本文選題：國(guó)家基本藥物 + 短缺�。� 參考：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:基于系統(tǒng)思想和供求理論,從國(guó)家基本藥物供應(yīng)鏈流程出發(fā),詳細(xì)分析影響基本藥物短缺的風(fēng)險(xiǎn)因素,篩選基本藥物短缺風(fēng)險(xiǎn)指標(biāo),并確定指標(biāo)權(quán)重,最終建立起基本藥物短缺風(fēng)險(xiǎn)評(píng)價(jià)指標(biāo)體系,為定量評(píng)估基本藥物短缺風(fēng)險(xiǎn)大小提供支撐,為建立基本藥物短缺風(fēng)險(xiǎn)預(yù)警體系奠定基礎(chǔ)。方法:(1)基本藥物短缺風(fēng)險(xiǎn)因素界定及指標(biāo)初篩方法,主要采用文獻(xiàn)研究和專家訪談法,通過(guò)前期文獻(xiàn)研究,對(duì)國(guó)內(nèi)外研究基本藥物短缺成因的文獻(xiàn)進(jìn)行梳理,同時(shí)訪談基本藥物生產(chǎn)企業(yè)、經(jīng)營(yíng)配送企業(yè)、醫(yī)療機(jī)構(gòu)、衛(wèi)生行政部門中高層管理人員共8人,聽取一線工作人員的具體意見后,科學(xué)、全面的分析影響基本藥物短缺的供應(yīng)鏈各環(huán)節(jié)風(fēng)險(xiǎn)因素,在此基礎(chǔ)上,對(duì)相關(guān)法規(guī)文獻(xiàn)進(jìn)行二次梳理,找出影響基本藥物短缺的具體指標(biāo),并對(duì)其合理歸類。(2)指標(biāo)評(píng)價(jià)方法,主要采用德爾菲法,按照參與意愿高、經(jīng)驗(yàn)豐富、短缺各風(fēng)險(xiǎn)領(lǐng)域全覆蓋的原則,選取藥品生產(chǎn)企業(yè)、藥品經(jīng)營(yíng)配送企業(yè)、醫(yī)療機(jī)構(gòu)、衛(wèi)生行政部門具有中高級(jí)職稱的管理人員共13人作為咨詢專家。通過(guò)電子郵件發(fā)放問(wèn)卷的形式,實(shí)施兩輪咨詢,以建立起基本藥物短缺風(fēng)險(xiǎn)評(píng)價(jià)指標(biāo)體系。(3)權(quán)重確定方法,主要采用層次分析法,通過(guò)構(gòu)造層次分析矩陣,根據(jù)專家打分情況,計(jì)算出各評(píng)價(jià)指標(biāo)的具體權(quán)重。結(jié)果:(1)基本藥物短缺風(fēng)險(xiǎn)因素涉及到基本藥物的生產(chǎn)、經(jīng)營(yíng)配送、臨床配備使用、政府管理、患者消費(fèi)等供應(yīng)鏈的各個(gè)環(huán)節(jié),其中生產(chǎn)、臨床配備使用及政府管理是影響基本藥物短缺風(fēng)險(xiǎn)的關(guān)鍵因素。(2)經(jīng)過(guò)兩輪咨詢后,構(gòu)建的基本藥物短缺風(fēng)險(xiǎn)評(píng)價(jià)指標(biāo)體系包括生產(chǎn)、經(jīng)營(yíng)配送、使用、政府4個(gè)一級(jí)指標(biāo),13個(gè)二級(jí)指標(biāo),45個(gè)三級(jí)指標(biāo)。同時(shí)經(jīng)過(guò)層次分析處理,結(jié)果顯示權(quán)重較大的一級(jí)指標(biāo)包括使用(W使用=0.3423)、政府(W政府=0.3028)、生產(chǎn)(W生產(chǎn)=0.261),是影響基本藥物短缺的主要因素。結(jié)論:為了提高基本藥物短缺干預(yù)效力,保障基本藥物供應(yīng)市場(chǎng)的穩(wěn)定運(yùn)行,應(yīng)逐步建立基本藥物短缺風(fēng)險(xiǎn)預(yù)警機(jī)制,優(yōu)化基本藥物全供應(yīng)鏈監(jiān)管,鼓勵(lì)利益相關(guān)方共同參與形成監(jiān)管合力。
[Abstract]:Objective: based on the theory of system and supply and demand, the risk factors affecting the shortage of essential drugs were analyzed in detail, and the risk index of the shortage of essential drugs was selected and the weight of the indexes was determined. Finally, the evaluation index system of essential drug shortage risk is established, which provides the support for the quantitative evaluation of the risk of essential drug shortage, and lays the foundation for the establishment of the risk warning system of essential drug shortage. Methods: (1) the methods of defining the risk factors of essential drug shortage and screening the index, mainly by literature research and expert interview, through the previous literature study, to comb the domestic and foreign literature on the causes of the shortage of essential drugs. At the same time, they interviewed eight senior management personnel in basic drug production enterprises, distribution enterprises, medical institutions, and health administration departments, and listened to the specific opinions of front-line staff. On the basis of comprehensive analysis of the risk factors in supply chain which affect the shortage of essential drugs, this paper makes a second combing of the relevant laws and regulations, finds out the specific indicators that affect the shortage of essential drugs, and classifies them reasonably. (2) the evaluation methods of indicators. Mainly using Delphi method, according to the principle of high willingness to participate, rich experience and full coverage of various risk areas of shortage, drug production enterprises, drug trading and distribution enterprises, and medical institutions are selected. The health administration department has the middle and senior title management staff altogether 13 people as the consultation expert. In order to establish the evaluation index system of the shortage risk of essential drugs, two rounds of consultation are carried out through the form of email questionnaire. (3) the method of determining the weight is mainly used in AHP, through constructing the AHP matrix, according to the situation of experts' scoring, Calculate the specific weight of each evaluation index. Results: (1) the risk factors of the shortage of essential drugs are related to the production, management and distribution of essential drugs, clinical equipment use, government management, patient consumption and so on. Clinical use and government management are the key factors affecting the risk of essential drug shortage. (2) after two rounds of consultation, the evaluation index system of essential drug shortage risk includes production, management, distribution and use. The government has 4 first-level indicators, 13 second-level indicators and 45 third-level indicators. At the same time, the results showed that the main factors affecting the shortage of essential drugs were the use of 0.3423, the government (0.3028) and the production (0.261). Conclusion: in order to improve the effectiveness of the essential drug shortage intervention and ensure the stable operation of the essential drug supply market, we should gradually establish the risk warning mechanism of the essential drug shortage and optimize the supervision of the whole supply chain of essential drugs. Stakeholders are encouraged to participate in the formation of regulatory synergies.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R95

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