| Objective Using quantitative and qualitative methods to systematic analysis ofthe changes of medication in township hospital outpatient of a city in ShandongProvince before and after the implementation of national essential medicine systemand the differences of medication between counties. Constructing the index systemwhich is used to evaluate the rational drug use in grassroots medical institutions anddetermining the weight of indexes. Then synthetic evaluate the present situation of therationality of prescription medication in township hospital outpatient after theimplementation of national essential medicine system. Identifying the obstacle factorsfor rational drug use of outpatient in township hospital of this city from themulti-dimensional perspective which conations the medical service provider,demander and management. Based on it, putting forward the strategy to standardizethe behavior of doctor’s prescription, and to promote the rational use of drug intownship hospital of this city.Method Methods of literature and in-depth interview were used to collect thehistorical data. Multi-stage stratified random sampling method is used to determinethe research objects, and the self-designed questionnaires are used to make across-sectional survey. The qualitative research methods such as Delphi method,focus-group-discussion were used to collect qualitative data by organizing experts and scholars, relevant department heads, staff and residents. The collecting list of existingdata made by the research group was used to collect the existing data. Indicators suchas mean, median, composition proportion were used to describing the differences ofmedication in the township hospital out-patient between both years and regions. UsedDelphi method to construct index system which evaluating the rationality ofoutpatient medication in grassroots medical institutions; Methods of RSR and clusteranalysis were used to synthetic evaluating the rationality of outpatient prescriptionmedication in township hospital; Methods of linear regression was used to identify thefactors which affect the rationality of doctors’ outpatient prescription medication, andpath analysis was used to exploring the mechanism and relationship of all the factors.Then put forward suggestions to improving the medication situation of townshiphospital outpatient in this city.Results After the implementation of national essential medicine system, thedrug revenues proportion of township hospital outpatient dropped to44.79%. In thecommonly used drugs of township hospital outpatient prescription, the proportion ofessential medicines, antibiotics and injections medicines had increased, and theproportion of Chinese patent medicines had descend. The MPR of commonly useddrugs in outpatient prescription has decreased from2.334to0.809after theimplementation of essential medicine system. The cost of per prescription, the drugs’number of per prescription, the percentage of prescription with antibiotics and thepercentage of prescription with hormone drugs were all descend. The percentage ofessential medicines using, the percentage of distinctly prescription and the integrity ofprescription writing had improved. What’s more the medication of township hospitalis different the economic development level of countis. By the Delphi Method, theindex system which is used to evaluate the rationality of outpatient medication ingrassroots medical institutions under the national essential medicine system wasconstrusted with seven indicators. The doctors’score of rationality of outpatientmedication in township hospital belongs to―medium‖occupied68%, and by theanalysis of Pareto chart the score was focus on―medium‖―higher‖and―lower‖, andthe frist two occupied78.83%. Ten influential factors of outpatient prescriptionmedication in township hospital was identified by the simple linear regression andfour common factors include element of doctors’ evaluation, element of doctors’ jobsatisfaction, element of management and element of patient’ require were abstractedby factor analysis. By the model of path analysis, it was found that element of doctors’ evaluation and element of management is advanced to the rationality ofoutpatient prescription medication in township hospital, and element of patient’require is obstructive for it. The direct effect value of these three factors were0.566、0.384and-0.103. Besides element of management and element of patient’ requireaffect the rationality of outpatient prescription medication in township hospitalindirectly, its indirect effect value were0.381and-0.015.Conclusions After the implement of national essential medicine system thedrug revenues proportion of township hospital outpatient shows a downward trend butthe overall level is still high. The price of medicines which commonly used intownship hospitals outpatient prescription had descended and reached theinternational reference level. The rationality of outpatient medication in townshiphospital have improved, but the utilization rate of antibiotic, injection and hormonedrugs is still higher than the value of international reference. After the implement ofnational essential medicine system, the mostly doctors’ score of rationality ofoutpatient medication in township hospital is good, but it can still be improved. Thefactors which affect the rational drug use of outpatient prescription medication intownship hospitals mainly included element of doctors’ evaluation, element ofmanagement and element of patient’ require, and the element of doctors’ evaluationhave the greatest directly impact. Besides a direct impact the element of managementand element of patient’ require have indirect impact on the rationality of outpatientmedication in township hospital by the element of doctors’evaluation. This study wasstarted after the implementation of the essential medicine system in all the city’stownship hospitals when the effect of policies more fully demonstrated. A variety ofresearch methods were used to do it. According to the study results, under theperspective of the medical service provider, demander and management put forwardcountermeasures and suggestions to improve the situation of outpatient medication intownship hospital. |
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