基于结构方程模型的我国县级以上医疗机构实施基本药物制度的影响因素研究

发布时间：2018-07-25 12:53

【摘要】：目的:分析影响基本药物制度实施的影响因素及潜在原因、各因素间关系及影响力度,针对各影响因素提出完善县级以上医疗机构实施基本药物制度的措施与建议。方法:在文献内容分析法的基础上对县级以上医疗机构相关人员发放调查问卷;采用最大似然法的结构方程模型对影响因素进行分析以得出影响因素之间相互关系及影响力度。结果:结构方程模型分析结果显示,从县级以上医疗机构视角出发,现有基本药物目录对制度实施的结果评价影响不显著;招标采购机制通过影响配送供应从而间接对结果评价产生作用;另外,制度保障措施一方面对结果评价存在直接影响,另一方面通过影响医务人员实施制度的主观意愿从而间接影响结果评价。结论与建议:(1)结合实际情况,分级别制定适合县级以上医疗机构的基本药物目录;(2)完善基本药物招标采购与配送供应机制,考虑将基本药物部分与非基本药物部分相互衔接;(3)尽快制定并落实针对县级以上医疗机构的财政补偿方案,定期对二三级公立医疗机构医务人员进行宣传培训和绩效评价工作。
[Abstract]:Objective: to analyze the factors affecting the implementation of the essential drugs system and their potential causes, the relationship between the factors and the degree of influence, and to put forward some measures and suggestions to improve the implementation of the essential drug system in medical institutions above the county level. Methods: based on the analysis of literature content, the related personnel of medical institutions at or above the county level were investigated, and the influence factors were analyzed by using the structure equation model of maximum likelihood method in order to find out the relationship between the influencing factors and the degree of influence. Results: the results of structural equation model analysis showed that, from the perspective of medical institutions above county level, the existing catalogue of essential drugs had no significant impact on the evaluation of the results of the implementation of the system. The bidding and purchasing mechanism has an indirect effect on the result evaluation by influencing the distribution and supply. In addition, on the one hand, the system safeguard measures have a direct impact on the result evaluation. On the other hand, it affects the result evaluation indirectly by influencing the subjective will of the medical staff to implement the system. Conclusions and suggestions: (1) according to the actual situation, to make the catalogue of essential drugs suitable for medical institutions at or above the county level, (2) to perfect the mechanism of bidding procurement and distribution of essential drugs, (3) to formulate and implement the financial compensation scheme for medical institutions above county level as soon as possible, and periodically carry out propaganda training and performance evaluation for the medical personnel of the second and third level public medical institutions.
【作者单位】：四川大学华西药学院;
【基金】：国家自然科学基金“新医改多重政策实施背景下基本药物可及性评价:指标及方法的建立与实证”(编号:71473170)
【分类号】：R951

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