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目的了解基本药物制度背景下山东省农村卫生服务机构门诊处方费用。方法于2012年8月—2013年1月,采用多阶段分层抽样的方法,在山东省抽取乡镇卫生院37家、村卫生室81家。以纳入机构的2009年(基本药物制度实施前)门诊处方和2012年(基本药物制度实施后)门诊处方为一般资料,分析基本药物制度实施前后乡镇卫生院和村卫生室的门诊处方费用变化情况,以及不同情况患者的处方费用变化情况。结果共纳入基本药物制度实施前乡镇卫生院门诊处方1 293张,村卫生室门诊处方1 230张;基本药物制度实施后乡镇卫生院门诊处方1 569张,村卫生室门诊处方1 861张。基本药物制度实施后,乡镇卫生院的中位门诊处方费用﹑“大处方”(药品种数>5种)费用﹑抗生素处方费用﹑激素类处方费用、非激素类处方费用、注射剂处方费用﹑非中成药处方费用低于实施前,差异有统计学意义(P<0.05);而“贵处方”(费用>100.0元)比例、非“大处方”费用、非抗生素处方费用、非注射剂处方费用﹑中成药处方费用与实施前比较,差异无统计学意义(P>0.05)。基本药物制度实施后,村卫生室的“贵处方”比例、中位门诊处方费用﹑“大处方”费用﹑非“大处方”费用、抗生素处方费用、非抗生素处方费用﹑激素类处方费用、非激素类处方费用、注射剂处方费用﹑非注射剂处方费用﹑中成药处方费用、非中成药处方费用均低于实施前,差异有统计学意义(P<0.05)。基本药物制度实施后,男性、女性、≤17岁、18~59岁、非慢性病乡镇卫生院患者的门诊处方费用低于实施前,差异有统计学意义(P<0.05);而≥60岁、患慢性病乡镇卫生院患者的门诊处方费用与实施前比较,差异无统计学意义(P>0.05)。男性、女性、≤17岁、18~59岁、≥60岁、患慢性病、非慢性病村卫生室患者的门诊处方费用均低于实施前,差异有统学意义(P<0.05)。结论基本药物制度实施后,山东省农村医疗机构的门诊处方费用有所降低,村卫生室优于乡镇卫生院。应继续贯彻落实基本药物制度,充分发挥政策效应,同时加强对老年和慢性病患者处方的监管力度。
Objective To understand the outpatient prescription costs of rural health service institutions in Shandong Province under the background of essential drugs. Methods From August 2012 to January 2013, a total of 37 township hospitals and 81 village clinics were selected in Shandong Province by multi-stage stratified sampling. To include the outpatient prescriptions of 2009 (before the implementation of the basic medicine system) and the outpatient prescriptions of 2012 (after the implementation of the basic medicine system) as general information, the outpatient prescription costs of township hospitals and village clinics were analyzed before and after the implementation of the basic drug system , As well as changes in the prescription costs of patients in different situations. Results A total of 1 293 outpatient clinics and 1 230 outpatient clinics in township hospitals were implemented before the implementation of the basic drug system. There were 1 569 outpatient clinics in township hospitals and 1 861 outpatient clinics in village clinics after the implementation of the basic drug system. The implementation of the basic drug system, the township hospitals, the median out-patient prescription costs ﹑ prescription (prescriptions) 5 kinds of costs ﹑ antibiotic prescription costs ﹑ hormone prescription costs non-hormonal prescription costs injection prescription costs (P <0.05), while the cost of non-proprietary Chinese medicines was lower than that before the implementation (P <0.05), while the proportion of “expensive prescriptions” (cost> 100.0 yuan), non-prescription cost, non-antibiotic prescription costs , Non-injection prescription costs, prescription costs of traditional Chinese medicine compared with before implementation, the difference was not statistically significant (P> 0.05). After the implementation of the basic drug system, the proportion of “expensive prescriptions” in village clinics, the median outpatient prescription costs, the cost of “prescriptions”, non-prescription expenses, prescription costs of antibiotics, prescription costs of non-antibiotics Hormone prescription costs, prescription costs of non-hormones, prescription injection costs, non-injection prescription costs, prescription costs of proprietary Chinese medicines, prescription costs of non-proprietary Chinese medicines were lower than before the implementation, the difference was statistically significant (P <0.05). After the implementation of the basic drug system, the out-patient prescription costs of male and female, ≤17 years of age and 18 to 59 years old, non-chronic township hospitals were significantly lower than those before implementation (P <0.05) Outpatient prescription costs of patients with chronic diseases in township hospitals were significantly different from those before implementation (P> 0.05). The outpatient prescription costs of male and female, ≤17 years old, 18 ~ 59 years old, ≥60 years old suffering from chronic diseases and non-chronic diseases were lower than those before the implementation in the village clinics (P <0.05). Conclusion After the implementation of the basic drug system, the outpatient prescription costs of rural medical institutions in Shandong Province have been reduced, and the village clinics are superior to township hospitals. The implementation of the basic drug system should continue to be implemented and the policy effects should be brought into full play. At the same time, the supervision on the prescriptions of elderly and chronic patients should be strengthened.