| Objective:(1)To explore the current status and rationality of Chinese patent medicines(CPMs)in primary health care institutions in China;(2)To analyze the preferences of the prescribing behavior of Chinese patent medicines by primary care physicians,and to provide a scientific basis for promoting the study of the rational use of CPMs in primary health care institutions.Methods: A cross-sectional study design was used for this study.(1)In the first phase,through the unannounced standardized patient method,standardized patients with 11 cases who were trained and validated to visit primary health care institutions in seven provinces in China following the normal process of medical care facilities,the data of treatment prescriptions were collected and a database was established.Data with prescriptions for CPMs were extracted and the current status of CPMs use was analyzed descriptively.In order to ensure the feasibility of the study,the cases of common cold with the highest usage rate of CPMs were taken as an example,the evaluation of the rationality of the use of CPMs was carried out in six dimensions,including the appropriateness of indications,appropriateness of dosage,appropriateness of route of administration,contraindications,the presence of "18 antibodies" and "19 fears" were considered,and whether to repeat the use of medicines.(2)In the second phase,a discrete choice experiment was used to analyze the preferences of the prescribing behavior by primary care physicians.the attributes of the prescribing behavior for CPMs of primary care physicians were determined by literature review,in-depth interviews,and expert consultation,and the final questionnaire was determined by partial factorial design using SAS,and all choice sets were assigned to three different versions of the questionnaire.A multi-stage stratified sampling method was used to conduct the questionnaire survey with primary care physicians in Gansu Province.The data were collected using the Research Electronic Data Capture(REDCap)system,and the data were formatted using Stata 16.0,and the count data were described by frequency and composition ratios.The data were analyzed using conditional logit models and mixed logit models as regression models for the respondents’ preferences.The test level was set at α=0.05,and the difference was statistically significant at P<0.05.Results:(1)A total of 1188 primary health care institutions were visited during the unannounced standardized visit phase,and 2154 successful visits were completed,with a visit success rate of 97.91%.1154(53.32%)visits were prescribed,including a total of 2545 drugs,of which 717(62.13%)visits prescribed CPMs.Analyzed by province,the percentage of visits that included prescriptions for CPMs was greater than50% in all seven provinces;analyzed by case,the top three CPM prescription rates were for common cold(84.91%),low back pain(75.83%),and hypertension(72.80%).262(36.54%)of the 717 visits where CPMs were prescribed were pure CPM prescriptions,455(63.46%)visits were prescriptions for a combination of CPMs and other drugs such as Western medicine.A total of 985 CPMs were prescribed,of which 401(40.71%)were recommended in the base drug list.Analyzed by province,Guizhou Province had the highest proportion of the base list of CPMs prescribed by primary care physicians(54.43%),followed by Gansu Province(44.83%)and Sichuan Province(44.44%);analyzed by case,the proportion of the base list of CPMs for angina barrera(63.89%),stress urinary incontinence(52.31%),and gastritis(44.19%)were in the top three;Among the different types of institutions,the highest proportion of the base list of CPMs was prescribed in township health centers(59.80%),and the lowest proportion was prescribed by doctors in clinics(17.48%);the proportion of the base list of CPMs was higher in the prescriptions of non-profit medical institutions than that of profit medical institutions.The chi-square test results showed that the differences in the proportion of prescriptions in the base list of CPMs prescribed in different provinces,cases,types of institutions,and types of institutional registration were statistically significant(P < 0.05).(2)Among the cases,the proportion of prescriptions of CPMs was the highest for common cold cases,and to ensure the feasibility of the study,prescriptions for common cold cases were analyzed in this study.A total of 191 visits were completed for common cold cases,of which 81(60%)visits of 135 common cold visits containing prescriptions of CPMs were correctly diagnosed,and 122 CPMs were prescribed,55(45.08%)of which were recommended in the basic national drug list.After the evaluation of the rationality of the prescription of CPMs,15(18.52%)visits were unreasonable,and the analysis of specific evaluation dimensions showed that the route of administration,contraindications and pairing prohibitions were reasonable,6(7.41%)visits were unreasonable in terms of indications,7(8.64%)visits were unreasonable in terms of dosage,and 3(3.70%)visits were repeated,with one visit in which both indications and dosage were unreasonable.(3)A total of 250 primary care physicians were invited to participate in the discrete choice experiment,and 214 valid questionnaires were returned,with an effective rate of 85.60%.The results of the mixed logit model showed that financial incentives,patient willingness,disease severity,drug effect,and adverse drug reactions all had significant effects on primary care physicians’ prescribing behavior of CPMs(P< 0.05),and the most important attribute among the five attributes was drug effect.Primary care physicians preferred to prescribe CPMs for patients when there was no financial incentive,the patient was willing to take the CPMs,the disease severity was mild or moderate,the drug effect was better,and the incidence of adverse drug reactions was lower.The preference for inclusion of attributes differed among primary care physicians with different characteristics when prescribing CPMs for patients with common cold,heterogeneity in primary care physicians’ preferences for financial incentives and severity of illness was greater.Conclusion:(1)CPMs are widely used in primary health care institutions in China,and the proportion of prescriptions for drug combination is high,but the proportion of CPMs in the base drug list is far from the target of 86% to 88% proposed by the World Health Organization(WHO),and the application of CPMs has unreasonable dosage,unreasonable indications and duplication of drugs.(2)The five factors(economic incentives,patient willingness,disease severity,drug effectiveness,and adverse drug reactions)of primary care physicians’ preferences for CPM prescription behavior laid the foundation for interventions on the irrational use of CPMs in subsequent studies,and the project team can conduct case modification and brief language development based on the factors preferred by primary care physicians,and can consider different brief language interventions based on the characteristics of primary care physicians when unannounced standardized patients visit primary health care institutions again in the future. |
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