that it was more convenient to buy medicines to the community healthservice institutions. Patients with chronic diseases and common were in the majority tocommunity health service institutions for treatment.72.99%of the patients chosemedication treatment;29.89%of the patients thought that community health serviceorganizations could meet their need for medication. But63.74%of the patients pointedthat sometimes they couldn’t buy any drugs in the community and9.79%of the patientsindicated that sometimes they couldn’t buy any medicines at all. Besides doctorssurveyed reflected pharmacies were often out of stock. This indicated that the essentialdrugs varieties still needed to be improved and drug delivery needed to be strengthened.After the implementation of the "zero-slip" policy,57.31%of the patients choseessential medicines. The analysis of the reasons for this phenomenon showed that69.01%of the patients said they used basic medicines because of community doctors’recommendation, and followed by lower drug prices. However,42.69%of the patientsdid not use essential drugs. The reasons showed that29.20%of the patients worried about the quality of medicines,28.29%of the patients complained that the drugs theyused were not within the essential drugs list and that17.27%of the patients pointed thatthe community was not equipped with the required drugs. The analysis of the patients’attitude to the essential drugs list showed75.67%of the patients hoped to expand thedrug list.After the implementation of the "zero-slip" policy, the most obvious feature of thechange of patients’ medication behavior was medicines location changes. The frequencyof54.56%of the patients to the community health service institutions increased, and thefrequency of10.86%of the patients to the big hospital increased.34.58%of the patientsto buy medicine location did not change significantly. It illustrated that theimplementation of the policy of "zero-slip" played a certain role in easing the flow oflarge hospital patients.By using logistic regression to analyze the factors influencing the change ofpatients’ drug use behavior, it indicated that the behavior was the result of combinedeffects, such as sex, education, health insurance type and Whether knowing the basicdrug system. The change of medicine location was the result of Age, monthly income,health insurance type, whether knowing what features of the basic drug system and drugcharacteristics.Conclusion1. The survey had a higher level of awareness and support for essential drugsystem. They also had a higher extent of recognition of the system.2. Price was not the first factor when patients bought drugs. The main reasons forpatients with no use of essential drugs were concerns about the quality of medicines,medicines needed not within essential drugs list, community health service institutionsnot equipped with the required drugs.3. Before and after the implementation of the basic drug system, the change ofpatients’ drug-using behavior was the result of a variety of factors. Replacement inpatients with essential drugs was affected by gender, education, type of health insuranceand whether knowing the basic drug system. The change of location of the patients tobuy medicine was affected by age, monthly income, health insurance type, whetherknowing the system of essential drugs and concerns about drug characteristics.4. There were some problems in the availability and protection of essentialmedicines. Patients and community physicians complained that the community health service institutions were of stock and shortage of basic drugs.