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

【摘要】：目的:基于系統(tǒng)思想和供求理論,從國家基本藥物供應鏈流程出發(fā),詳細分析影響基本藥物短缺的風險因素,篩選基本藥物短缺風險指標,并確定指標權重,最終建立起基本藥物短缺風險評價指標體系,為定量評估基本藥物短缺風險大小提供支撐,為建立基本藥物短缺風險預警體系奠定基礎。方法:(1)基本藥物短缺風險因素界定及指標初篩方法,主要采用文獻研究和專家訪談法,通過前期文獻研究,對國內外研究基本藥物短缺成因的文獻進行梳理,同時訪談基本藥物生產(chǎn)企業(yè)、經(jīng)營配送企業(yè)、醫(yī)療機構、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、全面的分析影響基本藥物短缺的供應鏈各環(huán)節(jié)風險因素,在此基礎上,對相關法規(guī)文獻進行二次梳理,找出影響基本藥物短缺的具體指標,并對其合理歸類。(2)指標評價方法,主要采用德爾菲法,按照參與意愿高、經(jīng)驗豐富、短缺各風險領域全覆蓋的原則,選取藥品生產(chǎn)企業(yè)、藥品經(jīng)營配送企業(yè)、醫(yī)療機構、衛(wèi)生行政部門具有中高級職稱的管理人員共13人作為咨詢專家。通過電子郵件發(fā)放問卷的形式,實施兩輪咨詢,以建立起基本藥物短缺風險評價指標體系。(3)權重確定方法,主要采用層次分析法,通過構造層次分析矩陣,根據(jù)專家打分情況,計算出各評價指標的具體權重。結果:(1)基本藥物短缺風險因素涉及到基本藥物的生產(chǎn)、經(jīng)營配送、臨床配備使用、政府管理、患者消費等供應鏈的各個環(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險的關鍵因素。(2)經(jīng)過兩輪咨詢后,構建的基本藥物短缺風險評價指標體系包括生產(chǎn)、經(jīng)營配送、使用、政府4個一級指標,13個二級指標,45個三級指標。同時經(jīng)過層次分析處理,結果顯示權重較大的一級指標包括使用(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。結論:為了提高基本藥物短缺干預效力,保障基本藥物供應市場的穩(wěn)定運行,應逐步建立基本藥物短缺風險預警機制,優(yōu)化基本藥物全供應鏈監(jiān)管,鼓勵利益相關方共同參與形成監(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.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R95

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