Analysis On The Implementation Effects Of Essential Drugs System In Village Health Clinic In Guizhou Province

ObjectiveThe present study is based on the the village health before and after the implementation of the basic drug system ability to achieve basic health security and the effect of a theoretical exploration and empirical research. This study combined literature specification and empirical research, qualitative and quantitative research, through effect evaluation before and after the implementation of the basic drug system for village health, including the comparison before and after the implementation of the health service efficiency, service effectiveness and service effectiveness indicators (variety of drugs, use of essential drugs, prescription drugs comparison, residents medication burden), procurement, distribution and use of essential medicines and other aspects of difference; implementation of national essential drug system of village health impact assessment, feasible way appropriate basis in reality and objective conditions and their impact; every avenue to explore specific operational strategies and methods of the development of village health under the conditions of national essential drug system.MethodsThrough Medline, CBM, CNKI disc retrieval tools, Internet network, monographs, literature research, lay the foundation for understanding the research status and dynamic of the research projects. Collection of domestic basic drug system development and integrated management of rural health services pathways and approches and means of the relevant literature, summed up the pathways and functions at home and abroad in the background conditions of the basic drug system integration of rural health development mode theory and methods, and to determine In this study, subjects of the investigation, content, methods, indicators and questionnaires in this study, we can learn the theory and methods summarized.Delphi method, interview government, health care management, pharmaceutical production, circulation and marketing chain departments, medical services agencies under the background of the basic drug system service capacity of village health effect and their pros and cons, the applicable conditions and different way to health services and population health consultation.Use of stratified sampling survey method, the implementation of essential drug system succively in different time based on the level of economic development, Guizhou Province Leishan county, Majiang County, Xiuwen County as survey sites, the three samples County, according to the county in accordance with the local social, economic and population development in order of good to poor (good, medium and poor), the choice of three township hospitals and10village clinics, a total of nine township hospitals and90village health clinic. Scene investigation uses the way of expert interviews, focus group discussions and questionnaires, statistics collection. Data processing mainly use policy analysis and multivariate statistical analysis and other methods. Each village health surveys100local patient,30local residents. Understand residents in rural medical institutions for treatment in the face of disease risk and the national essential drug system before and after the implementation of a variety of feelings, including treatment costs, treatment processes, the proportion of claims and costs, recovery from disease; understand the different policies and systems under the conditions of village health room varieties of drugs, the difference between the use of essential drugs, prescription drug use compared to residents medication burden.The data is expressed by x+s. Each group were compared using the t test, the X test used to compare rates. Two-tailed P<0.05as statistically significant.Results(A) Equipped with essential drugsThe average number of the township hospitals equipped with varieties of essential drugs an is342.if it was equipped with a number of417kinds of calculation, the ratio would be approximately82%. National directory with the proportion was significantly higher than the province added to the directory. Western medicine with higher than the proportion of Chinese medicine and proprietary Chinese medicine.(B) The rational use of essential drugsPrescription statistics showed that:the system before and after the implementation of the system. the prescription drug category average rise and fall:prescription drugs number of species does not meet the normal distribution, so the use of non-parametric test of Mann-Whitney Test results show that the sample counties basic average per prescription drug system before and after drug types mean differences are statistically significant.The proportional results of the use of antibiotics prescription show that:before and after the implementation of the three samples County village health proportion of antibiotic prescriptions change, the difference was statistically significant (P<0.05).The proportion of injection prescription:a slight change in the implementation of the basic drug system before and after injection usage samples county, township hospitals and village clinics, but the differences were not statistically significant (P>0.05).Addition of essential medicines results showed that:before the implementation, the addition of three samples County village health is higher than30%; after the implementation, the three samples County village health essential medicines addition ratio is about5%, part of the Essential Drugs List the outside drug prices higher than the national price ceiling.(C) Income and expenditure of village healthThe basic drug system, the village health medical income, drug income and other business income than those prior to the implementation of reduction corresponding increase in financial assistance, are significant determinants of income structure.(D) Outpatient impactThe basic drug system, the village health clinic has no significant reduction of the number, township hospitals gate (emergency) patient increased significantly, inpatient services flow to the county-level medical institutions. Utilization of medical services increased significantly. Three samples County village health clinic times are drugs did not reduce the basic drug system, only slowed down.(E) The new rural cooperative changes in the proportion of compensationThree samples County Farmer Participation in the village health clinic reimbursement ratio increased by about7.82%. Three sample counties in proportion to the compensation of the hospitalized patients adjust the consistency, and encourage patients to treatment in primary health care institutions, county, township institutions the proportion of claims has increased, the proportion of claims to the institutions at or above the county level lowered. Since the basic drug system, the compensation passengers increased significantly, the number of compensation is implemented by more than2.8times.Conclusion of the study(A) The Government of the health total investment is little. The compensation of medical institutions is inadequate; difficult to break the key interest groups Alliance; government financial compensation for medical and health service system in rural areas should be increased to change the mechanism of hospitals living on medicine;(B) Drug varieties of list of Essential Drugs are too broad, and primary health care institutions medication is relatively limited, the maximum effectiveness of essential drugs has not been a good play;(C) Overall, the implementation of essential drug system in the village health is still in its infancy; essential drugs system is implemented, expanded basic drug system benefit side, it helps to standardize the behavior of doctors in rural areas of medication, help give full play to network at the end of the village health functions.(D) after the impementation of the basic drug system, we should further increase the standardization of village health management to enhance the capacity of grass-roots medical staff services.Innovations(A) In this study, from social justice theoretical perspectives, we explored the service capacity and service under of underdeveloped rural health clinic under national essential drugs system, and then health service efficiency, service effectiveness and efficiency of services were compared between three counties to provide theoretical and practical support for further development of national essential drug policy.(B) Different from past research with one or two angles to study the essential drugs policy effects, we implemented multi-dimensional system analysis method to address essential drugs policies on rural health clinics. We analyzed the effect of essential drugs policy implementation involved with patient, providers, insurer, health managers and other point to. Additionally, combination of qualitative and quantitative, multi-dimensional analysis method are more objective and comprehensive to assess the implementation effects of the basic drug system. Limitations(A) Our study has a small sample size. This study assessed the effects of the essential drug policy in90rural health clinics,3counties in Guizhou, the findings do not represent the Midwest regional or national level;(B) This study is limited to horizontal comparison for cross-sectional survey data, and therefore cannot be analyzed the effect of essential drugs on the village health service capacity and effectiveness from the time variable system, and which made the results less objective, which requires further study to perfect.(C) In the analysis of the essential drug policy on village health service capacity and service, there is no exclusion of other confounding factors, such as social, economic, cultural and many other factors, we acknowledge these confounders affect the objectivity of research results; it is need to pending subsequent in-depth study.