The Study On Antibiotics Rational Use In County And Township Level Health Facilities In Hubei Province

Object:Based on the investigation of the management of medicines and the use of antimicrobial drugs of inpatients in County and Township level Health Facilities in Hubei rural area, and discovered the problems about medicines management and the use of antibiotics in hospitals. This study provided some intervention measures and suggestions to guide the rational use of antibiotics and effective management in hospitals as well as improve rational use of antibiotic drugs in rural areas.Methods:1. Field Methods: The study carried out by using the survey instruments designed by Management Sciences for Health / Rational Pharmaceutical Management Plus Program Center for Pharmaceutical Management/ U.S. Agency for International Development, How to Investigate Antimicrobial Drug Use in Hospitals: Selected Indicator; We sampled two county-level hospitals and two township hospitals in Hubei Province rural area in accordance with economic level. We collected medicine management information by questionnaire survey and interviewing 1or2 medicine manager in hospitals. We collected case samples by using systematic sampling method, that is start from a random number, according to a certain interval, sampling the hospital cases by this interval in 2006 in-patient medical cases. The total hospital cases we sample were 298, and eliminated incomplete and unclear hospital cases. We analyzed 293 hospital cases by statistics methods, in which, Xiaogan NO.1 People's Hospital accounted for 114 cases, Yangdian township hospital accounted for 51 cases, Dawu People's Hospital accounted for 77 cases, and Dawu Chengguan township hospital accounted for 51 cases.2. Statistical Method: Input the records of use of antibiotics in hospitalized patients in Microsoft Excel. Describe the rate or mean indicators about the use of antibiotics by using SPSS11.5, compare the differences about the use of antibiotics in the county and township hospitals by t-test, chi-square test.3. Rapid assessment Procedure: To reflect the rational use of antibiotics level in the rural areas by analyzing the key indicators of the use of antibiotics in health facilities. Results and Conclusions:1. The results of medicine management status in county and township hospitals: In county hospitals, the drug and therapeutics committee (DTC), essential medicine list, and the Antibiotics Prophylaxis Usage Criterion for Surgeries has been established. But there still are some problems in medicine management in township hospitals , Dawu Chenguan township hospital has not set down rules or principles for the medicine management; In Yangdian township hospital, we can find that the brand name and international nonproprietary names (INN) of medicines are both appeared in the essential medicine list; although some hospital expenditure on antimicrobial drugs as percentage of total hospital drug costs is just 27.97% ,which is as the average level of the whole county, but the cost of antibiotics in some township hospital is quite high, such as the figure of Yangdian is more than 51.34%; the storage of antibiotics is sufficient to supply basic antibacterial medical on study day.2. The results of county, township hospitals'prescribing Indicators: In four hospitals, the percentage of hospitalizations with one or more antimicrobial drugs prescribed is 86.69%, it varies from 81.82% to 94.12%, and the township hospitals are higher than county-level (chi-square test results:χ2=5.638, P=0.018, have statistic significance); Average number of antimicrobial drugs prescribed per hospitalization with antimicrobial drugs prescribed is 1.94, it varies from 1.57 to 2.23 in four hospitals; Average cost of antimicrobial drugs prescribed per hospitalization with antimicrobial drugs prescribed is between114.84-224.05yuan , and no statistic significance between county-level hospital and township hospitals (two independent samples t-test results: t= -1.031,p= 0.304. have no statistic significance); Based on 4 health facilities, the rate of the INN usage is more than 88%, the usage rate of antibiotics of EML is more than 85%, and Average duration of prescribed antimicrobial drug treatment is 5.03, the highest is 6.31 of Dawu county hospital, and the lowest is 3.87of Yangdian township hospital. The Percentage of surgical inpatients who received antimicrobial drug prophylaxis is 77%, and no difference in 2 levels'hospitals and different area hospital in same level. (chi-square test results:χ2c,t=0.147,χ2c=0.234,χ2t=0.266, p>0.05, have no statistic significance). The percentage of patients with pneumonia who are prescribed antimicrobial drugs in accordance with standard treatment guidelines (STGs) in 3 hospitals, Yangdian is the highest one, 88.89%, Xiaogan county hospital is 85.71%, and Dawu county hospital is71.43%.3. The results of patient care indicators in county and township hospitals: Percentage of doses of prescribed antimicrobial drugs actually administered in four medical are 100%; Average duration of hospital stay of patients who receive antimicrobial drugs is 9.42 days, it varies from 4.83~7.90days; Number of antimicrobial drug sensitivity tests reported per hospital admission including antimicrobial treatment are 0 in four health facilities.Conclusion:1. The imperfect medicine management of hospitals in rural area brings some problems in using antibiotics safely and rationally. The function of DTC in some hospitals didn't play well in clinic medicine management; some hospitals have no EML and STG, or EML are too wide, etc.2. Antibiotics medicines are irrational used in some hospitals: based on the survey of the prescriptions, we can find the rate of antibiotics medicines is too high, sometimes, doctors use medicines for prevention just based on the experience.3. There are some factors accounts for irrational use of antibiotics medicines in hospitals in rural area: insufficient budget, health facility management, health workers'poor knowledge, patient's improper inducement, etc.Suggestions:1. Health facilities should execute relative political policies of state medicine policy, and implement interventions to make the DTC take responsibility of the medicine management, implement the Monitoring-Training-Planning project to improve the knowledge and skill of the health workers, and constitute proper evaluation indicators of impact on interventions and study standard values.2. The government should increase the investment of finance for rural area. Perfect the doctors'compensations system for the separation of the income of medicine and health service. Make use the pressure of applying New-type Cooperative Medical System and apply many types of interventions to improve RUD in rural areas.