本文選題：國家基本藥物制度 + 社區(qū)衛(wèi)生服務(wù)　； 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：一、研究背景和目的為了緩解“看病難、看病貴”現(xiàn)象,減少居民就醫(yī)費(fèi)用負(fù)擔(dān),我國于2009年起開展了新一輪的覆蓋城鄉(xiāng)居民的醫(yī)療衛(wèi)生制度改革,即“新醫(yī)改”。其中,建立國家基本藥物制度,健全基層醫(yī)療衛(wèi)生服務(wù)體系是一項(xiàng)重點(diǎn)工作。國內(nèi)相關(guān)研究數(shù)據(jù)顯示,隨著國家基本藥物制度的逐步實(shí)施,基層醫(yī)療衛(wèi)生機(jī)構(gòu)不合理用藥情況得到改善,“大處方”行為逐漸得到遏制,醫(yī)療費(fèi)用得到有效控制[1-3]。然而,國家基本藥物制度在實(shí)踐過程中仍然存在不少問題,如何讓國家基本藥物制度在基層醫(yī)療衛(wèi)生機(jī)構(gòu)更好地推行,建立一個(gè)更趨成熟、完善的國家基本藥物制度體系是目前“新醫(yī)改”研究探索的重點(diǎn)。本研究通過調(diào)查順德區(qū)某社區(qū)衛(wèi)生服務(wù)中心2012-2015年基本藥物使用概況和門診處方各項(xiàng)指標(biāo),研究處方合理用藥情況及費(fèi)用變化規(guī)律,分析政策對基本藥物使用的影響,為促進(jìn)基層醫(yī)療合理用藥及控制醫(yī)療費(fèi)用提供依據(jù),為地區(qū)社區(qū)衛(wèi)生服務(wù)中心的發(fā)展規(guī)劃提供政策建議。二、研究方法主要采取系統(tǒng)抽樣法,隨機(jī)抽取順德區(qū)某社區(qū)衛(wèi)生服務(wù)中心“新醫(yī)改”前后(2012-2015年)機(jī)構(gòu)門診處方1728張作為樣本,通過Excel 2003建立數(shù)據(jù)庫和制作圖表,采用SPSS 16.0軟件統(tǒng)計(jì)分析。主要分析方法有描述性分析法、單因素方差分析法、χ2檢驗(yàn)及多元線性回歸分析法。三、研究結(jié)果1.“新醫(yī)改”后基本藥物配備率逐步達(dá)到了 100%。2.該中心比較注重遴選和使用中成藥,同時(shí)藥品銷量排名統(tǒng)計(jì)顯示該中心需進(jìn)一步加強(qiáng)合理用藥管控。3.在用藥品種類以心腦血管系統(tǒng)用藥、呼吸系統(tǒng)用藥、消化系統(tǒng)用藥排在前三位。4.處方用藥數(shù)量較實(shí)施國家基本藥物制度前顯著下降,處方抗菌藥物、注射劑使用情況明顯改善,處方費(fèi)用顯著下降,差異有統(tǒng)計(jì)學(xué)意義。5.回歸分析顯示患者就醫(yī)費(fèi)用與處方合理性相關(guān),提高處方合理用藥可一定程度上緩解就醫(yī)費(fèi)用的上升。6.心腦血管系統(tǒng)疾病構(gòu)成比及就診費(fèi)用逐年上升,提示該中心慢性病患者數(shù)量呈上升趨勢,做好預(yù)防保健工作有利于應(yīng)對人口老齡化帶來的問題。四、研究結(jié)論國家基本藥物制度的實(shí)施提高了社區(qū)醫(yī)療機(jī)構(gòu)的處方用藥合理性、減少了患者的醫(yī)療費(fèi)用。同時(shí)也存在單張?zhí)幏剿幬飻?shù)量偏多、政策支持不足、藥品遴選及管理缺陷等問題,要解決這些問題還需要各級醫(yī)療衛(wèi)生機(jī)構(gòu)與政府部門的重視與共同努力。
[Abstract]:First, research background and objective in order to alleviate the phenomenon of "difficult to see a doctor, expensive to see a doctor" and to reduce the burden of residents' medical expenses, China has carried out a new round of reform of medical and health system covering urban and rural residents since 2009, that is, "new medical reform". Among them, establish national essential drug system, perfect primary medical and health service system is a key work. Domestic related research data show that with the implementation of the national essential drug system, the irrational use of drugs in primary medical and health institutions has been improved, the "big prescription" behavior has gradually been contained, and medical expenses have been effectively controlled [1-3]. However, there are still many problems in the practice of the national essential drug system. How to better implement the national essential drug system in primary medical and health institutions and establish a more mature one? Perfect national essential drug system is the focal point of the current "new medical reform" research and exploration. In this study, we investigated the general situation of essential drugs used in a community health service center in Shunde district from 2012 to 2015 and the indexes of outpatient prescriptions, studied the rational use of prescriptions and the law of change in cost, and analyzed the influence of policies on the use of essential drugs. In order to promote the rational use of drugs in primary medical care and to control medical expenses, the policy suggestions are provided for the development planning of regional community health service centers. Second, the research method mainly adopts the systematic sampling method, randomly selects 1728 outpatient prescriptions of a community health service center in Shunde District before and after the "New Medical Reform" 2012-2015) as a sample, and sets up a database and makes charts through Excel 2003. SPSS 16.0 software was used for statistical analysis. The main analytical methods were descriptive analysis, single factor variance analysis, 蠂 2 test and multivariate linear regression analysis. Third, the research results 1. After the new medical reform, the basic drug allocation rate gradually reached 100. 2. The center pays more attention to the selection and use of proprietary Chinese medicines, and the ranking of drug sales shows that the center needs to further strengthen the control of rational drug use. In the use of drugs in the cardiovascular and cerebrovascular system drugs, respiratory system drugs, digestive system drugs in the top three. 4. The number of prescription drugs was significantly lower than that before the implementation of the national essential drug system, the use of prescription antibiotics and injections was significantly improved, and the prescription cost was significantly decreased, the difference being statistically significant. Regression analysis showed that the cost of medical treatment was related to the rationality of the prescription, and the increase of the cost of medical treatment could be alleviated to some extent by increasing the rational use of the prescription. The proportion of cardiovascular and cerebrovascular diseases and the cost of medical treatment are increasing year by year, which indicates that the number of chronic patients in the center is on the rise, and the preventive health care is helpful to deal with the problems caused by the aging of the population. Fourth, the implementation of the national essential drug system improves the rationality of prescribing drugs in community medical institutions and reduces the medical costs of patients. At the same time, there are many problems such as too many prescription drugs, insufficient policy support, drug selection and management defects. To solve these problems, medical and health institutions and government departments at all levels need to pay attention to and work together.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R95

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 周愛華;李立華;;基本藥物制度在基層醫(yī)療機(jī)構(gòu)實(shí)施現(xiàn)狀分析與思考[J];長江大學(xué)學(xué)報(bào)(自科版);2016年24期

2 田燕;廖文;胡明;;基本藥物制度實(shí)施前后四川省基層醫(yī)療衛(wèi)生機(jī)構(gòu)門診合理用藥分析[J];醫(yī)學(xué)與社會;2016年08期

3 孫楊;李雪萍;;西安市社區(qū)衛(wèi)生服務(wù)中心合理用藥現(xiàn)況調(diào)查[J];臨床醫(yī)學(xué)研究與實(shí)踐;2016年11期

4 左曉燕;詹長春;;基層醫(yī)療機(jī)構(gòu)實(shí)施國家基本藥物制度的效果評價(jià)指標(biāo)體系研究[J];中國全科醫(yī)學(xué);2016年19期

5 賈海藝;尹文強(qiáng);曹海虹;唐夢琦;馬牧野;陳鐘鳴;譚暉;;基本藥物制度背景下山東省社區(qū)衛(wèi)生服務(wù)中心門診處方費(fèi)用研究[J];中國全科醫(yī)學(xué);2016年19期

6 王海峰;;基于分級診療體系的基層醫(yī)療服務(wù)改革分析[J];首都食品與醫(yī)藥;2016年10期

7 俞衛(wèi)麗;;社區(qū)慢性病防治的全科醫(yī)療模式和效果分析[J];中國社區(qū)醫(yī)師;2016年13期

8 劉文靜;吳培培;張明珠;陸秋平;蔡森菲;汪勝;;浙江省基本藥物制度對社區(qū)衛(wèi)生服務(wù)機(jī)構(gòu)門診處方費(fèi)用的影響[J];現(xiàn)代醫(yī)藥衛(wèi)生;2016年05期

9 傅陳欣熹;楊姣;周小軍;況杰;李琦;廖新利;;南昌市2縣區(qū)基層衛(wèi)生機(jī)構(gòu)門診處方合理性分析[J];南昌大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2016年01期

10 文捷;杜福貽;李麗清;盧祖洵;;我國衛(wèi)生總費(fèi)用影響因素及實(shí)證研究[J];中國全科醫(yī)學(xué);2016年07期

，

本文編號：2022313