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目的了解云南省禄丰县乡、村两级医疗机构合作医疗实施后其处方用药的现状与存在问题,并提出促进合理用药的对策,进一步规范乡村医生用药行为。方法采用描述性统计分析方法和生物统计学分析方法。结果调查地区乡镇卫生院和村卫生室处方中,包含3~6种药品的比例分别为79.8%和76.9%,农村卫生室使用抗生素和激素的比例(分别为81%和32.5%)高于乡镇卫生院使用的比例(分别为77.3%和20.2%)。参加合作医疗病人门诊处方中含3~6种药品的比例均高于非参合病人,且其处方中药品费用和治疗总费用也高于非参合病人。结论乡村两级医疗机构的门诊处方中均存在一定程度的不合理、不安全用药现象,应通过规范供方服务行为和购药渠道和改革现行的村医报酬支付机制等措施,以改善乡村两级医疗机构不合理,不安全用药状况。
Objective To understand the current situation and existing problems of prescription medication after the implementation of cooperative medical service at rural and village medical institutions in Lufeng County, Yunnan Province. The countermeasures to promote the rational use of medicines were put forward to further standardize the practice of rural doctors. Methods Descriptive statistical methods and biostatistical methods were used. Results In the prescriptions of township hospitals and village clinics, the proportions of 3 to 6 medicines were 79.8% and 76.9% respectively. The proportion of antibiotics and hormones used in rural clinics (81% and 32.5% respectively) was higher than that of towns The proportion of hospitals used (77.3% and 20.2% respectively). The proportion of 3 to 6 kinds of drugs in the outpatient prescriptions of cooperative medical patients was higher than that of non-participating patients, and the cost of medicine and the total cost of treatment in the prescription were also higher than those of non-participating patients. Conclusion There is a certain degree of unreasonable and unsafe drug use in outpatient prescriptions at both rural and urban medical institutions. Measures should be taken to standardize supply-side service behaviors, drug purchase channels, and reform of the current village doctor payment mechanism to improve village two Level medical institutions unreasonable, unsafe medication situation.