Investigation On The Current Situation Of Drug Supply Guarantee In Yunnan Province And Construction Of Monitoring And Early Warning Platform

Objective:Drug shortage is a global problem with complex causes,which seriously affects the safety,effectiveness,timeliness and economy of patients’medication.This thesis,based on the perspective of provincial level,will answer the most basic problem to be solved in the field of drug shortage research:What drugs are in short supply?What are the influencing factors?Based on this,To seek measures,to explore how to mobilize stakeholders to carry out monitoring and early warning works.This thesis will conduct a comprehensive design of provincial multi-dimensional monitoring and early warning platform of shortage drugs,and put forward relevant policy recommendations,in order to improve the supply guarantee of shortage drugs in China,and enrich the theory of monitoring and early warning of shortage drugs theory and practice system.Methods:A combination of qualitative and quantitative methods were used for research.(1)The research on the shortage of drug supply guarantee in Yunnan Province mainly were used questionnaire survey methods,factor analysis,and expert interview.The questionnaire survey consisted of two parts.First,a survey for the current shortage of medicines in medical institutions.The person in charge of the pharmaceutical department was been asked to fill out the Information Sheet for Shortage of Medicines in Medical and Health Institutions,then we collected the questionnaire for statistics.The second was a survey of the factors affecting the shortage of drugs.Six regions were sampled.Medical institutions and manufacturing and distribution companies completed the Questionnaire for the Factors Influencing Drug Shortages.The obtained data was entered using EpiData 3.1 and SPSS 21.0.Descriptive statistical analysis,factor analysis and multiple regression analysis.In addition,during the two questionnaire surveys,representative units were selected for one-to-one expert interviews.(2)The construction of the monitoring and early warning platform mainly adopted the stakeholder analysis method,bibliography retrieval,expert interview,analytic hierarchy process.Firstly,based on the stakeholder theory,the stakeholders in China’s shortage drug monitoring and early warning process was defined,we analyzed the "resources" and "resistance" that each stakeholder had that affected the realization of the monitoring goals,and explored how to mobilize the strength of various stakeholders carried out multi-dimensional monitoring and early warning;Then we designed a provincial level shortage drug monitoring and early warning platform based on literature research,policy analysis and demand analysis.Finally,we generated monitoring index questionnaire by yaahp12.3 software and used the method of AHP to calculate the index weight.Results:The results of this thesis mainly include four aspects:(1)the current situation of drug shortage in Yunnan Province,through the statistics of 1,290 medical institutions in Yunnan Province with a shortage of medicines questionnaire,a total of 167 drugs were in shortage supply,including 135 biochemical drugs,32 kinds of proprietary Chinese medicines,85.0%of them were essential medicines,more than 58.1%of medicines are in shortage for more than one year,and 37.1%of medicines are injections.Among chemical drugs and biological drugs,the shortage of antimicrobial drugs and cardiovascular system drugs was more prominent,accounting for 11.4%and 9.6%,respectively;Among Chinese patent medicines,medical drugs account for the highest proportion,accounting for 15%.In addition,"transaction prices are low,enterprises are unwilling to produce" and "rejected bids or scrapped bids,no enterprise supply" are the primary and secondary reasons for the shortage.(2)In terms of analysis of influencing factors of drug shortage,a total of 531 valid questionnaires were included,and a total of 4 common factors were extracted through principal component factor analysis to have a greater impact on the drug shortage.The degree of influence from high to low are:price factor,usage factor,capacity factor,and demand factor.(3)In terms of the planning and design of platform,the main stakeholders of the monitoring and early warning system for the shortage of drugs in China were defined as government departments,medical institutions,manufacturing enterprises,distribution companies,and patients.Based on the interests of stakeholders,properly solving the difficulties of various stakeholders in the implementation process,and establishing a reasonable interest balance mechanism can only bring about the desired effect of drug monitoring and early warning of shortages.Based on stakeholder analysis,combined with the needs of provincial-level shortage drug management,a comprehensive design of the provincial-level shortage drug monitoring and early warning platform has been designed.It was composed of 5 major functional modules:drug shortage information collection,drug shortage information identification,drug shortage monitoring,early warning,statistical query and response,and drug shortage comprehensive service.Medical institutions,manufacturing enterprises,circulation enterprises and other monitoring personnel were as the main body of monitoring.A grading early warning mechanism consisting of three districts,counties,cities,and provinces was designed.The early warning levels are divided into three levels:orange,yellow,and blue.(4)In terms of monitoring indicators of the multi-dimensional monitoring and early warning platform for shortage medicines:based on the AHP,a hierarchical model of shortage medicines monitoring consisting of 4 primary indicators,9 secondary indicators,and 24 tertiary indicators was constructed.Among the first-level indicators,the drug attribute index has the highest weight,which was 0.394;among the second-level indicators,the shortage location index had the highest weight,0.223;and among the third-level indicators,were there alternative medicines with similar functions?The highest weight was 0.128.Conclusions:Based on the results of the study,opinions and suggestions were made from the two aspects of improving the supply guarantee of the shortage of drugs and the monitoring and early warning system.In terms of improved the shortage of drug supply guarantees:it’s recommended that the top-level design of the government should improve the drug price formation mechanism and adjust the shortage of drug supply with policy as the starting point;Provincial government departments should coordinate medical institutions and distribution companies to exchange information,update and monitor drug purchase prices;Medical institutions should raise the level of rational use of drugs and the replacement of shortages,and establish a scientific management system for shortages.Production and distribution companies should strengthen communication and docking with information from medical institutions to produce and distribute drugs to medical institutions in a timely manner;In terms of improved the shortage drug monitoring and early warning system:it is recommended that the top-level design of the government should refine the responsibilities of the linkage department and optimize the mechanism and system for monitoring and early warning of drug shortages;Provincial government departments can integrate information shortage islands,and connect information islands of the entire chain of shortage medicines;The medical institution level should implement the monitoring and early warning responsibility to improve the quality of the reported data.Production and distribution companies can participate in monitoring actively and play a monitoring and early warning role.