| OBJECTIVEThrough the summary and analysis about essential drug utilization in partial tertiary hospitals of China, we conducted multi-angle investigation of the essential drug utilization situation in a sample tertiary hospital in recent five years and compared specific requirements of the essential drug list suggested by the government and used in public hospitals, thus further understanding the effectiveness of essential drug utilization in tertiary hospitals as well as the existing difficulties and problems since the introduction of essential drug system. Furthermore, based on clinical practice, it aims to explore how tertiary hospitals can actually carry out the rational use of essential medicines, so as to provide reference and decision-making basis for the active execution of the national essential drug system and policies by public hospitals.METHODSThrough the review of relevant domestic data and the use of drug information management system in the sample tertiary hospital, a multi-angle data platform was established for the particular analysis about essential drug utilization situation in the sample hospital between 2010-2014. The emergency department with wide coverage of essential drug use and the most common comprehensive diseases were mainly elaborated. With the use of the Statal3.0 analysis system, the analytical results were treated by ICD-10 disease coding and international statistical classification. Based on the disease spectrum of emergency patients, representative antimicrobial drugs were selected, and indicators such as the use frequency of varieties of drugs were applied for analysis, thereby obtaining experience and problems about essential drug use in tertiary hospitals.RESULTS(1) Based on domestic reports of drug use situation in tertiary hospitals, the 2012 catalog variety equipped by general tertiary hospitals accounted for 54% of all varieties of the list in average; the percentage of sales amount for essential medicines was below 15% in average.(2) The demand for essential medicines by the tertiary sample hospital for clinical treatment from 2010 to 2014 was stable. There were no significant changes about essential medicines in the replacement of old successful bid catalogs. The CAGR of essential drug sales amount was 14.61%; Hospitals ha certain focused on using essential medicines. The constitute proportion of essential drug varieties had increased to 65.38% in 2014. However, there was still a gap with the 2012 variety matching degree of NLEM in terms of drug variety selection. As for the selection of drug specification, drug model and salting form, there was a malposition of specification with the essential drug catalog of the country, and the sales amount of essential medicines showed a declined trend.(3) The drugs of emergency department in the sample hospital accounted for fewer than 35.4%. Special rectification of antibiotics was initially effective in the hospital. The use frequency constituent ratio of anti-microbial drugs was 21.91%. In the treatment of respiratory system disease, the essential macrolides of anti-microbial drug was most frequently used, but the varietal structure of essential emergency drugs needed to be further optimized.CONCLUSIONTertiary hospitals have gradually been paying attention to the implementation and promotion of essential drug policies and systems in medical institutions, but the use situation differs a lot. Through the establishment of an optimized medicine management system and legal protection system, the availability of essential medicines can be ensured to prevent the exclusion of cheap and high-quality essential medicines from the hospital list due to the inaccessibility of them.(1) It is suggested to optimize the NLEM development mode, to carry out different levels of management about the essential drug list, and to introduce essential drug catalogs that can adapt to different levels of hospitals, and to increase the coverage of essential medicines in tertiary hospitals, thus helping to reduce the drug proportion in hospitals.(2) The catalog variety of essential medicines and the selection mechanism of product specifications should be improved, and evidence-based medicine and pharmacoeconomics evaluation approaches introduced, in order to have access to safe, effective and economic drug varieties and corresponding specifications.(3) Considering the large geographical difference in China, the local special essential drug supplementation catalog for diseases should be carried out for different provinces along with the increase of local special drug varieties and specifications for diseases.(4) Through the information construction of all levels of compatible drug use database, important technical supports and guarantees should be provided for rational use of drugs.(5) It is needed to strengthen irrational drug use supervision by health institutions, use approved prescriptions, follow doctors’advice, take "driving license type" of management, and standardize the diagnosis and treatment behavior of physicians.(6) It is necessary to keep improving the drug use information management system, optimize treatment ways via pharmacoeconomics evaluation method, to improve the efficiency of drug use, and to guarantee the safety of drug use.(7) In particular, we should promote and encourage the implementation of essential drug system by boosting the payment way reform and adopting the two-way grading referral system, so as to achieve reasonable medical care.(8) The propaganda work of the essential drug system should be emphasized to enhance the awareness of essential medicines by medical staff and patients and to improve the public awareness level of rational drug use.Therefore, only through the institutional reform and the comprehensive control of the health care system can it allow patients to really receive rational diagnosis and treatment and can the development of the medial industry enter to a healthy track, thus realizing the success of reform about the health care system. |
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