A Study On Execution Problems And Management Countermeasures Of Long Prescription Policy Of Chronic Disease Based On Smith Model

Objective:This study took the long prescription policy of pilot areas in China as the research object,compared the differences of long prescription policy between China and foreign countries,understood the implementation of long prescription policy in pilot areas of China,and used the Smith model to analyze policy implementation problems and management strategies to provide directive suggestions for the improvement of China's long prescription policy.Methods:The policy comparison analysis method was used to analyze the differences of long prescription policy between China and foreign countries.Selected the primary health care institutions in Shanghai,Shenzhen and Ningbo as the research sites,used the questionnaire survey method and interview method to investigate the implementation of long prescription policies in the pilot areas,and understand the cognitive status of general practitioners,pharmacists and patients on long prescriptions and their effects.Used the Smith model to sort out the problems and causes of long prescription policy implementation,and propose corresponding management strategies.Results:1.Compared with foreign countries,China's long prescription policy still needs to beimproved in terms of prescriptions,drug list,prescription duration and supporting management measures.2.Chronic patients had a certain demand for long prescriptions,64.4% of patients thought it was necessary to implement long prescription policy;the biggest advantage of long prescription was to save time(77.0%),the disadvantages included adjustmenting of medication was not timely(71.1%),communicating with doctors was reduced(63.4%)and worried about medication safety(49.4%);long prescriptions can promote the implementation of family doctor signing system,promote patient subsidence community to seek medical treatment;recommended expanding the disease types and drug varieties of long prescription,recommended prescription time 2-3 Months,follow-up time were twice a month;it was recommended to compensate medical staff,included raised medical fees,drug-related service fees and follow-up service fees.3.Long prescription implementation had the following problems: First,the long prescription policy coverage was too narrow and the policy content was not uniform;Second,the tertiary hospitals worried about the loss of patients,the primary health care institutions worried that the “drug ratio” exceeded the standard,and the general practitioners work enthusiasm were not high,pharmacist participation was not enough;Third,chronic disease patients had complicated conditions,drug safety awareness was not high,some patients had drug-selling phenomenon;Fourth,policy environment was restricted,incentive mechanism was not perfect,information technology was imperfect,etc..4.To solve the above problems,the propose solutions had : In the policy formulation,the concept of long prescription should be clarified,the diseases included in the long prescription policy should be expanded,and the relevant drug list should be established.As for the execution subject,the primary medical institutions should formulate standardized service procedures for the long prescriptions,and improve the pattern of the long prescriptions,and strengthen the regular follow-up work.In terms of target groups,it was necessary to strengthen the publicity of strengths,and improve patients' awareness ofdrug safety,and prevent patients from selling drugs by pouring drugs.In terms of implementation environment,the management of medical insurance cost of the long prescription should be made clear.The incentive mechanism of community health institutions the construction of community pharmacists,and the construction of community health information system should be promoted.Conclusions:Compared with foreign countries,the long prescription policy of China was not mature and had not certain reference significance.The implementation of the long prescription policy had a positive impact on patients and primary health care institutions,but there were still some outstanding problems in the implementation of the policy.It was recommended to develop a unified long prescription policy management norm across the country,focusing on policy development,implementation subjects,target groups and implementation environment.