Study On Essential Drugs And Rational Drugs Use In Village Clinics Of Gong’an County In Hubei Province, China

ObjectiveUnder the background of the implementation of the National Essential DrugSystem, the use of essential drugs, rational drug use and prescription fee wereinvestigated through the collection of village clinics’ prescriptions. To analyze theimpact of drug use and charges, and sum up the experience and lessons, to reveal theproblems faced by the implementation of the National Essential Drug System andmake policy recommendations for the better implementation of the National EssentialDrug System in village clinics.MethodsIn this study, prescriptions were selected from12village clinics in two towns ofGongan County, including3813before the implementation of the National EssentialDrug System and2217after. EpiData3.0was used to establish a database, andSPSS17.0and Excel software for statistical analysis, which includes descriptiveanalysis and inferential analysis. Multiple linear regression was used to analyze thefactors which influenced the dependent variable.ResultThe use of essential drugs:1. Before and after the implementation of the National Essential Drug System,the average number of essential drugs was3.48and2.94per prescription;97.01%and88.99%of total prescriptions contained essential drugs(P<0.05); essential drugsutilization rates were96.54%and94.76%(P<0.05), respectively;39drugs of the top 50were essential drugs which were same.2. Before and after the implementation of the National Essential Drug System,the national essential drugs are both106.The essential drugs of Hubei Province were39and47, and the non-essential drugs were56and52.In general,39.74%of theessential drugs of the National Essential Drug System List were used. Meanwhile,31.64%of the essential drugs of the Hubei Province’s essential drugs list were usedRational use of drugs:1. Among the1200prescriptions reviewed by experts,378of them wereirrational,accounting for31.50%of the sampled prescriptions. The rates of theirrational prescriptions were34.17%and28.83%, decreased after the implementationof the National Essential Drug System (P<0.05).2. Before and after the implementation of the National Essential Drug System,the average number of drugs was3.60and3.10per prescription (P<0.05);79.41%and70.32%of total prescriptions have antimicrobials(P<0.05),27.43%and30.74%of total drugs were antimicrobials(P<0.05), respectively;4.96%and5.50%of totalprescriptions have hormones(P>0.05), the utilization rate of hormones were1.39%and1.78%(P<0.05);75.45%and64.68%of total prescriptions have injection(P<0.05),the utilization rates of injection were89.12%and81.17%(P<0.05);16.68%and24.04%of total sampled prescriptions contained two kinds of antimicrobials;antimicrobials was used combining with hormones in4.04%and3.97%of totalsampled prescriptions (P>0.05).Analysis of prescription fee:1. Before and after the implementation of the National Essential Drug System,the average prescription fees were29.89RMB and21.69RMB(P<0.05), decreased27.43%.2.The results of multiple linear regression (R2=0.772) showed that the number ofprescription drugs, whether to use intravenous injection, whether to use antimicrobials,whether to use essential drugs, reimbursement of expenses and investigation areawere the main factors to affect the prescription fees of village clinics.Conclusions and recommendationsConclusions:(1) Essential drugs of the list in line with the actual situation of the village clinics in general, but further adjustments are needed.(2)The irrational drug use is still aserious problem, which needed to control.(3)The implementation of the NationalEssential Drug System had effectively decreased the growth of prescription fee.Suggestions:(1)To strengthen adjustment of the essential drugs list so as to suit for thesituation of the village clinics.(2)To develop the safeguard mechanisms to encouragevillage doctors to use essential drugs.(3)To strengthen the training for village doctorsto use essential drugs rationally.(4)To strengthen prescription management in villageclinics to promote prescription standardization.(5)To make villagers accept andsupport the propulsion of the National Essential Drug System by utilizing variouschanels.InnovationsSince the National Essential Drug System has been implemented for three years,the study on the essential drugs system concentrate on public rather than non-publicmedical and sanitary institutions. So the study is timely to provide policy advices toadvance the National Essential Drug System in village clinics. What’s more, thisstudy has a systematic research with comprehensive indicators, for example, thecontrol before and after the implementation of the National Essential Drug System,expert evaluation method and sampled prescriptions to learn about the current status.The results were significant for making policy on the National Essential Drug Systemin village clinics.