广州市基层医疗机构基本药物制度实施现况分析与研究

发布时间：2018-07-16 20:01

【摘要】：1目的通过对广州市基层医疗机构基本药物制度实施情况，患者满意度及医务人员满意度的调查，了解广州市基层医疗机构基本药物制度的实施效果和现况。分析比较广州市基本药物制度实施中出现的问题和取得的成就，为进一步完善广州市基本药物制度和基本药物目录提供数据资料，评价结果和建议，供决策使用。 2方法（1）文献研究法：主要收集近几年有关国内外基本药物和国家基本药物制度的研究文献，经过相关的分析处理，撰写综述以便供研究借鉴。（2）基本药物制度数据直报系统：通过广州市卫生信息中心基本药物直报系统提取广州市基层医疗机构基本药物配备使用、卫生服务利用情况、业务收支情况。（3）现况调查：采用典型抽样选取广州市145家政府办的社区卫生服务中心，同时每家选取10名医务人员，采用调查表收集社区卫生服务中心相关情况、医务人员认知及满意度情况；采用典型抽样抽取广州市15家社区卫生服务中心，每家基层医疗机构由两名调查员负责选取当天上午的门诊患者调查问卷。 3结果（1）广州市基层医疗机构门急诊人次和出院人次2010年到2012年年平均增长率分别为16.53%和24.87%，均呈逐年上升趋势。广州市2010年和2012人均门急诊费用分别为86.19元和85.56元，，人均门急诊药品费用分别为50.01元和47.99元。（2）广州市门急诊收入、住院收入和财政补偿收入2010年到2012年年平均增长率分别为23.40%、22.67%和22.33%。从2010年到2012年，门急诊药品收入占总收入的比例分别为58.35%，52.64%和52.95%，住院药品收入占占总收入比例分别为37.37%，34.42%和33.48%，均呈下降趋势。（3）从基本药物实际使用品种数上看，平均在550种左右，社区卫生服务中心配备品种数最高，一般镇卫生院配备品种数最少。选取10个关于基层医疗机构运行效率的指标，采用最优距离法进行综合评价分析。社区卫生服务中心2010年到2012年运行效果呈向上趋势。中心镇卫生院和一般镇卫生院均为2011年综合指标值最小，分别为0.0411和20.0255，说明2011年实施效果最好，其次为2012年，2010年最差。（4）医务人员基本药物知晓率总体偏高，24.5%的医务人员非常熟悉，60.5%表示比较熟悉。医务人员对基本药物制度可以降低患者医疗费用认可度最高，但对基本药物制度能增加患者满意度最低。2.3%的医务人员从未向患者宣传过基本药物知识，63.5%经常向患者宣传。（5）患者知晓率总体偏低，仅55.1%的门诊患者听说过国家基本药物制度，95.1%的患者愿意使用基本药物，其中主要以听医生为主，占42.5%。对医务人员服务态度满意度较高，但对药品种类满意度最低。分类树结果显示近半年来患者所花费的总医疗费用是影响门诊患者满意度的最重要因素，其次为职业。 4结论（1）基本药物制度对门急诊业务影响不大，但对住院业务有所冲击；基层医疗机构甚至出现患者返流至大医院的现象；（2）基层医疗机构均配备使用基本药物，但是国家基本药物目录品种偏少；基本药物缺失情况严重，存在不配送和配送不及时问题；（3）医务人员对基本药物制度认可度一般，向患者宣传的积极性不高；患者满意度较高，对基本药物种类满意度最低，同时认知程度不高。
[Abstract]:1 purposes
Through the investigation of the basic drug system implementation of the basic medical institutions in Guangzhou, the satisfaction of patients and the satisfaction of medical staff, the effect and current situation of the basic medical system of the basic medical institutions in Guangzhou are understood. The problems and achievements in the implementation of the basic drug system in Guangzhou are analyzed and compared, and the further improvement of Guangzhou is made in order to further improve the Guangzhou medical institution. The city's essential medicines system and basic drug list provide data, evaluation results and recommendations for decision making.
2 method
(1) literature research method: mainly collect research literature about basic drugs and national basic drug system at home and abroad in recent years, through related analysis and processing, write a summary for reference.
(2) the basic drug system data direct reporting system: through the Guangzhou municipal health information center basic drug direct reporting system to extract basic medical institutions in Guangzhou basic medical institutions, the use of basic medicine, health service utilization, business revenue and expenditure.
(3) the status survey: the community health service center of 145 governments in Guangzhou was selected by typical sampling, and 10 medical personnel were selected from each family. The questionnaire was used to collect the related information of community health service centers, the cognition and satisfaction of medical staff, and 15 community health service centers in Guangzhou were selected by typical sampling. A total of two investigators were selected to select the morning outpatient questionnaire.
3 Results
(1) the average annual growth rate of emergency patients and discharged people in Guangzhou medical institutions from 2010 to 2012, respectively, was 16.53% and 24.87%, respectively, showing an increasing trend year by year. In 2010 and 2012 per capita emergency expenses in Guangzhou were 86.19 yuan and 85.56 yuan respectively, and the cost of per capita emergency medicine was 50.01 yuan and 47.99 yuan, respectively.
(2) the average annual growth rate of Guangzhou emergency income, hospitalization income and financial compensation income from 2010 to 2012 was 23.40%. 22.67% and 22.33%. from 2010 to 2012 were 58.35%, 52.64% and 52.95%, respectively. The income of hospitalized drugs accounted for 37.37%, 34.42% and 33.48%, respectively. There is a downward trend.
(3) from the actual use of the basic drugs, the average number is about 550 species, the number of the community health service centers is the highest, and the number of the general township health centers is the least. 10 indexes on the operation efficiency of the basic medical institutions are selected and the optimal distance method is used for comprehensive evaluation and analysis. The community health service center is from 2010 to 2012. The operation effect was upward trend. The central town health hospital and the general town health hospital were the least comprehensive index in 2011, which were 0.0411 and 20.0255 respectively, indicating the best effect in 2011, followed by 2012, and the worst in 2010.
(4) the basic drug awareness rate of medical staff is generally high, 24.5% of the medical staff are very familiar with 60.5%, and 60.5% are familiar with them. The medical staff can reduce the medical expenses of the patients with the basic drug system, but the medical staff who can increase the lowest satisfaction of the patients with the basic drug system have never publicised the basic drug knowledge to the patients. Knowledge, 63.5% often publicize to the patient.
(5) the awareness rate of the patients was generally low. Only 55.1% of the outpatients had heard of the national basic drug system, and 95.1% of the patients were willing to use basic drugs. The majority of the patients were mainly listening to doctors, which accounted for a high degree of satisfaction to the service attitude of the medical staff and the lowest degree of satisfaction to the drug types. The results of the classification tree showed the total cost of the patients in the past six months. Medical expenses are the most important factors affecting the satisfaction of outpatients, followed by occupation.
4 Conclusion
(1) the basic drug system has little impact on the emergency service, but it has some impact on the inpatient service; the basic medical institutions even have the phenomenon of the patients returning to the large hospital.
(2) basic medical institutions are equipped with basic drugs, but the national basic drug catalogues are small; the lack of basic drugs is serious, and the problem of untimely delivery and distribution is not timely.
(3) the medical staff have a general acceptance of the basic drug system, and the enthusiasm of the patients is not high; the patients' satisfaction is high, the degree of satisfaction of the basic drugs is the lowest, and the degree of cognition is not high.
【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R95

【参考文献】