国家基本药物制度实施前后顺德某社区卫生服务中心基本药物使用变化规律研究

发布时间：2018-06-15 14:12

本文选题：国家基本药物制度 + 社区卫生服务　；参考：《南方医科大学》2017年硕士论文

【摘要】：一、研究背景和目的为了缓解“看病难、看病贵”现象,减少居民就医费用负担,我国于2009年起开展了新一轮的覆盖城乡居民的医疗卫生制度改革,即“新医改”。其中,建立国家基本药物制度,健全基层医疗卫生服务体系是一项重点工作。国内相关研究数据显示,随着国家基本药物制度的逐步实施,基层医疗卫生机构不合理用药情况得到改善,“大处方”行为逐渐得到遏制,医疗费用得到有效控制[1-3]。然而,国家基本药物制度在实践过程中仍然存在不少问题,如何让国家基本药物制度在基层医疗卫生机构更好地推行,建立一个更趋成熟、完善的国家基本药物制度体系是目前“新医改”研究探索的重点。本研究通过调查顺德区某社区卫生服务中心2012-2015年基本药物使用概况和门诊处方各项指标,研究处方合理用药情况及费用变化规律,分析政策对基本药物使用的影响,为促进基层医疗合理用药及控制医疗费用提供依据,为地区社区卫生服务中心的发展规划提供政策建议。二、研究方法主要采取系统抽样法,随机抽取顺德区某社区卫生服务中心“新医改”前后(2012-2015年)机构门诊处方1728张作为样本,通过Excel 2003建立数据库和制作图表,采用SPSS 16.0软件统计分析。主要分析方法有描述性分析法、单因素方差分析法、χ2检验及多元线性回归分析法。三、研究结果1.“新医改”后基本药物配备率逐步达到了 100%。2.该中心比较注重遴选和使用中成药,同时药品销量排名统计显示该中心需进一步加强合理用药管控。3.在用药品种类以心脑血管系统用药、呼吸系统用药、消化系统用药排在前三位。4.处方用药数量较实施国家基本药物制度前显著下降,处方抗菌药物、注射剂使用情况明显改善,处方费用显著下降,差异有统计学意义。5.回归分析显示患者就医费用与处方合理性相关,提高处方合理用药可一定程度上缓解就医费用的上升。6.心脑血管系统疾病构成比及就诊费用逐年上升,提示该中心慢性病患者数量呈上升趋势,做好预防保健工作有利于应对人口老龄化带来的问题。四、研究结论国家基本药物制度的实施提高了社区医疗机构的处方用药合理性、减少了患者的医疗费用。同时也存在单张处方药物数量偏多、政策支持不足、药品遴选及管理缺陷等问题,要解决这些问题还需要各级医疗卫生机构与政府部门的重视与共同努力。
[Abstract]:First, research background and objective in order to alleviate the phenomenon of "difficult to see a doctor, expensive to see a doctor" and to reduce the burden of residents' medical expenses, China has carried out a new round of reform of medical and health system covering urban and rural residents since 2009, that is, "new medical reform". Among them, establish national essential drug system, perfect primary medical and health service system is a key work. Domestic related research data show that with the implementation of the national essential drug system, the irrational use of drugs in primary medical and health institutions has been improved, the "big prescription" behavior has gradually been contained, and medical expenses have been effectively controlled [1-3]. However, there are still many problems in the practice of the national essential drug system. How to better implement the national essential drug system in primary medical and health institutions and establish a more mature one? Perfect national essential drug system is the focal point of the current "new medical reform" research and exploration. In this study, we investigated the general situation of essential drugs used in a community health service center in Shunde district from 2012 to 2015 and the indexes of outpatient prescriptions, studied the rational use of prescriptions and the law of change in cost, and analyzed the influence of policies on the use of essential drugs. In order to promote the rational use of drugs in primary medical care and to control medical expenses, the policy suggestions are provided for the development planning of regional community health service centers. Second, the research method mainly adopts the systematic sampling method, randomly selects 1728 outpatient prescriptions of a community health service center in Shunde District before and after the "New Medical Reform" 2012-2015) as a sample, and sets up a database and makes charts through Excel 2003. SPSS 16.0 software was used for statistical analysis. The main analytical methods were descriptive analysis, single factor variance analysis, 蠂 2 test and multivariate linear regression analysis. Third, the research results 1. After the new medical reform, the basic drug allocation rate gradually reached 100. 2. The center pays more attention to the selection and use of proprietary Chinese medicines, and the ranking of drug sales shows that the center needs to further strengthen the control of rational drug use. In the use of drugs in the cardiovascular and cerebrovascular system drugs, respiratory system drugs, digestive system drugs in the top three. 4. The number of prescription drugs was significantly lower than that before the implementation of the national essential drug system, the use of prescription antibiotics and injections was significantly improved, and the prescription cost was significantly decreased, the difference being statistically significant. Regression analysis showed that the cost of medical treatment was related to the rationality of the prescription, and the increase of the cost of medical treatment could be alleviated to some extent by increasing the rational use of the prescription. The proportion of cardiovascular and cerebrovascular diseases and the cost of medical treatment are increasing year by year, which indicates that the number of chronic patients in the center is on the rise, and the preventive health care is helpful to deal with the problems caused by the aging of the population. Fourth, the implementation of the national essential drug system improves the rationality of prescribing drugs in community medical institutions and reduces the medical costs of patients. At the same time, there are many problems such as too many prescription drugs, insufficient policy support, drug selection and management defects. To solve these problems, medical and health institutions and government departments at all levels need to pay attention to and work together.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R95

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