四川省78家医疗机构药品短缺情况调查与原因分析
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摘要
目的:调查四川省部分医疗机构药品短缺情况及其原因。方法:采取分层随机抽样法,选择四川省78家医疗机构为调查对象进行问卷调查,收集2015年1月-2017年6月期间药品短缺情况,主要包括医疗机构基本信息、药品短缺情况、具体短缺药品信息、药品短缺原因。对调查问卷收集的信息进行描述性分析,并采用SPSS 20.0软件对数据进行Logistic回归分析,找出影响药品短缺的关键因素。结果与结论:78家医疗机构包括三级医院13家、二级医院22家及基层医疗机构43家(社区卫生服务中心10家、乡镇卫生院33家);共发放调查问卷78份,回收率和有效率均为100%;其中68家医疗机构上报了206种短缺药品,合计240个品规;有88.34%以上的短缺药品价格低于50元。短缺药品主要类别为抗感染药物、中枢神经系统药物、心血管系统药物,且多为直接挂网采购类;暂时短缺(短缺时间<3个月)和长期短缺(短缺时间>12个月)的药品占比相对较高(合计占比超过68%);药品供货和医疗机构自身因素是导致药品短缺的两大主要原因。Logistic回归分析显示,影响药品短缺时间的因素主要为医院药品采购流程、医疗机构所处地区以及药品采购价格,影响医疗机构药品短缺品规数的因素主要有药品采购流程、医院采购目录限制、是否基层/非基层医疗机构、是否综合/专科医院。建议该省医疗机构可通过建设短缺药品信息管理平台、优化药品采购目录和计划、加强药房库存管理、建立配送企业监管制度等措施,来减少因自身原因导致的药品短缺现象。
OBJECTIVE:To investigate the situation and reasons of drug shortage in some medical institutions from Sichuan province. METHODS:A questionnaire survey was conducted among 78 medical institutions in Sichuan province by stratified random sampling. The situation of drug shortage were collected from Jan. 2015 to Jun. 2017, mainly including the basic information of medical institutions,drug shortage situation,specific drug shortage information and the reasons for drug shortage.Descriptive analysis of the information collected by the questionnaire was carried out,and Logistic regression analysis of the data by SPSS 20.0 software was adopted to find out the key factors affecting drug shortage. RESULTS & CONCLUSIONS:Totally 78 medical institutions include 13 third-level hospitals,22 second-level hospitals and 43 primary medical institutions(10 community health service centers,33 township health centers). A total of 78 questionnaires were sent out,and the recovery rate and effective rate both were 100%. Among them,68 medical institutions reported 206 shortage drugs totally,involving 240 specifications. The prices of more than 88.34% of the shortage drug were less than 50 yuan. Main types of shortage drugs included anti-infective drugs,central nervous system drugs and cardiovascular system drugs,and most of them were purchased directly through internet.The proportion of temporary shortage(shortage time<3 months) and long-term shortage(shortage time>12 months) was relatively high(more than 68% in total). Drug supply and medical institutions' own factors were two main causes of drug shortage.Logistic regression analysis showed that main factors affecting the time of drug shortage were hospital drug purchase process,location of medical institution and drug purchase price. The main factors affecting the specifications of drug shortage in medical institutions were the process of drug purchase,the limitation of hospital purchase catalogue,primary or non-primary medical institution,comprehensive or specialized hospitals. It is suggested that medical institutions in this region can reduce the drug shortage caused by their own reasons by building a platform for drug information management, optimizing drug purchase catalogues and plans,strengthening the management of pharmacy inventory and establishing a regulatory system for distribution enterprises.
OBJECTIVE:To investigate the situation and reasons of drug shortage in some medical institutions from Sichuan province. METHODS:A questionnaire survey was conducted among 78 medical institutions in Sichuan province by stratified random sampling. The situation of drug shortage were collected from Jan. 2015 to Jun. 2017, mainly including the basic information of medical institutions,drug shortage situation,specific drug shortage information and the reasons for drug shortage.Descriptive analysis of the information collected by the questionnaire was carried out,and Logistic regression analysis of the data by SPSS 20.0 software was adopted to find out the key factors affecting drug shortage. RESULTS & CONCLUSIONS:Totally 78 medical institutions include 13 third-level hospitals,22 second-level hospitals and 43 primary medical institutions(10 community health service centers,33 township health centers). A total of 78 questionnaires were sent out,and the recovery rate and effective rate both were 100%. Among them,68 medical institutions reported 206 shortage drugs totally,involving 240 specifications. The prices of more than 88.34% of the shortage drug were less than 50 yuan. Main types of shortage drugs included anti-infective drugs,central nervous system drugs and cardiovascular system drugs,and most of them were purchased directly through internet.The proportion of temporary shortage(shortage time<3 months) and long-term shortage(shortage time>12 months) was relatively high(more than 68% in total). Drug supply and medical institutions' own factors were two main causes of drug shortage.Logistic regression analysis showed that main factors affecting the time of drug shortage were hospital drug purchase process,location of medical institution and drug purchase price. The main factors affecting the specifications of drug shortage in medical institutions were the process of drug purchase,the limitation of hospital purchase catalogue,primary or non-primary medical institution,comprehensive or specialized hospitals. It is suggested that medical institutions in this region can reduce the drug shortage caused by their own reasons by building a platform for drug information management, optimizing drug purchase catalogues and plans,strengthening the management of pharmacy inventory and establishing a regulatory system for distribution enterprises.
引文
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[11]国家卫生计生委,国家发展改革委,工业和信息化部,等.关于改革完善短缺药品供应保障机制的实施意见[EB/OL].[2018-10-07].http://www.nhc.gov.cn/yaozs/s3581/201706/ec2c5910ba4341559e0176e5e237d5e6.shtml.
[12]舒永全,童荣生.医院药品采购工作中常见问题及处理[J].中国药房,2011,22(33):3114-3115.
[13]何梦婷,冯国忠,周振,等.国外药品短缺处理机制的比较及对我国的启示[J].中国药事,2017,31(9):980-983.
[14]U.S.Food and Drug Administration.CDER conversation:FDA’s drug shortages prevention strategies[EB/OL].[2018-10-07].https://www.fda.gov/Drugs/News Events/ucm432474.html.
[15]高晨,王孝蓉.美国医院药剂师协会药品缺货管理指南[J].中国医院药学杂志,2006,26(10):1289-1290.
[16]王晓君.供应链下短缺药品的现状分析与应对措施[J].中医药管理杂志,2018,26(15):10-12.
[17]徐帆,孙琳,杨中磊,等.医院药品采购计划管理信息系统的设计与应用[J].中国药房,2014,25(29):2728-2731.
[18]李培芳,方焱,张善堂,等.医疗机构药品短缺原因分析与防范[J].药学实践杂志,2015,33(2):179-182.
[19]BOCQUET F,DEGRASSATTHéAS A,PEIGNéJ,et al.The new regulatory tools of the 2016 Health Law to fight drug shortages in France[J].Health Policy,2017,121(5):471-476.
[20]四川省药械集中采购服务中心.四川省药械集中采购服务中心关于开展短缺药品信息上报工作的通知[EB/OL].[2018-10-07].https://www.scbid.gov.cn/HomePage/Show Detail.aspx?InfoId=26449.
[2]FOX ER,BIRT A,JAMES KB,et al.ASHP guidelines on managing drug product shortages in hospitals and health systems[J].Am J Health Syst Pharm,2009,66(15):1399-1406.
[3]U.S.Food and Drug Administration.Drug shortage management[EB/OL].[2018-10-01].https://www.fda.gov/downloads/aboutfda/centersoffices/officeofmedicalproductsandtobacco/cder/manualofpoliciesprocedures/ucm079936.pdf.
[4]武丽娜,方宇,杨才君,等.我国药品短缺问题研究进展评述[J].中国药事,2016,30(5):458-465.
[5]江苏省卫生厅,江苏省经济和信息化委员会,江苏省财政厅,等.关于印发《江苏省短缺药品供应保障方案》的通知[EB/OL].(2013-01-15)[2018-10-01].http://jsggzy.jszwfw.gov.cn/ypcg/017005/20130115/6a755400-63cd-4996-8962-ec864b8ecc77.html.
[6]陈新谦,金有豫,汤光.新编药物学[M].17版.北京:人民卫生出版社,2011:34-938.
[7]四川省卫生计生委.关于发布2015年四川省公立医院药品集中采购实施方案的通知[EB/OL].[2018-10-07].http://cdsip.nhfpc.gov.cn/publish/show592.html.
[8]胡安琪,李勇,马爱霞,等.全国26家医疗卫生机构药品短缺原因的调查分析[J].中国药房,2017,28(27):3754-3758.
[9]YANG C,CAI W,LI Z,et al.The current status and effects of emergency drug shortages in China:perceptions of emergency department physicians[J].PLoS One,2018,13(10):1-14.
[10]BARLAS S.FDA strategies to prevent and respond to drug shortages:finding a better way to predict and prevent company closures[J].P&T,2013,38(5):261-263.
[11]国家卫生计生委,国家发展改革委,工业和信息化部,等.关于改革完善短缺药品供应保障机制的实施意见[EB/OL].[2018-10-07].http://www.nhc.gov.cn/yaozs/s3581/201706/ec2c5910ba4341559e0176e5e237d5e6.shtml.
[12]舒永全,童荣生.医院药品采购工作中常见问题及处理[J].中国药房,2011,22(33):3114-3115.
[13]何梦婷,冯国忠,周振,等.国外药品短缺处理机制的比较及对我国的启示[J].中国药事,2017,31(9):980-983.
[14]U.S.Food and Drug Administration.CDER conversation:FDA’s drug shortages prevention strategies[EB/OL].[2018-10-07].https://www.fda.gov/Drugs/News Events/ucm432474.html.
[15]高晨,王孝蓉.美国医院药剂师协会药品缺货管理指南[J].中国医院药学杂志,2006,26(10):1289-1290.
[16]王晓君.供应链下短缺药品的现状分析与应对措施[J].中医药管理杂志,2018,26(15):10-12.
[17]徐帆,孙琳,杨中磊,等.医院药品采购计划管理信息系统的设计与应用[J].中国药房,2014,25(29):2728-2731.
[18]李培芳,方焱,张善堂,等.医疗机构药品短缺原因分析与防范[J].药学实践杂志,2015,33(2):179-182.
[19]BOCQUET F,DEGRASSATTHéAS A,PEIGNéJ,et al.The new regulatory tools of the 2016 Health Law to fight drug shortages in France[J].Health Policy,2017,121(5):471-476.
[20]四川省药械集中采购服务中心.四川省药械集中采购服务中心关于开展短缺药品信息上报工作的通知[EB/OL].[2018-10-07].https://www.scbid.gov.cn/HomePage/Show Detail.aspx?InfoId=26449.