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目的:分析国家基本药物制度作用下的村卫生室处方费用变化情况及影响因素,为完善村卫生室基本药物制度提供政策建议。方法:对湖北省公安县两个乡镇12个村卫生室国家基本药物制度实施前3 813张(2011年)和实施后2 217张(2012年)处方进行分析。结果:基本药物实施前后村卫生室平均处方费用分别为29.89元和21.69元,平均降低了8.20元,降低了27.43%(P<0.05)。在制度实施前,村民实付费用的处方有86.94%在集中在30元以下,实施后,村民实付费用在20元以下处方占到90.40%。对数线性回归分析表明,有12变量(处方用药数、静脉注射和使用抗菌素等)影响村卫生室处方费用,决定系数R2=0.772。结论:国家基本药物制度对村卫生室处方费用增长起到抑制作用,今后要加强村卫生室合理用药,以控制处方费用的增长。
OBJECTIVE: To analyze the changes of prescription costs and influencing factors of village clinics under the influence of the national essential medicines system, and to provide policy recommendations for improving the basic medicines system in village clinics. Methods: 3 813 pre-implementation (2011) and 2 217 pre-implementation (2012) prescriptions of 12 national clinics in 12 village clinics in two towns and villages in Gong’an County, Hubei Province were analyzed. Results: The average prescription cost of village clinics before and after the implementation of essential drugs were 29.89 yuan and 21.69 yuan, respectively, with an average reduction of 8.20 yuan and a decrease of 27.43% (P <0.05). Before the implementation of the system, 86.94% of the villagers actually paid the prescriptions concentrated below 30 yuan. After the implementation, the villagers actually paid 90% of the prescriptions with the cost below 20 yuan. Log-linear regression analysis showed that there are 12 variables (prescription drug use, intravenous injection and use of antibiotics, etc.) affect the village clinic prescription costs, the coefficient of determination R2 = 0.772. Conclusion: The national essential drug system has an inhibitory effect on the increase of prescription costs in village clinics. In the future, it is necessary to strengthen the rational use of drugs in village clinics to control the growth of prescription costs.