武汉市某三级甲等医院门诊患者用药情况分析
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摘要
研究目的
本研究主要针对中国目前合理用药研究的不足以及全球合理用药研究关注的焦点，对武汉市某三级甲等医院全年门诊患者电子处方信息进行分析，从而为了解大型综合医院合理用药现状提供可靠的有代表性参考数据。
研究方法
本研究首先通过文献研究了解国内外合理用药现状，掌握世界卫生组织推荐的WHO/INRUD处方指标分析方法以及ATC/DDD药物利用分析方法，在此基础上抽取某三级甲等医院2012年近百万门诊患者的电子处方信息，对医院门诊病人处方用药情况进行总体分析。同时对上呼吸道感染、5岁以下儿童腹泻、高血压和糖尿病四种常见病处方用药情况进行分病种针对性分析。本研究主要分析指标为门诊患者单次就诊用药个数、处方费用、注射剂使用比例、抗生素使用比例、激素使用比例、抗病毒药物使用比例以及抗高血压和降糖药物的使用频度等。在统计分析过程中，使用均数、标准差、中位数、构成比及率等对门诊患者基本特征和处方指标进行描述性分析，根据患者基本特征和就诊医生职称不同采用2检验、 t检验等对各处方指标进行分组比较，最后通过多因素Logistic回归模型分析门诊患者单次就诊用药个数和处方费用的主要影响因素。本研究中所有相关数据处理工作都应用SAS9.2软件进行统计分析。
结果
1、门诊患者总体用药情况。本研究主要对990029位门诊患者处方用药情况进行统计分析，患者平均年龄为38.77，标准差为19.97，男性和女性患者分别占44.79%和55.21%，自费和医保患者分别占95.45%和4.55%。门诊患者就诊医务人员职称分布主要为主任医师、副主任医师及主治医师，分别占31.76%、31.51%及31.77%。门诊患者单次就诊平均用药个数为2.50，抗生素使用比例为24.31%，激素使用比例为17.33%，注射剂使用比例为23.70%，单次就诊平均处方费用为581.14元，中位数为293.4元。患者性别、年龄、付费方式、就诊科室和医生职称不同，其处方指标有明显差异。多因素Logistic回归分析显示，与女性患者相比，男性患者单次就诊发生高处方费用和过多联合用药的可能性增加，OR值分别为1.52和1.09。随着年龄的升高，门诊患者发生高处方费用和过多联合用药的可能性增加。与医保患者相比，自费患者单次就诊发生高处方费用和过多联合用药的可能性增加，OR值分别为2.00和1.52。不同科室之间，内科门诊患者发生高处方费用和过多联合用药的可能性最大。不同职称医生之间，副主任医师开具的处方发生高处方费用和过多联合用药的可能性最大。
2、门诊上呼吸道感染患者用药情况。本研究中共有31909位门诊上呼吸道感染患者，门诊患者单次就诊平均用药个数为2.56，抗生素使用比例为64.05%，激素使用比例为16.62%，抗病毒药物使用比例为10.45%，注射剂使用比例为43.89%，单次就诊平均处方费用为254.25元，中位数为171.40元。患者性别、年龄、付费方式和就诊医生职称不同，其处方指标有明显差异。
3、门诊5岁以下儿童腹泻患者用药情况。本研究中共有1749位5岁以下儿童腹泻患者，门诊患者单次就诊平均用药个数为2.52，抗生素使用比例为25.52%，抗病毒药物使用比例为5.91%，注射剂使用比例为25.50%，单次就诊平均处方费用为102.29元，中位数为79.80元。患者年龄和就诊医生职称不同，其处方指标有明显差异。不同性别和付费方式患者的处方指标差别不明显。
4、高血压患者用药情况。本研究中共有28788位高血压患者，门诊患者单次就诊平均用药个数为3.28，单次就诊平均处方费用为530.84元，中位数为370.55元。研究中共有6大类40种抗高血压药物，钙拮抗剂、肾素-血管紧张素系统抑制剂和β-受体阻滞剂是最常用的三类抗高血压药物，使用频率分别为35.85%、30.28%和20.07%。氨氯地平、非洛地平、硝苯地平、厄贝沙坦和培哚普利是使用频度最高的5种抗高血压药物，其限定日费用在40种抗高血压药物中的排序分别为21、23、27、18和22，属于经济适中类药物。
5、糖尿病患者用药情况。本研究中共有8986位糖尿病患者，门诊患者单次就诊平均用药个数为2.88，单次就诊平均处方费用为701.02元，中位数为491.1元。研究中共有7大类18种降糖类药物，胰岛素、磺脲类促分泌药和葡萄糖苷酶抑制剂是最常用的三类降糖药物，使用频率分别为26.43%、18.27%和15.47%。胰岛素注射液、格列美脲、格列齐特、西格列汀和二甲双胍是使用频度最高的5种降糖药物，其限定日费用在18种降糖药物中的排序分别为4、17、16、9和14，属于经济适中类药物。
结论和建议
门诊患者单次就诊平均处方费用过高，处方用药指标与合理水平尚有差距，医师职称类型和患者付费方式对医生处方行为有显著影响，上呼吸道感染患者治疗过程中存在过度使用抗生素和激素现象，小儿腹泻、高血压和糖尿病治疗基本符合临床治疗指南。有必要扩大国家基本药物制度在三级医院的实施范围，降低患者门诊疾病经济负担。医院应该对医师处方行为进行定期监督评价，尤其是对上呼吸道感染患者处方重点关注，采取相应干预措施控制药物不合理使用。另外，有必要以前瞻性设计现场调查的方式对门诊患者处方指标进行研究。
创新和局限性
首先，本次研究对象选择和研究内容具有创新性。合理用药是目前卫生政策领域研究的重点，本研究是国内首次抽取年门诊量超过百万的三级甲等特大规模医院整年的门诊患者电子处方信息进行全面的统计分析。其次，研究方法和研究视角具有创新性。本研究在综合分析门诊患者处方合理用药的基础上首次同时对多种常见病用药情况分病种研究。另外，与已有研究只分析处方用药不同，本研究首次立足大样本数据对医生处方行为的影响因素进行了分析。同时，本研究还发现了一些比较有意义的创新性结论，如本研究首次发现了在三级甲等医院，副主任医师开具处方中处方用药个数以及药品费用明显高于其他医师。另外医保患者处方用药个数和费用远低于自费患者的发现也为进一步了解医生处方行为提供了新的研究思路和依据。
研究不足和局限性。首先，本研究的现场具有一定的特殊性，研究结论在推广到其他医院时需要考虑到医院级别和规模对数据结果的影响。另外，本研究为回顾性分析，由于缺少患者病史、疾病严重程度等重要数据，在分析处方用药是否合理时只能根据临床指南从宏观层面加以评价，而不能针对单张处方进行具体分析。最后由于缺少患者服药时间等信息，本研究在计算ATC/DDD药物利用指标是只能初步计算用药频度，限制了进一步对DDD/100病人/天进行更详细的分析。
Objective
Rational drug use has attracted global attentions now. However, reliable data aboutrational drug use is in short supply in China. This study aims to provide reliable andrepresentative data about rational drug use in outpatients in large general hospitals byanalyzing electronic prescriptions of outpatients obtained from a tertiary level hospital inWuhan City.
Methods
We conducted comprehensive reviews of literature on rational drug use to understandthe current research situation and master the standard analysis methods recommended bythe World Health Organization (WHO). The WHO/INRUD prescription indicators analysismethod and the ATC/DDD drug utilization analysis method were applied in this study.Nearly one million electronic prescriptions of outpatient in a tertiary level hospital inWuhan City in2012were collected and analyzed. In addition, medicine use in upperrespiratory tract infections outpatients, children less than5years old with acute diarrhea,hypertensive and diabetics were analyzed separately. The main measurements used in thisstudy to assess rational drug use were average number of drugs per encounter, averageprescription cost, percentage of encounters with an injection prescribed, percentage ofencounters with an antibiotic prescribed, percentage of encounters with a hormoneprescribed, percentage of encounters with an antiviral drug prescribed, frequency ofantihypertensive and hypoglycemic agents prescribed, and so on. In the present study, descriptive analysis was carried out for demographics data and prescribing indicators.
2Test, Student's t-test and ANOVA were conducted to compare prescribing indicatorsbetween groups due to different outpatient socio-demographic characteristics and doctortitle. Multivariate logistic regression analysis was used to analyze determinant factors ofaverage number of drugs per encounter and average prescription cost. SAS9.2was used forall data analysis.
Results
1. Medicine use in all outpatients.
990,029outpatients' prescriptions were analyzed in the study. The average age of alloutpatients was38.77, standard deviation was19.97. Of the outpatients,44.79%weremales.95.45%were private patients. Outpatients were mainly treated by attending doctors,associate chief physicians and chief physicians; the proportion was31.76%,31.51%and31.77%, respectively. The average number of drugs per prescription was2.50, thepercentage of injection prescriptions was23.70%, the percentage of prescriptionscontaining antibiotics or hormone was24.31%and17.33%, respectively. The averageprescription cost was581.14and the median was293.4. Prescribing patterns, in terms ofaverage prescription cost, the number of drugs per prescriptions and the percentage ofprescriptions with antibiotics, injections, or hormones, were significantly different due tooutpatient's age, gender, modes of payment, clinical departments and doctors' titles. Theresults of the multivariate logistic regression analysis showed that males were more likelyto be prescribed with high cost prescriptions and to have excessive drug combination usethan females, the OR was1.52and1.09. The probability of being prescribed with high costprescriptions and to have excessive drug combination use increased among the outpatientswho are older. Compared with outpatients insured by medical insurance, private patientswere greater likelihood to be prescribed with high cost prescriptions and to have excessivedrug combination use. The OR was2.00and1.52. In terms of clinical departments,outpatients of the internal medicine were more likely to be prescribed with high costprescriptions and to have excessive drug combination use than that in other departments.And associate chief physicians had greater odds to prescribe high cost prescriptions and to use excessive drug combination than their counterparts.
2. Medicine use in outpatients with upper respiratory tract infections
31,909prescriptions of outpatients with upper respiratory tract infection were analyzedin the study. The average number of drugs per prescription was2.56, the percentage ofprescriptions with antibiotics, hormones, antiviral agents and injections were64.05%,16.62%,10.45%and43.89%, respectively. The average prescription cost was254.25andthe median was171.40. Prescribing patterns were significantly different due to outpatient'sage, gender, modes of payment, and doctors'titles.
3. Medicine use in children less than5years old with acute diarrhea
A total of1,749children under five years old suffered from diarrhea in the study. Theaverage number of drugs per prescription was2.52, the percentage of prescriptions withantibiotics, antiviral agents and injections were25.52%,5.91%and25.50%, respectively.The average prescription cost was102.29and the median was79.80. With regard to variousprescribing indicators, there were significant differences among outpatients with differentage and different doctors' titles. While there were no obvious statistics difference betweenmales and females and among outpatients with different modes of payment.
4. Medicine use in outpatient with hypertension
28,788prescriptions of outpatients with hypertension were analyzed in the study. Theaverage number of drugs per prescription was3.28. The average prescription cost was530.84and the median was370.55. There were a total of40kinds of antihypertensive drugsin six categories. Calcium antagonists, Rennin-angiotensin system inhibitors and β-receptorblockers were most commonly used, with the frequency of utilization were35.85%,30.28%and20.07%, respectively. Amlodipine, Felodipine, Nifedipine, Irbesartan andPerindopril were the top five kinds of antihypertensive agents which were most frequentlyused, and their rankings of defined daily cost (DDDc) among40kinds of antihypertensivedrugs were21,23,27,18and22, respectively. Thus, the five most frequently usedantihypertensive agents were economic affordable.
5. Medicine use in outpatients with diabetes
8,986prescriptions of outpatients with diabetes were analyzed in the study. Theaverage number of drugs per prescription was2.88. The average prescription cost was701.02and the median was491.1. There were a total of18kinds of hypoglycemic agents inseven categories. Insulin, sulfonylurea secretagogues drugs and glucosidase inhibitors weremost commonly used; with the frequency of utilization were26.43%,18.27%and15.47%,respectively. Insulin injection, Glimepiride, Gliclazide, Sitagliptin and Metformin were thetop five kinds of hypoglycemic drugs which were most frequently used, and their rankingsof defined daily cost (DDDc) among18kinds of antihypertensive drugs were4,17,16,9and14, respectively. Thus, the five most frequently used hypoglycemic agents wereeconomic affordable.
Conclusions and suggestions
The average prescription cost for an outpatient encounter is relatively too high.Prescribing indicators such as percentage use of antibiotics are still higher than therecommended level. There are significant associations between doctors' prescribingbehaviors and their titles, as well as outpatients' payment modes. It is worth noting thatthere is irrational usage of antibiotics and hormones among outpatients with upperrespiratory tract infection. However, the medical treatments for children less than5yearsold with acute diarrhea, hypertensive and diabetics are in line with the clinical guidelines ingeneral. It is necessary to implement essential drug system in outpatient department oftertiary level hospitals to alleviate outpatients' economic burden. The managementdepartment of hospital should assess and supervise doctors' prescribing behaviors regularly,especially for prescriptions of outpatients with upper respiratory tract infection, and takemeasures to control the irrational drug use. In addition, it is needed to conduct prospectivestudies to investigate outpatient prescribing indicators.
Innovations and limitations
First of all, participants and research contents of the study is innovative. Rational druguse is a hot research field of health policy, and our study firstly and comprehensivelyanalyzed all outpatients' electronic prescriptions collected from a tertiary level hospitalwhose outpatients exceed one million in a year. Second, the research method and perspective in this current study are innovative. In addition to comprehensively analyzerational drug use among outpatients, this study preliminary explored rational drug useamong various common diseases. Moreover, previous researches only investigated rationaldrug use, while our study explored the factors influencing doctors' prescribing behavior onbasis of large samples as well. Meanwhile, our study had some innovative and interestingfindings. For example, associate chief physicians had greater odds to prescribe high costprescriptions and to use excessive drug combination than their counterparts. In addition, thenumber and cost of drug use of outpatients insured by medical insurance were much lessthan those of private patients, which may provide a new perspective to understand doctors'prescription behaviors.There are still some limitations needed to be pointed out. First, thestudy was carried out in a relatively particular hospital, and may not be representative ofoutpatients from different levels and scales of hospitals. Second, this study was aretrospective analysis, and patient's disease history, severity of illness and some otherimportant data were not collected, so we could only analyze rational drug usemacroscopically under the clinical guidelines instead of analyzing a single prescription indetail. Finally, due to the lack of information on taking medicine of participants, the studyonly analyzed the frequency of drug use, a preliminary indicator of ATC/DDD system, andit limited to analyze other prescription indicators such as DDD/100patients/day further.
本研究主要针对中国目前合理用药研究的不足以及全球合理用药研究关注的焦点，对武汉市某三级甲等医院全年门诊患者电子处方信息进行分析，从而为了解大型综合医院合理用药现状提供可靠的有代表性参考数据。
研究方法
本研究首先通过文献研究了解国内外合理用药现状，掌握世界卫生组织推荐的WHO/INRUD处方指标分析方法以及ATC/DDD药物利用分析方法，在此基础上抽取某三级甲等医院2012年近百万门诊患者的电子处方信息，对医院门诊病人处方用药情况进行总体分析。同时对上呼吸道感染、5岁以下儿童腹泻、高血压和糖尿病四种常见病处方用药情况进行分病种针对性分析。本研究主要分析指标为门诊患者单次就诊用药个数、处方费用、注射剂使用比例、抗生素使用比例、激素使用比例、抗病毒药物使用比例以及抗高血压和降糖药物的使用频度等。在统计分析过程中，使用均数、标准差、中位数、构成比及率等对门诊患者基本特征和处方指标进行描述性分析，根据患者基本特征和就诊医生职称不同采用2检验、 t检验等对各处方指标进行分组比较，最后通过多因素Logistic回归模型分析门诊患者单次就诊用药个数和处方费用的主要影响因素。本研究中所有相关数据处理工作都应用SAS9.2软件进行统计分析。
结果
1、门诊患者总体用药情况。本研究主要对990029位门诊患者处方用药情况进行统计分析，患者平均年龄为38.77，标准差为19.97，男性和女性患者分别占44.79%和55.21%，自费和医保患者分别占95.45%和4.55%。门诊患者就诊医务人员职称分布主要为主任医师、副主任医师及主治医师，分别占31.76%、31.51%及31.77%。门诊患者单次就诊平均用药个数为2.50，抗生素使用比例为24.31%，激素使用比例为17.33%，注射剂使用比例为23.70%，单次就诊平均处方费用为581.14元，中位数为293.4元。患者性别、年龄、付费方式、就诊科室和医生职称不同，其处方指标有明显差异。多因素Logistic回归分析显示，与女性患者相比，男性患者单次就诊发生高处方费用和过多联合用药的可能性增加，OR值分别为1.52和1.09。随着年龄的升高，门诊患者发生高处方费用和过多联合用药的可能性增加。与医保患者相比，自费患者单次就诊发生高处方费用和过多联合用药的可能性增加，OR值分别为2.00和1.52。不同科室之间，内科门诊患者发生高处方费用和过多联合用药的可能性最大。不同职称医生之间，副主任医师开具的处方发生高处方费用和过多联合用药的可能性最大。
2、门诊上呼吸道感染患者用药情况。本研究中共有31909位门诊上呼吸道感染患者，门诊患者单次就诊平均用药个数为2.56，抗生素使用比例为64.05%，激素使用比例为16.62%，抗病毒药物使用比例为10.45%，注射剂使用比例为43.89%，单次就诊平均处方费用为254.25元，中位数为171.40元。患者性别、年龄、付费方式和就诊医生职称不同，其处方指标有明显差异。
3、门诊5岁以下儿童腹泻患者用药情况。本研究中共有1749位5岁以下儿童腹泻患者，门诊患者单次就诊平均用药个数为2.52，抗生素使用比例为25.52%，抗病毒药物使用比例为5.91%，注射剂使用比例为25.50%，单次就诊平均处方费用为102.29元，中位数为79.80元。患者年龄和就诊医生职称不同，其处方指标有明显差异。不同性别和付费方式患者的处方指标差别不明显。
4、高血压患者用药情况。本研究中共有28788位高血压患者，门诊患者单次就诊平均用药个数为3.28，单次就诊平均处方费用为530.84元，中位数为370.55元。研究中共有6大类40种抗高血压药物，钙拮抗剂、肾素-血管紧张素系统抑制剂和β-受体阻滞剂是最常用的三类抗高血压药物，使用频率分别为35.85%、30.28%和20.07%。氨氯地平、非洛地平、硝苯地平、厄贝沙坦和培哚普利是使用频度最高的5种抗高血压药物，其限定日费用在40种抗高血压药物中的排序分别为21、23、27、18和22，属于经济适中类药物。
5、糖尿病患者用药情况。本研究中共有8986位糖尿病患者，门诊患者单次就诊平均用药个数为2.88，单次就诊平均处方费用为701.02元，中位数为491.1元。研究中共有7大类18种降糖类药物，胰岛素、磺脲类促分泌药和葡萄糖苷酶抑制剂是最常用的三类降糖药物，使用频率分别为26.43%、18.27%和15.47%。胰岛素注射液、格列美脲、格列齐特、西格列汀和二甲双胍是使用频度最高的5种降糖药物，其限定日费用在18种降糖药物中的排序分别为4、17、16、9和14，属于经济适中类药物。
结论和建议
门诊患者单次就诊平均处方费用过高，处方用药指标与合理水平尚有差距，医师职称类型和患者付费方式对医生处方行为有显著影响，上呼吸道感染患者治疗过程中存在过度使用抗生素和激素现象，小儿腹泻、高血压和糖尿病治疗基本符合临床治疗指南。有必要扩大国家基本药物制度在三级医院的实施范围，降低患者门诊疾病经济负担。医院应该对医师处方行为进行定期监督评价，尤其是对上呼吸道感染患者处方重点关注，采取相应干预措施控制药物不合理使用。另外，有必要以前瞻性设计现场调查的方式对门诊患者处方指标进行研究。
创新和局限性
首先，本次研究对象选择和研究内容具有创新性。合理用药是目前卫生政策领域研究的重点，本研究是国内首次抽取年门诊量超过百万的三级甲等特大规模医院整年的门诊患者电子处方信息进行全面的统计分析。其次，研究方法和研究视角具有创新性。本研究在综合分析门诊患者处方合理用药的基础上首次同时对多种常见病用药情况分病种研究。另外，与已有研究只分析处方用药不同，本研究首次立足大样本数据对医生处方行为的影响因素进行了分析。同时，本研究还发现了一些比较有意义的创新性结论，如本研究首次发现了在三级甲等医院，副主任医师开具处方中处方用药个数以及药品费用明显高于其他医师。另外医保患者处方用药个数和费用远低于自费患者的发现也为进一步了解医生处方行为提供了新的研究思路和依据。
研究不足和局限性。首先，本研究的现场具有一定的特殊性，研究结论在推广到其他医院时需要考虑到医院级别和规模对数据结果的影响。另外，本研究为回顾性分析，由于缺少患者病史、疾病严重程度等重要数据，在分析处方用药是否合理时只能根据临床指南从宏观层面加以评价，而不能针对单张处方进行具体分析。最后由于缺少患者服药时间等信息，本研究在计算ATC/DDD药物利用指标是只能初步计算用药频度，限制了进一步对DDD/100病人/天进行更详细的分析。
Objective
Rational drug use has attracted global attentions now. However, reliable data aboutrational drug use is in short supply in China. This study aims to provide reliable andrepresentative data about rational drug use in outpatients in large general hospitals byanalyzing electronic prescriptions of outpatients obtained from a tertiary level hospital inWuhan City.
Methods
We conducted comprehensive reviews of literature on rational drug use to understandthe current research situation and master the standard analysis methods recommended bythe World Health Organization (WHO). The WHO/INRUD prescription indicators analysismethod and the ATC/DDD drug utilization analysis method were applied in this study.Nearly one million electronic prescriptions of outpatient in a tertiary level hospital inWuhan City in2012were collected and analyzed. In addition, medicine use in upperrespiratory tract infections outpatients, children less than5years old with acute diarrhea,hypertensive and diabetics were analyzed separately. The main measurements used in thisstudy to assess rational drug use were average number of drugs per encounter, averageprescription cost, percentage of encounters with an injection prescribed, percentage ofencounters with an antibiotic prescribed, percentage of encounters with a hormoneprescribed, percentage of encounters with an antiviral drug prescribed, frequency ofantihypertensive and hypoglycemic agents prescribed, and so on. In the present study, descriptive analysis was carried out for demographics data and prescribing indicators.
2Test, Student's t-test and ANOVA were conducted to compare prescribing indicatorsbetween groups due to different outpatient socio-demographic characteristics and doctortitle. Multivariate logistic regression analysis was used to analyze determinant factors ofaverage number of drugs per encounter and average prescription cost. SAS9.2was used forall data analysis.
Results
1. Medicine use in all outpatients.
990,029outpatients' prescriptions were analyzed in the study. The average age of alloutpatients was38.77, standard deviation was19.97. Of the outpatients,44.79%weremales.95.45%were private patients. Outpatients were mainly treated by attending doctors,associate chief physicians and chief physicians; the proportion was31.76%,31.51%and31.77%, respectively. The average number of drugs per prescription was2.50, thepercentage of injection prescriptions was23.70%, the percentage of prescriptionscontaining antibiotics or hormone was24.31%and17.33%, respectively. The averageprescription cost was581.14and the median was293.4. Prescribing patterns, in terms ofaverage prescription cost, the number of drugs per prescriptions and the percentage ofprescriptions with antibiotics, injections, or hormones, were significantly different due tooutpatient's age, gender, modes of payment, clinical departments and doctors' titles. Theresults of the multivariate logistic regression analysis showed that males were more likelyto be prescribed with high cost prescriptions and to have excessive drug combination usethan females, the OR was1.52and1.09. The probability of being prescribed with high costprescriptions and to have excessive drug combination use increased among the outpatientswho are older. Compared with outpatients insured by medical insurance, private patientswere greater likelihood to be prescribed with high cost prescriptions and to have excessivedrug combination use. The OR was2.00and1.52. In terms of clinical departments,outpatients of the internal medicine were more likely to be prescribed with high costprescriptions and to have excessive drug combination use than that in other departments.And associate chief physicians had greater odds to prescribe high cost prescriptions and to use excessive drug combination than their counterparts.
2. Medicine use in outpatients with upper respiratory tract infections
31,909prescriptions of outpatients with upper respiratory tract infection were analyzedin the study. The average number of drugs per prescription was2.56, the percentage ofprescriptions with antibiotics, hormones, antiviral agents and injections were64.05%,16.62%,10.45%and43.89%, respectively. The average prescription cost was254.25andthe median was171.40. Prescribing patterns were significantly different due to outpatient'sage, gender, modes of payment, and doctors'titles.
3. Medicine use in children less than5years old with acute diarrhea
A total of1,749children under five years old suffered from diarrhea in the study. Theaverage number of drugs per prescription was2.52, the percentage of prescriptions withantibiotics, antiviral agents and injections were25.52%,5.91%and25.50%, respectively.The average prescription cost was102.29and the median was79.80. With regard to variousprescribing indicators, there were significant differences among outpatients with differentage and different doctors' titles. While there were no obvious statistics difference betweenmales and females and among outpatients with different modes of payment.
4. Medicine use in outpatient with hypertension
28,788prescriptions of outpatients with hypertension were analyzed in the study. Theaverage number of drugs per prescription was3.28. The average prescription cost was530.84and the median was370.55. There were a total of40kinds of antihypertensive drugsin six categories. Calcium antagonists, Rennin-angiotensin system inhibitors and β-receptorblockers were most commonly used, with the frequency of utilization were35.85%,30.28%and20.07%, respectively. Amlodipine, Felodipine, Nifedipine, Irbesartan andPerindopril were the top five kinds of antihypertensive agents which were most frequentlyused, and their rankings of defined daily cost (DDDc) among40kinds of antihypertensivedrugs were21,23,27,18and22, respectively. Thus, the five most frequently usedantihypertensive agents were economic affordable.
5. Medicine use in outpatients with diabetes
8,986prescriptions of outpatients with diabetes were analyzed in the study. Theaverage number of drugs per prescription was2.88. The average prescription cost was701.02and the median was491.1. There were a total of18kinds of hypoglycemic agents inseven categories. Insulin, sulfonylurea secretagogues drugs and glucosidase inhibitors weremost commonly used; with the frequency of utilization were26.43%,18.27%and15.47%,respectively. Insulin injection, Glimepiride, Gliclazide, Sitagliptin and Metformin were thetop five kinds of hypoglycemic drugs which were most frequently used, and their rankingsof defined daily cost (DDDc) among18kinds of antihypertensive drugs were4,17,16,9and14, respectively. Thus, the five most frequently used hypoglycemic agents wereeconomic affordable.
Conclusions and suggestions
The average prescription cost for an outpatient encounter is relatively too high.Prescribing indicators such as percentage use of antibiotics are still higher than therecommended level. There are significant associations between doctors' prescribingbehaviors and their titles, as well as outpatients' payment modes. It is worth noting thatthere is irrational usage of antibiotics and hormones among outpatients with upperrespiratory tract infection. However, the medical treatments for children less than5yearsold with acute diarrhea, hypertensive and diabetics are in line with the clinical guidelines ingeneral. It is necessary to implement essential drug system in outpatient department oftertiary level hospitals to alleviate outpatients' economic burden. The managementdepartment of hospital should assess and supervise doctors' prescribing behaviors regularly,especially for prescriptions of outpatients with upper respiratory tract infection, and takemeasures to control the irrational drug use. In addition, it is needed to conduct prospectivestudies to investigate outpatient prescribing indicators.
Innovations and limitations
First of all, participants and research contents of the study is innovative. Rational druguse is a hot research field of health policy, and our study firstly and comprehensivelyanalyzed all outpatients' electronic prescriptions collected from a tertiary level hospitalwhose outpatients exceed one million in a year. Second, the research method and perspective in this current study are innovative. In addition to comprehensively analyzerational drug use among outpatients, this study preliminary explored rational drug useamong various common diseases. Moreover, previous researches only investigated rationaldrug use, while our study explored the factors influencing doctors' prescribing behavior onbasis of large samples as well. Meanwhile, our study had some innovative and interestingfindings. For example, associate chief physicians had greater odds to prescribe high costprescriptions and to use excessive drug combination than their counterparts. In addition, thenumber and cost of drug use of outpatients insured by medical insurance were much lessthan those of private patients, which may provide a new perspective to understand doctors'prescription behaviors.There are still some limitations needed to be pointed out. First, thestudy was carried out in a relatively particular hospital, and may not be representative ofoutpatients from different levels and scales of hospitals. Second, this study was aretrospective analysis, and patient's disease history, severity of illness and some otherimportant data were not collected, so we could only analyze rational drug usemacroscopically under the clinical guidelines instead of analyzing a single prescription indetail. Finally, due to the lack of information on taking medicine of participants, the studyonly analyzed the frequency of drug use, a preliminary indicator of ATC/DDD system, andit limited to analyze other prescription indicators such as DDD/100patients/day further.
引文
1. WHO. The rational use of drugs. Report of the Conference of Experts. Geneva: WorldHealth Organization;1985.
2. E S. Adherence to long-term therapies. Evidence for action. Geneva: World HealthOrganization;2003.
3. WHO. Using indicators to measure country pharmaceutical situations: Fact book onWHO Level I and Level II monitoring indicators. Geneva: World Health Organization;2006.
4. Pirmohamed M. Adverse drug reactions as cause of admission to hospital: Prospectiveanalysis of18,820patients. BMJ,2004,329:15-19.
5. Hitchen L. Adverse drug reactions result in250,000UK admissions a year. BMJ,2006,332(7550):1109.
6. Levy SB. Antibiotic resistance-the problem intensifies. Adv Drug Deliv Rev,2005,57(10):1446-1450.
7. Harbarth S, Samore MH. Antimicrobial resistance determinants and future control.Emerg Infect Dis,2005,11(6):794-801.
8. Livermore D. Bacterial resistance: Origins, epidemiology, and impact. ClinicalInfectious Diseases,2003,36:S11-S23.
9. White TJ, Arakelian A, Rho JP. Counting the costs of drug-related adverse events.Pharmacoeconomics,1999,15(5):445-458.
10. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions inhospitalized patients: a meta-analysis of prospective studies. JAMA,1998,279(15):1200-1205.
11. Medicine Io. Microbial threats to health: emergence, detection and response.Washington, D.C.: National Academies Press;1998.
12. Pechere JC, Hughes D, Kardas P, et al. Non-compliance with antibiotic therapy foracute community infections: a global survey. Int J Antimicrob Agents,2007,29(3):245-253.
13. W K, R L. Priority medicines for Europe and the world. Geneva: World HealthOrganization;2004.
14. Lansang MA, Lucas-Aquino R, Tupasi TE, et al. Purchase of antibiotics withoutprescription in Manila, the Philippines. Inappropriate choices and doses. J Clin Epidemiol,1990,43(1):61-67.
15. Medicine Io. Reducing and preventing adverse drug events to decrease hospital costs.Washington, D.C.: Agency for Healthcare Research and Quality;2001.
16. Resistance: a sensitive issue. The European roadmap to combat antimicrobialresistance. Utrecht: The Strategic Council on Resistance in Europe;2004.
17. S VdG, A H. Self-medication in developing countries. Journal of Social andAdministrative Pharmacy,1990,7(4):199-204.
18. L. G. Self-medication with antibiotics in Europe and its determinants. Dissertation:Groningen University;2007.
19. Simonsen L, Kane A, Lloyd J, et al. Unsafe injections in the developing world andtransmission of bloodborne pathogens: a review. Bull World Health Organ,1999,77(10):789-800.
20. WHO. How to investigate drug use in health facilities: Selected drug use indicators.Geneva: World Health Organization;1993.
21. Ahmed SM, Islam QS. Availability and rational use of drugs in primary healthcarefacilities following the national drug policy of1982: is Bangladesh on right track? J HealthPopul Nutr,2012,30(1):99-108.
22. Dong L, Yan H, Wang D. Drug prescribing indicators in village health clinics across10provinces of Western China. Fam Pract,2011,28(1):63-67.
23. Odusanya. Drug use indicators at a secondary health care facility in Lagos, Nigeria.Journal of Community Medicine&Primary Health Care,2004,16:21-24.
24. Bashrahil KA. Indicators of rational drug use and health services in Hadramout, Yemen.East Mediterr Health J,2010,16(2):151-155.
25. Li Y, Xu J, Wang F, et al. Overprescribing in China, driven by financial incentives,results in very high use of antibiotics, injections, and corticosteroids. Health Aff (Millwood),2012,31(5):1075-1082.
26. Pavin M, Nurgozhin T, Hafner G, et al. Prescribing practices of rural primary healthcare physicians in Uzbekistan. Trop Med Int Health,2003,8(2):182-190.
27. Keohavong B, Syhakhang L, Sengaloundeth S, et al. Rational use of drugs: prescribingand dispensing practices at public health facilities in Lao PDR. Pharmacoepidemiol DrugSaf,2006,15(5):344-347.
28. WHO. Medicines use in primary care in developing and transitional countries: Factbook summarizing results from studies reported between1990and2006. Geneva: WorldHealth Organization;2009.
29. WHO. Promoting rational use of medicines: Core components. WHO PolicyPerspectives on Medicines, No.5. Geneva: World Health Organization;2002.
30. WHO. The Word Medicine Situation2004. Geneva: World Health Organization;2004.
31. WHO. The Word Medicine Situation2011. Geneva: World Health Organization;2011.
32. van Roosmalen MS, Braspenning JC, De Smet PA, et al. Antibiotic prescribing inprimary care: first choice and restrictive prescribing are two different traits. Qual SafHealth Care,2007,16(2):105-109.
33.李志毅.常见小儿上呼吸道感染不合理用药分析.中国误诊学杂志,2006,11:2231-2232.
34.何建荣.儿科上呼吸道感染处方用药分析.基层医学论坛,2013,4:520-521.
35.金世红,周仲华.海口社区卫生服务机构急性上呼吸道感染患者用药情况分析.中国全科医学,2009,22:2048-2050.
36.王建国,崔明辰,王凤枝.乡村医生治疗小儿上呼吸道感染用药情况的调查.中国实用乡村医生杂志,2007,4:59-60.
37. Esposito S, Blasi F, Bosis S, et al. Aetiology of acute pharyngitis: the role of atypicalbacteria. J Med Microbiol,2004,53:645-651.
38. Allander T, Tammi MT, Eriksson M, et al. Cloning of a human parvovirus by molecularscreening of respiratory tract samples. Proc Natl Acad Sci U S A,2005,102(36):12891-12896.
39. Allander T, Emerson SU, Engle RE, et al. A virus discovery method incorporatingDNase treatment and its application to the identification of two bovine parvovirus species.Proc Natl Acad Sci U S A,2001,98(20):11609-11614.
40.王菊莉,顾镜月,王显鹤.小儿腹泻的合理用药问题.中国社区医师,2006,10:15.
41.姜凤桂,李莉.小儿腹泻的用药原则.青岛医药卫生,2001,(04):298-299.
42.杨敬博,何国珍,杨仁和,等.不同级别医疗单位上呼吸道感染临床用药调查.药物流行病学杂志,2002,3:132-134.
43.易洁梅.急性上呼吸道感染患者的用药调查分析.实用药物与临床,2008,2:93-94.
44.郭廷建.急性上呼吸道感染门诊处方构成及费用分析.卫生经济研究,2012,3:54-56.
45.刘金英,阙伟东.急性上呼吸道感染的用药误区.中国医药指南,2011,2:160-161.
46.邹洁.急性上呼吸道感染患者用药情况调查分析.中国医药导报,2011,13:137-138.
47.张国龙.急性上呼吸道感染在社区卫生服务机构中的用药情况分析.中国医药导刊,2009,12:2069-2070.
48.吕志强,郭晓东,仲华,等.急诊治疗上呼吸道感染用药分析.中华医院感染学杂志,2009,18:2478.
49.柯金珍.我院小儿腹泻治疗用药的调查分析.海峡药学,2008,4:112-113.
50.黄义樵,周颖.262例小儿腹泻的用药分析.北方药学,2011,12:77.
51.孟锐.药事管理学(第2版).北京:科学出版社;2009.
52.张新平,李少丽.药物政策学.北京:科学出版社;2003.
53.金有豫.聚焦国家基本药物制度.中国药房,2010,8:675-678.
54.张文双,杨永弘. ATC/DDD系统的建立及其在药物利用研究中的应用.临床药物治疗杂志,2009,1:32-37.
55. Elseviers MM, Ferech M, Vander Stichele RH, et al. Antibiotic use in ambulatory carein Europe (ESAC data1997-2002): trends, regional differences and seasonal fluctuations.Pharmacoepidemiol Drug Saf,2007,16(1):115-123.
56. Bergman U. The history of the Drug Utilization Research Group in Europe.Pharmacoepidemiol Drug Saf,2006,15(2):95-98.
57. Behan K, Cutts C, Tett SE. Uptake of new drugs in rural and urban areas of Queensland,Australia: the example of COX-2inhibitors. Eur J Clin Pharmacol,2005,61(1):55-58.Epub2005/03/24.
58.席雅琳.门诊电子处方点评实践与用药合理性分析.中国药事,2012,12:1418-1420.
59.李茜,尤海生,孙青,等.某三级甲等教学医院门诊处方点评及用药分析.中国药师,2013,2:275-277.
60.麻琳瑜.我院900例门诊患者合理用药国际指标调研及分析.中国药房,2011,4:302-304.
61.蔡华晶,黄强增,倪政彪.我院2010年门诊处方点评与分析.临床合理用药杂志,2011,15:10-12.
62.卫生部.2012年全国抗菌药物临床应用专项整治活动方案.北京:卫生部;2012.
63. Emmerick IC, Luiza VL, Pepe VL. Pharmaceutical services evaluation in Brazil:broadening the results of a WHO methodology. Cien Saude Colet,2009,14(4):1297-1306.
64.林伟豪,刘付有兰,韩德忠.门诊抗菌药物处方调查与分析.中国现代药物应用,2008,19:120-122.
65.倪国荣,杨晓敏.我院处方点评分析.北方药学,2011,4:89-90.
66.梁佩红.我院门诊处方评价分析.中国药业,2010,(06):40-41.
67.王建,邓筱华.2010年前3季度处方管理及不合理用药点评.中国医院用药评价与分析,2011,1:86-88.
68.王春燕,舒丽芯,韩冰.利用电子处方信息分析门诊医师处方行为.药学实践杂志,2012,3:235-238.
69. Sun X, Jackson S, Carmichael GA, et al. Prescribing behaviour of village doctors underChina's New Cooperative Medical Scheme. Soc Sci Med,2009,68(10):1775-1779.
70.孙晓筠, Adrian·Sleigh,李士雪,等.新型农村合作医疗对乡村医生处方行为的影响研究.中国卫生经济,2006,4:42-44.
71.夏国俊.抗菌药物临床应用指导原则北京:中国中医药出版社;2004.
72.张丽明,陈琦,王丽俊,等.地塞米松治疗婴幼儿急性上呼吸道感染发热的利弊分析.中国实用儿科杂志,2002,4:218.
73.王明春.不同级别医院儿童上呼吸道感染用药调查.河北医学,2011,5:702-703.
74.江丽欢.门诊处方糖皮质激素类药物应用情况分析.中国医院用药评价与分析,2010,9:777-779.
75.粟珊,张永丽,唐文.我院糖皮质激素类药物门诊处方分析.中国药业,2012,22:67-69.
76.吴迪.小儿腹泻临床用药的发展.实用医技杂志,2006,18:3209-3210.
77.郝晓飞.小儿腹泻的合理用药.临床合理用药杂志,2012,27:37-38.
78.赖艳,温悦,孟德胜.某三甲医院门诊患者抗高血压用药处方分析.中国药师,2011,9:1343-1345.
79.黄秋红,聂然.抗高血压药门诊处方分析.首都医药,2010,10:20-22.
80.董芳.抗高血压药物门诊处方用药分析.临床医药实践,2011,12:918-921.
81.黄骞.门诊抗高血压用药分析.当代医学,2012,34:128.
82.刘爱云,孙聊东,孟庆河,等.胰岛素泵联合动态血糖监测治疗初诊重症2型糖尿病有效性和安全性.中国糖尿病杂志,2007,10:611-612.
83.刘敏,刘靓,黄昭穗,等.胰岛素泵治疗在糖尿病烧伤患者围手术期的应用研究.中国糖尿病杂志,2009,4:267-268+277.
84.杨文芬.2006～2007年我院治疗糖尿病药物用药分析.黑龙江医药,2009,1:86-87.
85.李艳翠,雷力力.我院2004～2008年糖尿病用药情况及经济学分析.黑龙江医药科学,2010,6:73-74.
86.潘美云,林西西.我院2008年门诊糖尿病患者的用药统计分析.海峡药学,2010,5:206-208.
1. WHO. The rational use of drugs. Report of the Conference of Experts. Geneva: WorldHealth Organization;1985.
2.姚岚,秦立轩,金建强,等.合理用药的国际研究进展.中国初级卫生保健,2002,3:8-10.
3.张新平,李少丽.药物政策学.北京:科学出版社;2003.
4. E S. Adherence to long-term therapies. Evidence for action. Geneva: World HealthOrganization;2003.
5. WHO. Using indicators to measure country pharmaceutical situations: Fact book onWHO Level I and Level II monitoring indicators. Geneva: World Health Organization;2006.
6.孟锐..药事管理学(第2版).北京:科学出版社;2009.
7. WHO. Medicines use in primary care in developing and transitional countries: Factbook summarizing results from studies reported between1990and2006. Geneva: WorldHealth Organization;2009.
8. WHO. Promoting rational use of medicines: Core components. WHO PolicyPerspectives on Medicines, No.5. Geneva: World Health Organization;2002.
9. Pirmohamed M. Adverse drug reactions as cause of admission to hospital: Prospectiveanalysis of18,820patients. BMJ,2004,329:15-19.
10. Hitchen L. Adverse drug reactions result in250,000UK admissions a year. BMJ,2006,332(7550):1109.
11. Levy SB. Antibiotic resistance-the problem intensifies. Adv Drug Deliv Rev,2005,57(10):1446-1450.
12. Harbarth S, Samore MH. Antimicrobial resistance determinants and future control.Emerg Infect Dis,2005,11(6):794-801.
13. Livermore D. Bacterial resistance: Origins, epidemiology, and impact. ClinicalInfectious Diseases,2003,36:S11-S23.
14. White TJ, Arakelian A, Rho JP. Counting the costs of drug-related adverse events.Pharmacoeconomics,1999,15(5):445-458.
15. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions inhospitalized patients: a meta-analysis of prospective studies. JAMA,1998,279(15):1200-1205.
16. Medicine Io. Microbial threats to health: emergence, detection and response.Washington, D.C.: National Academies Press;1998.
17. Pechere JC, Hughes D, Kardas P, et al. Non-compliance with antibiotic therapy foracute community infections: a global survey. Int J Antimicrob Agents,2007,29(3):245-253.
18. W K, R L. Priority medicines for Europe and the world. Geneva: World HealthOrganization;2004.
19. Lansang MA, Lucas-Aquino R, Tupasi TE, et al. Purchase of antibiotics withoutprescription in Manila, the Philippines. Inappropriate choices and doses. J Clin Epidemiol,1990,43(1):61-67.
20. Medicine Io. Reducing and preventing adverse drug events to decrease hospital costs.Washington, D.C.: Agency for Healthcare Research and Quality;2001.
21. Resistance: a sensitive issue. The European roadmap to combat antimicrobialresistance. Utrecht: The Strategic Council on Resistance in Europe;2004.
22. S VdG, A H. Self-medication in developing countries. Journal of Social andAdministrative Pharmacy,1990,7(4):199-204.
23. L. G. Self-medication with antibiotics in Europe and its determinants. Dissertation:Groningen University;2007.
24. Simonsen L, Kane A, Lloyd J, et al. Unsafe injections in the developing world andtransmission of bloodborne pathogens: a review. Bull World Health Organ,1999,77(10):789-800.
25. WHO. The Word Medicine Situation2011. Geneva: World Health Organization;2011.
26.张文双,杨永弘. ATC/DDD系统的建立及其在药物利用研究中的应用.临床药物治疗杂志,2009,1:32-37.
27. Elseviers MM, Ferech M, Vander Stichele RH, et al. Antibiotic use in ambulatory carein Europe (ESAC data1997-2002): trends, regional differences and seasonal fluctuations.Pharmacoepidemiol Drug Saf,2007,16(1):115-123.
28. Bergman U. The history of the Drug Utilization Research Group in Europe.Pharmacoepidemiol Drug Saf,2006,15(2):95-98.
29. Behan K, Cutts C, Tett SE. Uptake of new drugs in rural and urban areas of Queensland,Australia: the example of COX-2inhibitors. Eur J Clin Pharmacol,2005,61(1):55-58.
30. WHO. How to investigate drug use in health facilities: Selected drug use indicators.Geneva: World Health Organization;1993.
31.张新平,金新政,王铁军,等. WHO促进合理用药的核心政策及干预措施.中国卫生质量管理,2003,6:40-42.
32.曾繁典.国家药物政策与临床合理用药.国际医药卫生导报,2003,11:93-96.
33.刘建美,周筱青,朱士俊,等.合理用药调研指标的应用和研究现状.中华医院管理,2010,26(11):848-851.
34.李青,曾繁典.制定我国国家药物政策的紧迫性及其建议.药物流行病学杂志,2003,6:281-285.
35. WHO. The Word Medicine Situation2004. Geneva: World Health Organization;2004.
36. Goossens H. European Surveillance of Antimicrobial Consumption Project Group.Comparison of outpatient systemic antibacterial use in2004in the United States and27European countries. Clinical Infectious Diseases,2007,44:1091-1095.
37. Grigoryan L, Haaijer-Ruskamp FM, Burgerhof JG, et al. Self-medication withantimicrobial drugs in Europe. Emerg Infect Dis,2006,12(3):452-459.
38. Goossens H. Antibiotic consumption and link to resistance. Clin Microbiol Infect,2009,15Suppl3:12-15.
39. van Roosmalen MS, Braspenning JC, De Smet PA, et al. Antibiotic prescribing inprimary care: first choice and restrictive prescribing are two different traits. Qual SafHealth Care,2007,16(2):105-109.
40. Li Y, Xu J, Wang F, et al. Overprescribing in China, driven by financial incentives,results in very high use of antibiotics, injections, and corticosteroids. Health Aff (Millwood),2012,31(5):1075-1082.
41. Dong L, Yan H, Wang D. Drug prescribing indicators in village health clinics across10provinces of Western China. Fam Pract,2011,28(1):63-67.
42.杨敬博,何国珍,杨仁和,等.不同级别医疗单位上呼吸道感染临床用药调查.药物流行病学杂志,2002,3:132-134.
43.王明春.不同级别医院儿童上呼吸道感染用药调查.河北医学,2011,3:702-703.
44.李志毅.常见小儿上呼吸道感染不合理用药分析.中国误诊学杂志,2006,11:2231-2232.
45.何建荣.儿科上呼吸道感染处方用药分析.基层医学论坛,2013,4:520-521.
46.金世红,周仲华.海口社区卫生服务机构急性上呼吸道感染患者用药情况分析.中国全科医学,2009,22:2048-2050.
47.王建国,崔明辰,王凤枝.乡村医生治疗小儿上呼吸道感染用药情况的调查.中国实用乡村医生杂志,2007,4:59-60.
48. Esposito S, Blasi F, Bosis S, et al. Aetiology of acute pharyngitis: the role of atypicalbacteria. J Med Microbiol,2004,53:645-651. Epub2004/06/09.
49. Allander T, Tammi MT, Eriksson M, et al. Cloning of a human parvovirus by molecularscreening of respiratory tract samples. Proc Natl Acad Sci USA,2005,102(36):12891-12896.
50. Allander T, Emerson SU, Engle RE, et al. A virus discovery method incorporatingDNase treatment and its application to the identification of two bovine parvovirus species.Proc Natl Acad Sci U S A,2001,98(20):11609-11614..
51.王菊莉,顾镜月,王显鹤.小儿腹泻的合理用药问题.中国社区医师,2006,10:15.
52.姜凤桂,李莉.小儿腹泻的用药原则.青岛医药卫生,2001,4:298-299.
53.易洁梅.急性上呼吸道感染患者的用药调查分析.实用药物与临床,2008,2:93-94.
54.郭廷建.急性上呼吸道感染门诊处方构成及费用分析.卫生经济研究,2012,3:54-56.
55.刘金英,阙伟东.急性上呼吸道感染的用药误区.中国医药指南,2011,2:160-161.
56.邹洁.急性上呼吸道感染患者用药情况调查分析.中国医药导报,2011,13:137-138.
57.张国龙.急性上呼吸道感染在社区卫生服务机构中的用药情况分析.中国医药导刊,2009,12:2069-2070.
58.吕志强,郭晓东,仲华,等.急诊治疗上呼吸道感染用药分析.中华医院感染学杂志,2009,18:2478.
59.柯金珍.我院小儿腹泻治疗用药的调查分析.海峡药学,2008,(04):112-113.
60.黄义樵,周颖.262例小儿腹泻的用药分析.北方药学,2011,12:77.
61. Dong L, Yan H, Wang D. Antibiotic prescribing patterns in village health clinics across10provinces of Western China. J Antimicrob Chemother,2008,62(2):410-415.
62.赫强,郑小华,刘毅.四川贫困地区村卫生站处方行为分析.中国卫生事业管理,2006,6:361-362.
63.王爱荣,冯学山,龚幼龙,等.《中国农村卫生服务筹资和农村医生报酬机制研究》系列报告之十一乡村医生处方行为分析.中国初级卫生保健,2000,11:18-20.
64. Francke AL, Smit MC, de Veer AJ, et al. Factors influencing the implementation ofclinical guidelines for health care professionals: a systematic meta-review. BMC MedInform Decis Mak,2008,8:38.
65. Grimshaw J. Effectiveness and efficiency of guideline dissemination andimplementation strategies. Health Technology Assessment,2004,8(6):1-72.
66. Grol R, Grimshaw J. From best evidence to best practice: effective implementation ofchange in patients' care. Lancet,2003,362(9391):1225-1230.
67. Lu CY, Ross-Degnan D, Soumerai SB, et al. Interventions designed to improve thequality and efficiency of medication use in managed care: a critical review of the literature-2001-2007. BMC Health Serv Res,2008,8:75.
68. Jamtvedt G, Young JM, Kristoffersen DT, et al. Audit and feedback: effects onprofessional practice and health care outcomes. Cochrane Database Syst Rev,2006,(2):CD000259.
69. Wensing M, van der Weijden T, Grol R. Implementing guidelines and innovations ingeneral practice: which interventions are effective? Br J Gen Pract,1998,48(427):991-997.
70. Wills CE. Review: evidence on the effectiveness of interventions to improve patientadherence to prescribed medications is limited. Evid Based Nurs,2008,11(4):109.
71. Bosch-Capblanch X, Abba K, Prictor M, et al. Contracts between patients andhealthcare practitioners for improving patients' adherence to treatment, prevention andhealth promotion activities. Cochrane Database Syst Rev,2007,(2):CD004808.
72. Vermeire E, Wens J, Van Royen P, et al. Interventions for improving adherence totreatment recommendations in people with type2diabetes mellitus. Cochrane DatabaseSyst Rev,2005,(2):CD003638.
73. van Dulmen S, Sluijs E, van Dijk L, et al. Patient adherence to medical treatment: areview of reviews. BMC Health Serv Res,2007,7:55.
74. van Dulmen S, Sluijs E, van Dijk L, et al. Furthering patient adherence: a positionpaper of the international expert forum on patient adherence based on an internet forumdiscussion. BMC Health Serv Res,2008,8:47.
75. Huttner B. CHAMP Consortium. Characteristics and outcomes of public campaignswith the aim to improve outpatient antibiotic use in high income countries. LancetInfectious Diseases,2010,10(1):17-31.
76. Sabuncu E, David J, Bernede-Bauduin C, et al. Significant reduction of antibiotic usein the community after a nationwide campaign in France,2002-2007. PLoS Med,2009,6(6):e1000084.
77. WHO. Country pharmaceutical situations. Fact book on WHO Level1indicators2007.Geneva: World Health Organization;2009.
78. WHO. Global strategy for containment of antimicrobial resistance. Geneva: WorldHealth Organization;2001.
79. Park S, Soumerai SB, Adams AS, et al. Antibiotic use following a Korean nationalpolicy to prohibit medication dispensing by physicians. Health Policy Plan,2005,20(5):302-309.
80. Bavestrello L, Cabello A, Casanova D. Impact of regulatory measures in the trends ofcommunity consumption of antibiotics in Chile. Rev Med Chil,2002,130(11):1265-1272.
81. Austvoll-Dahlgren A, Aaserud M, Vist G, et al. Pharmaceutical policies: effects of capand co-payment on rational drug use. Cochrane Database Syst Rev,2008,(1):CD007017.
82. National medicines policy2000. Canberra: Commonwealth Department of Health andAged Care;2000.
2. E S. Adherence to long-term therapies. Evidence for action. Geneva: World HealthOrganization;2003.
3. WHO. Using indicators to measure country pharmaceutical situations: Fact book onWHO Level I and Level II monitoring indicators. Geneva: World Health Organization;2006.
4. Pirmohamed M. Adverse drug reactions as cause of admission to hospital: Prospectiveanalysis of18,820patients. BMJ,2004,329:15-19.
5. Hitchen L. Adverse drug reactions result in250,000UK admissions a year. BMJ,2006,332(7550):1109.
6. Levy SB. Antibiotic resistance-the problem intensifies. Adv Drug Deliv Rev,2005,57(10):1446-1450.
7. Harbarth S, Samore MH. Antimicrobial resistance determinants and future control.Emerg Infect Dis,2005,11(6):794-801.
8. Livermore D. Bacterial resistance: Origins, epidemiology, and impact. ClinicalInfectious Diseases,2003,36:S11-S23.
9. White TJ, Arakelian A, Rho JP. Counting the costs of drug-related adverse events.Pharmacoeconomics,1999,15(5):445-458.
10. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions inhospitalized patients: a meta-analysis of prospective studies. JAMA,1998,279(15):1200-1205.
11. Medicine Io. Microbial threats to health: emergence, detection and response.Washington, D.C.: National Academies Press;1998.
12. Pechere JC, Hughes D, Kardas P, et al. Non-compliance with antibiotic therapy foracute community infections: a global survey. Int J Antimicrob Agents,2007,29(3):245-253.
13. W K, R L. Priority medicines for Europe and the world. Geneva: World HealthOrganization;2004.
14. Lansang MA, Lucas-Aquino R, Tupasi TE, et al. Purchase of antibiotics withoutprescription in Manila, the Philippines. Inappropriate choices and doses. J Clin Epidemiol,1990,43(1):61-67.
15. Medicine Io. Reducing and preventing adverse drug events to decrease hospital costs.Washington, D.C.: Agency for Healthcare Research and Quality;2001.
16. Resistance: a sensitive issue. The European roadmap to combat antimicrobialresistance. Utrecht: The Strategic Council on Resistance in Europe;2004.
17. S VdG, A H. Self-medication in developing countries. Journal of Social andAdministrative Pharmacy,1990,7(4):199-204.
18. L. G. Self-medication with antibiotics in Europe and its determinants. Dissertation:Groningen University;2007.
19. Simonsen L, Kane A, Lloyd J, et al. Unsafe injections in the developing world andtransmission of bloodborne pathogens: a review. Bull World Health Organ,1999,77(10):789-800.
20. WHO. How to investigate drug use in health facilities: Selected drug use indicators.Geneva: World Health Organization;1993.
21. Ahmed SM, Islam QS. Availability and rational use of drugs in primary healthcarefacilities following the national drug policy of1982: is Bangladesh on right track? J HealthPopul Nutr,2012,30(1):99-108.
22. Dong L, Yan H, Wang D. Drug prescribing indicators in village health clinics across10provinces of Western China. Fam Pract,2011,28(1):63-67.
23. Odusanya. Drug use indicators at a secondary health care facility in Lagos, Nigeria.Journal of Community Medicine&Primary Health Care,2004,16:21-24.
24. Bashrahil KA. Indicators of rational drug use and health services in Hadramout, Yemen.East Mediterr Health J,2010,16(2):151-155.
25. Li Y, Xu J, Wang F, et al. Overprescribing in China, driven by financial incentives,results in very high use of antibiotics, injections, and corticosteroids. Health Aff (Millwood),2012,31(5):1075-1082.
26. Pavin M, Nurgozhin T, Hafner G, et al. Prescribing practices of rural primary healthcare physicians in Uzbekistan. Trop Med Int Health,2003,8(2):182-190.
27. Keohavong B, Syhakhang L, Sengaloundeth S, et al. Rational use of drugs: prescribingand dispensing practices at public health facilities in Lao PDR. Pharmacoepidemiol DrugSaf,2006,15(5):344-347.
28. WHO. Medicines use in primary care in developing and transitional countries: Factbook summarizing results from studies reported between1990and2006. Geneva: WorldHealth Organization;2009.
29. WHO. Promoting rational use of medicines: Core components. WHO PolicyPerspectives on Medicines, No.5. Geneva: World Health Organization;2002.
30. WHO. The Word Medicine Situation2004. Geneva: World Health Organization;2004.
31. WHO. The Word Medicine Situation2011. Geneva: World Health Organization;2011.
32. van Roosmalen MS, Braspenning JC, De Smet PA, et al. Antibiotic prescribing inprimary care: first choice and restrictive prescribing are two different traits. Qual SafHealth Care,2007,16(2):105-109.
33.李志毅.常见小儿上呼吸道感染不合理用药分析.中国误诊学杂志,2006,11:2231-2232.
34.何建荣.儿科上呼吸道感染处方用药分析.基层医学论坛,2013,4:520-521.
35.金世红,周仲华.海口社区卫生服务机构急性上呼吸道感染患者用药情况分析.中国全科医学,2009,22:2048-2050.
36.王建国,崔明辰,王凤枝.乡村医生治疗小儿上呼吸道感染用药情况的调查.中国实用乡村医生杂志,2007,4:59-60.
37. Esposito S, Blasi F, Bosis S, et al. Aetiology of acute pharyngitis: the role of atypicalbacteria. J Med Microbiol,2004,53:645-651.
38. Allander T, Tammi MT, Eriksson M, et al. Cloning of a human parvovirus by molecularscreening of respiratory tract samples. Proc Natl Acad Sci U S A,2005,102(36):12891-12896.
39. Allander T, Emerson SU, Engle RE, et al. A virus discovery method incorporatingDNase treatment and its application to the identification of two bovine parvovirus species.Proc Natl Acad Sci U S A,2001,98(20):11609-11614.
40.王菊莉,顾镜月,王显鹤.小儿腹泻的合理用药问题.中国社区医师,2006,10:15.
41.姜凤桂,李莉.小儿腹泻的用药原则.青岛医药卫生,2001,(04):298-299.
42.杨敬博,何国珍,杨仁和,等.不同级别医疗单位上呼吸道感染临床用药调查.药物流行病学杂志,2002,3:132-134.
43.易洁梅.急性上呼吸道感染患者的用药调查分析.实用药物与临床,2008,2:93-94.
44.郭廷建.急性上呼吸道感染门诊处方构成及费用分析.卫生经济研究,2012,3:54-56.
45.刘金英,阙伟东.急性上呼吸道感染的用药误区.中国医药指南,2011,2:160-161.
46.邹洁.急性上呼吸道感染患者用药情况调查分析.中国医药导报,2011,13:137-138.
47.张国龙.急性上呼吸道感染在社区卫生服务机构中的用药情况分析.中国医药导刊,2009,12:2069-2070.
48.吕志强,郭晓东,仲华,等.急诊治疗上呼吸道感染用药分析.中华医院感染学杂志,2009,18:2478.
49.柯金珍.我院小儿腹泻治疗用药的调查分析.海峡药学,2008,4:112-113.
50.黄义樵,周颖.262例小儿腹泻的用药分析.北方药学,2011,12:77.
51.孟锐.药事管理学(第2版).北京:科学出版社;2009.
52.张新平,李少丽.药物政策学.北京:科学出版社;2003.
53.金有豫.聚焦国家基本药物制度.中国药房,2010,8:675-678.
54.张文双,杨永弘. ATC/DDD系统的建立及其在药物利用研究中的应用.临床药物治疗杂志,2009,1:32-37.
55. Elseviers MM, Ferech M, Vander Stichele RH, et al. Antibiotic use in ambulatory carein Europe (ESAC data1997-2002): trends, regional differences and seasonal fluctuations.Pharmacoepidemiol Drug Saf,2007,16(1):115-123.
56. Bergman U. The history of the Drug Utilization Research Group in Europe.Pharmacoepidemiol Drug Saf,2006,15(2):95-98.
57. Behan K, Cutts C, Tett SE. Uptake of new drugs in rural and urban areas of Queensland,Australia: the example of COX-2inhibitors. Eur J Clin Pharmacol,2005,61(1):55-58.Epub2005/03/24.
58.席雅琳.门诊电子处方点评实践与用药合理性分析.中国药事,2012,12:1418-1420.
59.李茜,尤海生,孙青,等.某三级甲等教学医院门诊处方点评及用药分析.中国药师,2013,2:275-277.
60.麻琳瑜.我院900例门诊患者合理用药国际指标调研及分析.中国药房,2011,4:302-304.
61.蔡华晶,黄强增,倪政彪.我院2010年门诊处方点评与分析.临床合理用药杂志,2011,15:10-12.
62.卫生部.2012年全国抗菌药物临床应用专项整治活动方案.北京:卫生部;2012.
63. Emmerick IC, Luiza VL, Pepe VL. Pharmaceutical services evaluation in Brazil:broadening the results of a WHO methodology. Cien Saude Colet,2009,14(4):1297-1306.
64.林伟豪,刘付有兰,韩德忠.门诊抗菌药物处方调查与分析.中国现代药物应用,2008,19:120-122.
65.倪国荣,杨晓敏.我院处方点评分析.北方药学,2011,4:89-90.
66.梁佩红.我院门诊处方评价分析.中国药业,2010,(06):40-41.
67.王建,邓筱华.2010年前3季度处方管理及不合理用药点评.中国医院用药评价与分析,2011,1:86-88.
68.王春燕,舒丽芯,韩冰.利用电子处方信息分析门诊医师处方行为.药学实践杂志,2012,3:235-238.
69. Sun X, Jackson S, Carmichael GA, et al. Prescribing behaviour of village doctors underChina's New Cooperative Medical Scheme. Soc Sci Med,2009,68(10):1775-1779.
70.孙晓筠, Adrian·Sleigh,李士雪,等.新型农村合作医疗对乡村医生处方行为的影响研究.中国卫生经济,2006,4:42-44.
71.夏国俊.抗菌药物临床应用指导原则北京:中国中医药出版社;2004.
72.张丽明,陈琦,王丽俊,等.地塞米松治疗婴幼儿急性上呼吸道感染发热的利弊分析.中国实用儿科杂志,2002,4:218.
73.王明春.不同级别医院儿童上呼吸道感染用药调查.河北医学,2011,5:702-703.
74.江丽欢.门诊处方糖皮质激素类药物应用情况分析.中国医院用药评价与分析,2010,9:777-779.
75.粟珊,张永丽,唐文.我院糖皮质激素类药物门诊处方分析.中国药业,2012,22:67-69.
76.吴迪.小儿腹泻临床用药的发展.实用医技杂志,2006,18:3209-3210.
77.郝晓飞.小儿腹泻的合理用药.临床合理用药杂志,2012,27:37-38.
78.赖艳,温悦,孟德胜.某三甲医院门诊患者抗高血压用药处方分析.中国药师,2011,9:1343-1345.
79.黄秋红,聂然.抗高血压药门诊处方分析.首都医药,2010,10:20-22.
80.董芳.抗高血压药物门诊处方用药分析.临床医药实践,2011,12:918-921.
81.黄骞.门诊抗高血压用药分析.当代医学,2012,34:128.
82.刘爱云,孙聊东,孟庆河,等.胰岛素泵联合动态血糖监测治疗初诊重症2型糖尿病有效性和安全性.中国糖尿病杂志,2007,10:611-612.
83.刘敏,刘靓,黄昭穗,等.胰岛素泵治疗在糖尿病烧伤患者围手术期的应用研究.中国糖尿病杂志,2009,4:267-268+277.
84.杨文芬.2006～2007年我院治疗糖尿病药物用药分析.黑龙江医药,2009,1:86-87.
85.李艳翠,雷力力.我院2004～2008年糖尿病用药情况及经济学分析.黑龙江医药科学,2010,6:73-74.
86.潘美云,林西西.我院2008年门诊糖尿病患者的用药统计分析.海峡药学,2010,5:206-208.
1. WHO. The rational use of drugs. Report of the Conference of Experts. Geneva: WorldHealth Organization;1985.
2.姚岚,秦立轩,金建强,等.合理用药的国际研究进展.中国初级卫生保健,2002,3:8-10.
3.张新平,李少丽.药物政策学.北京:科学出版社;2003.
4. E S. Adherence to long-term therapies. Evidence for action. Geneva: World HealthOrganization;2003.
5. WHO. Using indicators to measure country pharmaceutical situations: Fact book onWHO Level I and Level II monitoring indicators. Geneva: World Health Organization;2006.
6.孟锐..药事管理学(第2版).北京:科学出版社;2009.
7. WHO. Medicines use in primary care in developing and transitional countries: Factbook summarizing results from studies reported between1990and2006. Geneva: WorldHealth Organization;2009.
8. WHO. Promoting rational use of medicines: Core components. WHO PolicyPerspectives on Medicines, No.5. Geneva: World Health Organization;2002.
9. Pirmohamed M. Adverse drug reactions as cause of admission to hospital: Prospectiveanalysis of18,820patients. BMJ,2004,329:15-19.
10. Hitchen L. Adverse drug reactions result in250,000UK admissions a year. BMJ,2006,332(7550):1109.
11. Levy SB. Antibiotic resistance-the problem intensifies. Adv Drug Deliv Rev,2005,57(10):1446-1450.
12. Harbarth S, Samore MH. Antimicrobial resistance determinants and future control.Emerg Infect Dis,2005,11(6):794-801.
13. Livermore D. Bacterial resistance: Origins, epidemiology, and impact. ClinicalInfectious Diseases,2003,36:S11-S23.
14. White TJ, Arakelian A, Rho JP. Counting the costs of drug-related adverse events.Pharmacoeconomics,1999,15(5):445-458.
15. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions inhospitalized patients: a meta-analysis of prospective studies. JAMA,1998,279(15):1200-1205.
16. Medicine Io. Microbial threats to health: emergence, detection and response.Washington, D.C.: National Academies Press;1998.
17. Pechere JC, Hughes D, Kardas P, et al. Non-compliance with antibiotic therapy foracute community infections: a global survey. Int J Antimicrob Agents,2007,29(3):245-253.
18. W K, R L. Priority medicines for Europe and the world. Geneva: World HealthOrganization;2004.
19. Lansang MA, Lucas-Aquino R, Tupasi TE, et al. Purchase of antibiotics withoutprescription in Manila, the Philippines. Inappropriate choices and doses. J Clin Epidemiol,1990,43(1):61-67.
20. Medicine Io. Reducing and preventing adverse drug events to decrease hospital costs.Washington, D.C.: Agency for Healthcare Research and Quality;2001.
21. Resistance: a sensitive issue. The European roadmap to combat antimicrobialresistance. Utrecht: The Strategic Council on Resistance in Europe;2004.
22. S VdG, A H. Self-medication in developing countries. Journal of Social andAdministrative Pharmacy,1990,7(4):199-204.
23. L. G. Self-medication with antibiotics in Europe and its determinants. Dissertation:Groningen University;2007.
24. Simonsen L, Kane A, Lloyd J, et al. Unsafe injections in the developing world andtransmission of bloodborne pathogens: a review. Bull World Health Organ,1999,77(10):789-800.
25. WHO. The Word Medicine Situation2011. Geneva: World Health Organization;2011.
26.张文双,杨永弘. ATC/DDD系统的建立及其在药物利用研究中的应用.临床药物治疗杂志,2009,1:32-37.
27. Elseviers MM, Ferech M, Vander Stichele RH, et al. Antibiotic use in ambulatory carein Europe (ESAC data1997-2002): trends, regional differences and seasonal fluctuations.Pharmacoepidemiol Drug Saf,2007,16(1):115-123.
28. Bergman U. The history of the Drug Utilization Research Group in Europe.Pharmacoepidemiol Drug Saf,2006,15(2):95-98.
29. Behan K, Cutts C, Tett SE. Uptake of new drugs in rural and urban areas of Queensland,Australia: the example of COX-2inhibitors. Eur J Clin Pharmacol,2005,61(1):55-58.
30. WHO. How to investigate drug use in health facilities: Selected drug use indicators.Geneva: World Health Organization;1993.
31.张新平,金新政,王铁军,等. WHO促进合理用药的核心政策及干预措施.中国卫生质量管理,2003,6:40-42.
32.曾繁典.国家药物政策与临床合理用药.国际医药卫生导报,2003,11:93-96.
33.刘建美,周筱青,朱士俊,等.合理用药调研指标的应用和研究现状.中华医院管理,2010,26(11):848-851.
34.李青,曾繁典.制定我国国家药物政策的紧迫性及其建议.药物流行病学杂志,2003,6:281-285.
35. WHO. The Word Medicine Situation2004. Geneva: World Health Organization;2004.
36. Goossens H. European Surveillance of Antimicrobial Consumption Project Group.Comparison of outpatient systemic antibacterial use in2004in the United States and27European countries. Clinical Infectious Diseases,2007,44:1091-1095.
37. Grigoryan L, Haaijer-Ruskamp FM, Burgerhof JG, et al. Self-medication withantimicrobial drugs in Europe. Emerg Infect Dis,2006,12(3):452-459.
38. Goossens H. Antibiotic consumption and link to resistance. Clin Microbiol Infect,2009,15Suppl3:12-15.
39. van Roosmalen MS, Braspenning JC, De Smet PA, et al. Antibiotic prescribing inprimary care: first choice and restrictive prescribing are two different traits. Qual SafHealth Care,2007,16(2):105-109.
40. Li Y, Xu J, Wang F, et al. Overprescribing in China, driven by financial incentives,results in very high use of antibiotics, injections, and corticosteroids. Health Aff (Millwood),2012,31(5):1075-1082.
41. Dong L, Yan H, Wang D. Drug prescribing indicators in village health clinics across10provinces of Western China. Fam Pract,2011,28(1):63-67.
42.杨敬博,何国珍,杨仁和,等.不同级别医疗单位上呼吸道感染临床用药调查.药物流行病学杂志,2002,3:132-134.
43.王明春.不同级别医院儿童上呼吸道感染用药调查.河北医学,2011,3:702-703.
44.李志毅.常见小儿上呼吸道感染不合理用药分析.中国误诊学杂志,2006,11:2231-2232.
45.何建荣.儿科上呼吸道感染处方用药分析.基层医学论坛,2013,4:520-521.
46.金世红,周仲华.海口社区卫生服务机构急性上呼吸道感染患者用药情况分析.中国全科医学,2009,22:2048-2050.
47.王建国,崔明辰,王凤枝.乡村医生治疗小儿上呼吸道感染用药情况的调查.中国实用乡村医生杂志,2007,4:59-60.
48. Esposito S, Blasi F, Bosis S, et al. Aetiology of acute pharyngitis: the role of atypicalbacteria. J Med Microbiol,2004,53:645-651. Epub2004/06/09.
49. Allander T, Tammi MT, Eriksson M, et al. Cloning of a human parvovirus by molecularscreening of respiratory tract samples. Proc Natl Acad Sci USA,2005,102(36):12891-12896.
50. Allander T, Emerson SU, Engle RE, et al. A virus discovery method incorporatingDNase treatment and its application to the identification of two bovine parvovirus species.Proc Natl Acad Sci U S A,2001,98(20):11609-11614..
51.王菊莉,顾镜月,王显鹤.小儿腹泻的合理用药问题.中国社区医师,2006,10:15.
52.姜凤桂,李莉.小儿腹泻的用药原则.青岛医药卫生,2001,4:298-299.
53.易洁梅.急性上呼吸道感染患者的用药调查分析.实用药物与临床,2008,2:93-94.
54.郭廷建.急性上呼吸道感染门诊处方构成及费用分析.卫生经济研究,2012,3:54-56.
55.刘金英,阙伟东.急性上呼吸道感染的用药误区.中国医药指南,2011,2:160-161.
56.邹洁.急性上呼吸道感染患者用药情况调查分析.中国医药导报,2011,13:137-138.
57.张国龙.急性上呼吸道感染在社区卫生服务机构中的用药情况分析.中国医药导刊,2009,12:2069-2070.
58.吕志强,郭晓东,仲华,等.急诊治疗上呼吸道感染用药分析.中华医院感染学杂志,2009,18:2478.
59.柯金珍.我院小儿腹泻治疗用药的调查分析.海峡药学,2008,(04):112-113.
60.黄义樵,周颖.262例小儿腹泻的用药分析.北方药学,2011,12:77.
61. Dong L, Yan H, Wang D. Antibiotic prescribing patterns in village health clinics across10provinces of Western China. J Antimicrob Chemother,2008,62(2):410-415.
62.赫强,郑小华,刘毅.四川贫困地区村卫生站处方行为分析.中国卫生事业管理,2006,6:361-362.
63.王爱荣,冯学山,龚幼龙,等.《中国农村卫生服务筹资和农村医生报酬机制研究》系列报告之十一乡村医生处方行为分析.中国初级卫生保健,2000,11:18-20.
64. Francke AL, Smit MC, de Veer AJ, et al. Factors influencing the implementation ofclinical guidelines for health care professionals: a systematic meta-review. BMC MedInform Decis Mak,2008,8:38.
65. Grimshaw J. Effectiveness and efficiency of guideline dissemination andimplementation strategies. Health Technology Assessment,2004,8(6):1-72.
66. Grol R, Grimshaw J. From best evidence to best practice: effective implementation ofchange in patients' care. Lancet,2003,362(9391):1225-1230.
67. Lu CY, Ross-Degnan D, Soumerai SB, et al. Interventions designed to improve thequality and efficiency of medication use in managed care: a critical review of the literature-2001-2007. BMC Health Serv Res,2008,8:75.
68. Jamtvedt G, Young JM, Kristoffersen DT, et al. Audit and feedback: effects onprofessional practice and health care outcomes. Cochrane Database Syst Rev,2006,(2):CD000259.
69. Wensing M, van der Weijden T, Grol R. Implementing guidelines and innovations ingeneral practice: which interventions are effective? Br J Gen Pract,1998,48(427):991-997.
70. Wills CE. Review: evidence on the effectiveness of interventions to improve patientadherence to prescribed medications is limited. Evid Based Nurs,2008,11(4):109.
71. Bosch-Capblanch X, Abba K, Prictor M, et al. Contracts between patients andhealthcare practitioners for improving patients' adherence to treatment, prevention andhealth promotion activities. Cochrane Database Syst Rev,2007,(2):CD004808.
72. Vermeire E, Wens J, Van Royen P, et al. Interventions for improving adherence totreatment recommendations in people with type2diabetes mellitus. Cochrane DatabaseSyst Rev,2005,(2):CD003638.
73. van Dulmen S, Sluijs E, van Dijk L, et al. Patient adherence to medical treatment: areview of reviews. BMC Health Serv Res,2007,7:55.
74. van Dulmen S, Sluijs E, van Dijk L, et al. Furthering patient adherence: a positionpaper of the international expert forum on patient adherence based on an internet forumdiscussion. BMC Health Serv Res,2008,8:47.
75. Huttner B. CHAMP Consortium. Characteristics and outcomes of public campaignswith the aim to improve outpatient antibiotic use in high income countries. LancetInfectious Diseases,2010,10(1):17-31.
76. Sabuncu E, David J, Bernede-Bauduin C, et al. Significant reduction of antibiotic usein the community after a nationwide campaign in France,2002-2007. PLoS Med,2009,6(6):e1000084.
77. WHO. Country pharmaceutical situations. Fact book on WHO Level1indicators2007.Geneva: World Health Organization;2009.
78. WHO. Global strategy for containment of antimicrobial resistance. Geneva: WorldHealth Organization;2001.
79. Park S, Soumerai SB, Adams AS, et al. Antibiotic use following a Korean nationalpolicy to prohibit medication dispensing by physicians. Health Policy Plan,2005,20(5):302-309.
80. Bavestrello L, Cabello A, Casanova D. Impact of regulatory measures in the trends ofcommunity consumption of antibiotics in Chile. Rev Med Chil,2002,130(11):1265-1272.
81. Austvoll-Dahlgren A, Aaserud M, Vist G, et al. Pharmaceutical policies: effects of capand co-payment on rational drug use. Cochrane Database Syst Rev,2008,(1):CD007017.
82. National medicines policy2000. Canberra: Commonwealth Department of Health andAged Care;2000.