摘要
研究背景：
当前,“看病贵,看病难”已经成为全国普遍存在的突出问题。解决这个问题需要标本兼治、综合治理,除了国家应加大卫生投入和扩大医疗保险覆盖面外,还要采取有效措施解决药品问题。国家基本药物制度作为我国“医改”四大组成部分之一,对于控制药品费用、提高卫生服务质量至关重要。政府通过必要的调控和干预,大幅度减轻群众药物费用负担,提高公众的药品可获得性。因此,基本药物的的推广、完善意义深远、责任重大。目前来讲,基本药物的宣传、普及力度不够,公众认知度低。基本药物的可及性较低,而这一情况在农村地区更为突出。农村基层医生能否优先处方基本药物,以及提高对基本药物的认可程度可能是提高农村地区基本药物可及性的一条途径。
研究目的：
本研究以山东省乡医生和村医生为研究对象,使用自制调查表,了解山东省乡医生和村医生对于国家基本药物的认知情况,分析乡医生和村医生对基本药物的疗效认可差异的影响因素,并研究本省乡医生和村医生对于国家基本药物的使用情况,了解乡医生和村医生对基本药物政策的意见和建议。为卫生管理部门推广基本药物制度、规范用药行为提供政策依据。
研究方法：
本研究采用多层整群随机抽样方法,调查对象为山东省蓬莱市、文登市、平度市、青州市、沂源县、阳谷县、鱼台县、沂水县、曹县等九县区的乡医生和村医生,共发放调查问卷520份,收回有效问卷467份,有效回收率为90.7%。调查工具为自行设计的调查问卷,在课题组统一培训的调查员的指导下,由乡医生和村医生自行填写完成。采用Epidata软件建立数据库,运用SPSS16.0软件进行统计分析。资料分析方法主要有：(1)符合正态分布或近似正态分布的数值型资料采用均数、标准差,分类资料采用率和构成比进行一般情况的描述；
(2)利用X2检验对村医生和乡镇卫生院医生的基本情况,以及他们对基本药物认知情况、使用情况进行分析；(3)利用有序Logistic回归进行乡医生及村医生对基本药物的疗效认可差异的影响因素进行单因素及多因素分析。
主要结果：
(1)基本药物概念在山东省乡医生和村医生范围内知晓率为92.0%,但分析发现大部分乡医生和村医生对于国家基本药物还需进一步的了解。(2)乡医生和村医生基本药物知晓主要来源是电视／广播、业务培训、报纸／专业杂志。(3)乡医生和村医生中认为国家基本药物疗效很好、较好、一般较差者的比例分别为55.5%、29.8%、14.3%、0.4%。多因素分析结果显示,影响乡镇卫生院医生对基本药物的疗效认可程度的因素主要有性别、婚姻状况、所学专业、从事本专业年限、学历、专业技术职务、收入、执业资格；影响村卫生室医生对基本药物的疗效认可程度的因素主要有性别、婚姻状况、从事本专业年限、学历、收入。(4)96.1%的乡医生和村医生愿意并实际在处方中选择基本药物,报销比例大、上级要求、病人要求三者是医生愿意使用基本药物的主要原因。(5)91.9%的乡医生和村医生希望进行基本药物方面的培训。(6)81.6%的乡医生和村医生经常向病人推荐使用基本药物,当医生向病人推荐基本药物时,65%的病人乐意接受。(7)44.5%的乡医生和村医生对制药厂家有所偏好,52.2%的乡医生和村医生对药品品牌有所偏好者。(8)乡医生和村医生针对高血压、Ⅱ型糖尿病、腹泻3种常见病(没有并发症或较轻)的处方药品中基本药物比例约为70-80%。
结论与建议：
(1)加强对乡医生和村医生的国家基本药物制度的培训,培养基层医师科学合理的用药习惯；(2)加强基本药物的宣传,提高群众对基本药物的认知度和信赖度；(3)规范乡医生和村医生处方行为,完善乡医生和村医生推荐处方,促使农村医务人员规范、合理、安全、经济地使用药物；(4)建立财政补贴制度,采取建立财政补贴硬性制度为主,同时适当提高医疗服务价格和药事费；(5)建议由国家部委牵头建立医疗机构药品招标采购的全国标准。
Background:
Presently, "To take medical treatment expensively and difficultly" already become a prominent national universal question. The country should not only expand the hygienic investment and outside the expansion medical insurance coverage, but also adopt the effective action to solve the drugs question.The national essential drugs system are very important in regarding the control drugs expense, improving the health grade of service.The government take measures to lightens the populace medicine expense burden, enhances the public the drugs profitability through the essential regulation and the intervention. Presently, the propaganda and the popular dynamics on essential drugs are insufficient, the public cognition of essential drugs is relatively low. Essential drugs's availability is optimistic, this situation is more prominent in the countryside area. Doctor can does the prescription with essential drugs first, as well as enhance it possibly to increase a countryside area essential drugs availability is an effective way.
Objectives:
The study aims to understand the national essential drugs cognition situation, service condition and the suggestion on this policy of rural doctor in Shandong Province and analyse its influencing factors, provide recommendation for the drug control department and the health department to consummate the essential drugs system, to improve the standard clinical medication behaviour.
Methods:
The study interviewers were health professionals in Wendeng, Pingdu, Qingzhou, Yiyuan, Yanggu, Yutai, Yishui, Penglai, Caoxian, in Shandong province.520 questionnaire were distributed and 467 copies were collected, the effective rate is 90.7%. Data analysis methods are:(1)Mean and standard deviation were used to describe the general situation in the numeric data or nearly numeric data. (2)X-test was used in the analysis of basic situation, as well as its essential drugs cognition situation and the service condition.. (3)Logistic Regression was used to explore the influencing factors in the multivariate analysis.
Main Results:
(1)The knowing rate of the concept of essential drugs among rural doctor in Shandong Province is 92.0%, but the relative analyses discovers majority of rural doctor also needs further understanding to essential drugs. (2)The main source for rural doctor to know essential drugs is television/broadcast, vocational training, newspaper/specialized magazine. (3)Rural doctor consider that curative effect proportion of the national essential drugs as very good, good, generally bad is 55.5%, 29.8%,14.3%,0.4%. Multivariate analysis result demonstrates that sex, marital status, study specialized, specialized age limit, school record, specialized technology post, income, practice qualification were main influencing factors of curative effect approval degree among Villages and towns Public health center doctor. Sex, marital status, specialized age limit, school record, income were main influencing factors of curative effect approval degree among village clinic doctor. (4)96.1% rural doctors want and actual choose the basic drug in prescription, high proportion of reimbursement, high authority requests and patient requests are the primary cause for doctor to use the essential drugs. (5)91.9% rural doctors hoped that carries on the training of essential drugs. (6)81.6% rural doctors recommend the essential drugs frequently to the patient,65% patients are glad to accept when doctor recommends. (7)44.5% rural doctors have the institute to the drugs manufacture factory by chance, 52.2% rural doctors have the institute to the drugs brand by chance. (8)In view of hypertension,Ⅱdiabetes, diarrhea 3 kind of common diseases (does not have complication or light) in the prescription drugs which rural doctor gives, the essential drugs accounts Approximately is 70%-80%.
Conclusions and suggestions:
(1)Strengthen the training to rural doctor's about national essential drugs, trains the science reasonable medication custom of rural doctors.(2)Strengthens the essential drugs the propaganda, enhances the populace to the essential drugs cognition and the faith.(3)Standard the prescription behaviour of rural doctor, perfect the recommends prescription of rural doctor, urges the rural doctor to use the medicine economically,, reasonably and safely. (4)Establish fiscal subsidy system and raises the medical service price and the medicine matter expense suitably. (5)Establishment Medical establishment drugs procurement national standard.
引文
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