PHP21 Does National Essential Medicine System Improve Rational Drug Use in Primary Health Care Facilities? An Empirical Study in Rural China

Abstract

To examine the effect of National Essential Medicine System (NEMS) on rational drug use (RDU) in primary health care facilities in rural China and to provide reflections and policy implications for currently implemented new health care reform. Data was obtained from 151 township hospitals in four provinces by means of field survey (stratified random sampling) conducted between 2010∼2011. Indicators of RDU were compared before and after NEMS, and discussed in regard to WHO Standard Guidelines or data from other researches. Under NEMS, average number of drugs per encounter decreased from 3.64 to 3.46 (p<0.01). Little effect was found in the average number of antibiotics per encounter, but the percentage of encounters with antibiotics prescribed decreased from 60.26% to 58.48%(p<0.01). The percentage of encounters with injection prescribed and the percentage of encounters with hormone prescribed also decreased and the current proportion was 40.31% and 11.16%, respectively. But unfortunately all the above values remained higher than WHO international standards. The percentage of drugs prescribed from National Essential Drug List increased from 63.33% to 79.89% (p<0.01). The average expenses per encounter increased from RMB 25.77 to 26.71 with the available data, but was not significant (p=0.362) and warranted further investigation. The implementation of NEMS has greatly improved rational drug use in primary health care facilities in rural China. But the over-prescription of antibiotics and injections and polypharmacy remain common. Treatment guidelines should be established and closely adhered to. Continuing medical education on RDU for both health workers and the public as well as intensive support supervision are the essential actions taken.