| Build drug supply system, and promote the clinical rational drug use has always been one of the important work of deepening the reform in China. The drug price in medical institution was depending on the drug price addition policy in our country, and it played a very important role in ensure the medical institution running in past decades. But in recent year, the policy induced the medical institutions, especially in some physicians, prescribed a huge price prescription and expensive drug, and this situation make patitents pay more, do a negative affect for clinical rational drug and drug supply security.Cancel the drug price addition policy and cut off the interests chain of pharmaceutical and physician were the important problem to be solved in this new round of medical and health system reform in our country. Class-? general hospitals were important fields to deepen reform in our country at present, especially in Anhui province, the core of medication reform were promote the conversion of public hospital running mechanism. In the "three synchronization" reform process of cancel drug price addition policy, adjust the medical service price and implement the drug with quantity purchases. It has a great reference meaning for implement the medication reform in public hospital and builds a suitable performance evaluation system for medication reform to understand the present situation of class-? general hospital drug use.In order to make the research results has a better representative, the research objects of this subject were Anhui provicine class-? comprehensive public hospital. According the defference of regional and the economic development, used stratified sampling method, sampled five class-? medical institutions, and analysed the situation of drug sales in this 5 hospitals in 2008 and 2013 respectively before and after the reform. From the three dimensions of drug availability, affordability and rational drug use, choose the medication reform evaluation core index and rational drug use survey system index after the literature research, evaluate the drug use situation of Anhui province in method of drug use, explore the drug use problem in the implementation of reform in Anhui province class-? public hospital. Under the new situation of Anhui province medication reform, provide policy recommendations for promote the clinical rational drug use, build perfect drug supply system.The main content summarized as follows:1 The composition of drug use in Anhui province class-? public hospitalCollected drug use date of 5 class-? hospital in January 1 to December 31,2008, and January 1 to December 31,2013, calculated the following indicators respectively. 1.1 Analysis of drug use amount:Calculate all varieties drugs amount in 2008 and 2013, and it could be used to compare different areas of drug consumption level.Sorted and numbered various kinds of medicine sales amount, and draw the top 20 drug by sales amount. Results show that top 10 drug by sales amount in 2008 were: monosialotetrahexosyl ganglioside, omeprazole, cedamandole, cefotiam, cefmenoxime, Human recombinant interleukin-II, oxiracetam, levofloxacin, cefepime, cefoxitin; Top 10 drug by sales amount in 2013 were:monosialotetrahexosyl ganglioside, oxiracetam, cefotiam, pantoprazole, docetaxel, imatinib, deproteinised calf blood injection, cefoxitin, aidi, coenzyme complex. 1.2 Analysis of drug use frequency (DDDs):Calculate all varieties drugs DDDs in 2008 and 2013,and the result show the top 10 DDDs drugs in 2008:Vitamin C injection, isosorbide mononitrate, Vitamin C tablets, trimebutine, clarithromycin, cefixime,nitrendipine, levocetirizine, irbesartan, itraconazole; The top 10 DDDs drugs in 2013:Vitamin C injection, amlodipine, nifedipin, D-Cal, thrombin, isosorbide mononitrate, tripterygium glycosides, digoxin, total glucosides of paeony, leucogen.2 The composition of all the classification drugs use in Anhui province grade III public hospitalBased on the analysis of all compostion drugs structure, according to the classification of pharmacological effects, study the two annual drug use situation of amount and DDDs respectively, and explore the irrationally drug use phenomena in clinic more specifically.2.1 Analysis of antimicrobial drugs of amount and DDDs. The amount and DDDs of antimicrobial drugs were increase in 2013 than 2008 (32.03% and 13.94% respectively), the increasing range of antimicrobial drugs were significant lower than total amount and total DDDs (212.99% and 81.47% respectively). The amount of carbapenems drugs and glycopeptides antibiotics were in top 20 durgs in 2013. Compare with 2008 top 20 durgs list of DDDs, the aminoglycoside durgs were out of top 20 durg list of DDDs in 2013, and the DDDs of macrolides durgs were increased.2.2 Analysis of nervous system drugs of amount and DDDs. The amount and DDDs of nervous system drugs were increase in 2013 than 2008 (323.76% and 136.27% respectively). The increasing range of amount were significant greater than DDDs, it indicated that the expensive nervous system drugs were significant growth. The cranial nerve nutrition drugs were the biggest category in amount in 2013, and the adjust cerebral blood flow and cerebral metabolic drugs were the biggest category in DDDs. Monosialoteterahexosyl ganglioside were top 1 durg in amount of 2008 and 2013.2.3 Analysis of digestive system drugs of amount and DDDs. The amount and DDDs of digestive system drugs of amount and DDDs were increase in 2013 than 2008 (249.94% and 76.24% respectively). All the top 20 durg of amount were PPIs and hepatobiliary and pancreatic diseases durgs in 2008 and 2013. The PPIs amount rate was decreased, and the PPIs DDDs were increased.2.4 Analysis of circulatory system drugs of amount and DDDs. The amount and DDDs of circulatory system drugs of amount and DDDs were increase in 2013 than 2008 (268.35% and 181.15% respectively). Compare with 2008 top 20 durgs list of amount and DDDs, the antianginal and vasodilators were decreased, the diuretics were out of top 20 amount list. The antiarrhythmics were not in top 20 amounts and DDDs list. And the antihypertensive drugs use has tendency of concentration.2.5 Analysis of hormonal drugs of amount and DDDs. The amount and DDDs of hormonal drugs of amount and DDDs were increase in 2013 than 2008 (189.97% and 160.21% respectively). The increasing range of amount and DDDs were close, it indicated that the increase of hormount drugs were DDDs. The insulin was the biggest category in amount in 2008 and 2013.2.6 Analysis of nutrition drugs of amount and DDDs. The amount and DDDs of nutrition drugs of amount and DDDs were increase in 2013 than 2008 (187.62% and 46.41% respectively). The EN durgs amount was in low level in 2008 and 2013. The fat milk and amino acids amount rate were the top 1 in 2008 and 2013. The electrolyte and trace elements has a great increase in 2013. The invert sugar and electrolytes injection amount were in top 5 in 2008 and 2013, and in other research not show that phenomenon.2.7 Analysis of Chinese patent medicine drugs of amount and DDDs. The amount and DDDs of Chinese patent medicine drugs were increase in 2013 than 2008 (231.60% and 142.27% respectively). The auxiliary antitumor medicine was the biggest category in amount top 20. The activating blood circulation proprietary Chinese medicine was top 1 category in DDDs top 20 in 2008 and 2013.2.8 Analysis of anticarcinogen drugs of amount and DDDs. The amount and DDDs of anticarcinogen drugs of amount and DDDs were increase in 2013 than 2008 (1053.64% and 561.81% respectively). The cancer targeted drugs amount has a huge increase in 2013, and the reasons of that were the usage of cancer targeted drugs was growth and the price of it was expensive.3 Analysis of the drug use changes in 2008 and 2013Consider from the aspect of drug amount, only the antimicrobial drug growth rate lower than the total drug amount growth rate, the other drugs had a great growth, especially in the antitumor drugs and the nervous system drugs. Most of drugs has a rational reason for growth, but some drugs has a irrational growth, such as invert sugar and electrolytes injection. Consider from the aspect of DDDs, antimicrobial drug, Chinese patent drugs, nervous system drugs and digestive system drugs lower than the total drug DDDs, the other drugs were growth, especially in the antitumor drugs. From what has been discussed above, only the antimicrobial drug had a lower growth rate than the total drug amount and the total drug DDDs that were show the effect of the rectification of antimicrobial drugs and indicate the irrational use of antimicrobial drugs were getting control. The growth rate of antitumor drug amount and DDDs were the highest in total amount growth rate and total DDDs growth rate, it may due to the small base date in 2008 and the rapid growth in recent years. The amount of Chinese patent drugs (the amount growth rate was 231.60%, the DDDs growth rate was 142.27%) and nervous system drugs (the amount growth rate was 323.76%, the DDDs growth rate was 136.27%) had a great growth, and the DDDs growth rate of the two types of drugs were lower than the total drug DDDS, and we can inference from above that the great growth amount of the two types drug was mainly for the growth of expensive drugs or for the relatively concentrated drug use in clinic. |
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