To Evaluate The Effect Of Rational Use Of Drugs Interventions In Rural Hospitals In Huangzhong County, Qinghai Province

Objective: The aim of this study was to evaluate the effects after implement the rational use of drugs interventions by using time series analysis methods in rural hospitals in Huangzhong County, Qinghai Province and to ensure the rational use of drugs (RUD) policies are effective and sustainable.Methods:Literature review, field investigation, expert consultation, and statistical methods were used in this study. In rural hospitals, we selected seven core indicators from SDUI (Selected Drug Use Indicators, SDUI) as a measure of rational use of drugs. They included the average number of drugs per encounter, the percentage of antibiotics, the percentage of encounters with prescribed cortex hormones, the percentage of injections, the percentage of drugs prescribed by generic name, the percentage of essential drug, and the average expenditure of prescription drugs. A systematic random sample of outpatient prescriptions during the period of January 2000 to May 2005 was drawn. Analyses were carried out by using SPSS13.0 software package.Results: During the 2000-2005, the average number of drugs per encounter was2.93,2.85,3.60,3.12,3.05,2.90,respectively;After the new rural cooperative medical system implementing in 2003, it decreased gradually 94.94%,81.68%,83.70%,84.96%,86.32%,89.15% of drugs were prescribed by generic name, and the percentage of encounters with cortex hormone prescribed was6.25%,2.39%,0,1.84%,0.67%,2.32%, respectively. The results of nonparametric tests showed that no significant difference before and after the implement of the cooperative medical system. The percentage of antibiotics was 18.3%,10.2%,6.1%,20.8%,15.1%,9%,respectively, and the percentage of injections was39.17%,29.76%,42.86%,43.88%,22.6%,29.21%, respectively.The nonparametric tests showed that the cooperative medical system has played a positive role in promoting the rational use of antibiotics and injections. The percentage of essential drugs used was 83.57%,80.65%,82.85%,83.62%,86.07%,86.89%, respectively, and it increased year by year. The nonparametric tests still showed that cooperative medical system has promoted the use of essential drugs. The median of average expenditure of prescription drugs was 6.8,9.7,15.9,15.15,17.42,15.21 Yuan. The t-test showed that the cooperative medical system has played a positive role in controlling prescription drug costs. The time series showed that there were no rising, declining, or periodic trends in all models ,but the average number of drugs per encounter, the percentage of antibiotics, the average expenditure of prescription drugs from 2000-2005 would keep on increasing till the end of 2005 by the expectation of the model.Conclusion: All core indicators in rural hospitals demonstrated the values are closed to the standard and scientific values, which means the interventions of the rational use of drug make sense. We recommend strengthening the rural health service system, reducing treatment costs, establishing an incentive mechanism, and advancing the level of the rational use of drugs in Huangzhong County. In addition, we recommend combining the training of medical staff and health educators for farmers and continuing to strengthen the supervision of, assessment of, and feedback on the rational use of drugs.The mathematical model of rational use of drugs in rural medical institutions was builded by author through adopting the Box-Jenkins method, which is an innovation, and has a higher reference value for intervention effect forecasts of rational use of drugs. The insufficient is that intervention evaluation of rational use of drugs is a comprehensive and complex process, and the indicators can't evaluation of rational use of drugs across-the-board.