ABSTRACT
OBJECTIVE To provide reference for improving the rational use of antimicrobial drugs in primary township medical institutions. METHODS Based on the county prescription pre-review center， a team led by anti-infective clinical pharmacists constructed the management mode for the use of antimicrobial drugs in county-level medical communities with clinical pharmacists as the main team by finding out the main problems in the use of antimicrobial drugs in primary township medical institutions， providing feedback on the problems， organizing relevant training for the problems， improving the customization rules of the prescription pre-review software， implementing the automatic interception and pharmacist online prescription review and other measures. Data on the use of antimicrobial drugs were collected and compared in the 15 primary township medical institutions between January-June in 2022 （before the implementation of the mode） and January-June in 2023 （after the implementation of the mode）. RESULTS Compared with before the implementation of the mode， the utilization rate of antimicrobial drugs in outpatients of primary township medical institutions decreased from 24.97% before the implementation of the mode to 19.39% after the implementation of the mode； the utilization rate of antimicrobial injection in outpatients decreased from 66.10% to 46.80%； the utilization rate of intravenous drip of antimicrobial drugs in outpatients decreased from 52.33% to 40.35%； the rates of combined use of antimicrobial drugs in outpatients decreased from 12.70% to 8.19%； the reasonable rate of antimicrobial prescribing in outpatients increased from 55.28% to 73.93%. After the implementation of the mode， the proportion of antimicrobial prescriptions for each diagnosis was basically the same as before； the defined daily dose system （DDDs） and proportion of a few antimicrobial drugs changed compared with before according to the anatomical therapeutic chemical classification of drugs， among which DDDs of lincomycin， gentamicin and other drugs declined significantly； DDDs of antimicrobial drugs for each classification was basically the same as before according to AWaRe classification. CONCLUSIONS The management mode of the use of antimicrobial drugs led by anti-infective clinical pharmacists is constructed in the prescription pre-reviewing center of county-level medical communities， which can effectively improve the rational use of antimicrobial drugs in the primary township medical institutions.
ABSTRACT
OBJECTIVE:To analyze the current status and problems of medicine purchase and distribution of county,township public medical institutions in Hubei province,and to propose targeted policy recommendations. METHODS:By stratified typical sampling,medicine data of 3 county medical institutions and 40 township medical institutions in 3 counties of Hubei province were collected from medicine bidding and purchasing platform of county health and family planning bureau and hospital information system (HIS). Medicine purchase and distribution,distribution rate,purchase and distribution of essential medicine,Chinese patent medicine and injection,general information of top 10 medicines in the list of purchase amount were analyzed in different levels of medical institutions. RESULTS:The medicine purchase and distribution amount of the township medical institutions were lower than those of county medical institutions, but the total amount and distribution rate were higher than county medical institutions. The purchase amount of essential medicine accounted for nearly 3/4 of the total amount (90.6％ of the township medical institutions,and 48.4％ of the county medical institutions);the purchase amount of Chinese patent medicine accounted for about 1/4 of the total amount (35.4％ of the township medical institutions,15.4％ of the county medical institutions);purchase amount of injection accounted for nearly half (34.6％ of the township medical institutions,and 59.3％ of the county medical institutions). The distribution rates of essential medicine,Chinese patent medicine and injection were 93.0％,93.3％,and 93.2％in township medical institutions,and 81.8％,78.6％ and 79.6％ in county medical institutions,respectively. The rate of medicine distribution of township medical institutions was higher than that of the county medical institutions. The top 10 medicines in the list of purchase amount included 6 kinds of antibiotics,and the top 5 medicines included 2 kinds of injection. CONCLUSIONS:The policy of essential medicine purchase is well implemented in Hubei province,and purchase rate of essential medicine meet the policy requirements(40％-50％);but the proportion of injection purchase can partly reflect the high usage of injection,which may indicate the abuse of injection, and Chinese patent medicine has become an integral part of medicine purchase. Moreover, medicines still have the status of distribution untimely,and medicine distribution of the township medical institutions is better than that of county medical institutions.