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目的通过预调查了解成都市部分基层医疗卫生服务机构(三圈七院六站)主要疾病排名和合理应用抗感染药物情况,为进一步全面调查和循证遴选成都市基层基本药物目录和促进抗感染药物合理用药提供证据。方法随机抽样调查成都市7个乡院/中心和卫生站的门诊和住院病人常见疾病,通过问卷调查了解基层医院常见疾病(前三位)的用药情况,同时统计成都市5个乡镇卫生院2006年度门诊及住院病人抗感染用药情况,包括种类、品种数、金额和使用频度。结果本次预调查的城乡基层医疗卫生服务机构的就诊疾病构成存在差异,社区卫生服务中心/站前三位疾病为糖尿病、高血压、慢性阻塞性肺炎和呼吸道感染;乡镇卫生院/站前三位疾病主要为呼吸系统、消化系统和泌尿系统感染疾病。基层医院常见疾病(前三位)用药习惯调查显示,对感染性疾病主要以抗感染药物辅以对症药物治疗。常见疾病(前三位)用药习惯品种与相关疾病指南推荐的治疗药物比较,结果提示医生按习惯处方开药情况明显。抗感染药物使用情况分析显示,农村乡院用药品种40～58种,抗感染用药金额占药品金额的30%～50%。金额排前4位的抗感染药物主要为头孢类、青霉素类、喹诺酮类和大环内酯类。日均费用最高的药品是头孢类抗感染药物。结论城乡主要疾病负担存在差异,建议结合疾病负担制定适合基层诊疗情况的疾病标准诊疗指南,明确用药指征,规范基层医生用药。完善药品遴选机制,针对主要疾病负担遴选基层医疗机构常用药品。通过比较多种药品的日均费用和一个疗程的费用遴选同类药品中成本效果较好的品种,控制药品费用。加强对抗感染药物使用的培训和扩大耐药菌监测网络,提高治疗效果。
Objective To investigate the rank order of major diseases and rational use of anti-infectives in some primary health care institutions in Chengdu (three circles and seven hospitals and six stations) through pre-investigation. In order to further comprehensively investigate and evidence-based the selection of primary basic medicines in Chengdu and promote anti-infectives Proper drug use to provide evidence. Methods A total of 7 outpatients and inpatients with common disease at inpatient and inpatient stations in 7 township hospitals / clinics and clinics in Chengdu were randomly sampled. The prevalence of common diseases in the grass-roots hospitals (top 3) was estimated by questionnaire survey. At the same time, statistics were made on 5 township hospitals in Chengdu Annual outpatient and inpatient anti-infection medication, including the type, variety, amount and frequency of use. Results The pre-investigation of urban and rural primary health care services for treatment of the composition of the disease there are differences, community health service center / top three diseases for diabetes, hypertension, chronic obstructive pneumonia and respiratory tract infections; township hospitals / Bit diseases are mainly respiratory, digestive and urinary tract infections. Primary hospital common diseases (top three) drug habits survey shows that the main infectious diseases with anti-infective drugs supplemented by symptomatic drug treatment. Common diseases (top three) medication habits varieties and related diseases guidelines recommend the comparison of therapies, the results suggest that doctors prescribe prescribed habits clear. Analysis of the use of anti-infective drugs shows that 40 to 58 kinds of drugs are used in rural homesteads, and the amount of anti-infective drugs accounts for 30% -50% of the amount of medicines. The top four anti-infectives in the top four were cephalosporins, penicillins, quinolones and macrolides. The highest average daily cost of drugs is cephalosporin anti-infectives. Conclusions There are differences in the major disease burden between urban and rural areas. It is suggested to formulate a standard diagnosis and treatment guideline for diseases according to the burden of disease, clarify the indication of medication, and standardize the use of primary doctors. Improve the drug selection mechanism, the selection of primary care institutions for the main disease burden of commonly used drugs. By comparing the daily average cost of a variety of drugs and a course of the cost of selection of similar drugs in the cost-effective varieties, control of drug costs. Strengthen the training on the use of anti-infective drugs and expand the surveillance network for drug-resistant bacteria so as to improve the treatment effect.