Objective: To know the development of essential medicine in China and provide a reference for the update of the National Essential Medicine List (NEML) through the comparative study between two version’s Provincinal Essential Medicine Supplementary Lists (PEML) in China; to descriptively study the current situation of rational drug utilization at basic level after the medical reform and to provide references and suggestions for the implement of essential medicine policy and rational drug use through prescriptions analysis by the selected drug use indicators (SDUIs) method. Methods: Nine provinces were stratified randomly sampled from east, middle and west parts of China. The essential medicine supplementary lists of each province (PEMLs) were retrieved from the official websites of Health and Family Planning Commission in each province. Then all the data were input, organized and analyzed in Excel 2007 version and SPSS 19.0 version. And in the next study, retrospectively analyzed 15798 prescriptions from April 2014 to August 2014 of a hospital in Ningxia, China, including pediatric, gynecological, internal, surgery and other prescriptions of various kinds of diseases. 7369 male patients and 8429 female patients are range from 1 day to 90 years old. To judge the essential drugs by 2012 version of the National Essential Medicine List and 2014 Ningxia Essential Medicine List. To input the general information of the prescriptions and analyze them by Excel 2007. To descriptively study the current situation of rational drug utilization in the hospital by SDUIs which are established by International Network for Rational Use of Drugs and World Health Organization. Results: There is no statistical significance between the amount of PEMLs and the economic situation of each provinces. There are great differences among the PEMLs of different provinces in aspects of species, amounts, and the classification management, especially in Chinese patent medicine. Descriptively studied the rational drug utilization based on prescription analysis of the hospital in Ningxia. The results are below: (1) The average number of drugs prescribed per encounter was 3.1; (2) The percentage of encounters with an antibiotic drugs prescribed was 31.96% and that with combined use was 11.09%; vii (3) The percentage of encounters with an injection prescribed was 25.18%; (4) The percentage of encounters with hormone prescribed was 5.18%; (5) The percentage of drugs prescribed from essential medicine lists was 46.49%. Conclusions and Policy Recommendations: Conclusions: (1) There is no statistical significance between the amount of PEMLs and the economic situation of each provinces; there are great differences among the PEMLs of different provinces in aspects of species, amounts, and the classification management. (2) The rational drug utilization in this secondary hospital remains to improve: the average number of drugs prescribed per encounter is in the range of National Prescription Administrative Policy, however it is higher than SDUIs reference value; the percentage of encounters with an antibiotic drugs prescribed is higher than SDUIs reference value; the percentage of encounters with an injection prescribe is higher than SDUIs reference value; the percentage of drugs prescribed from essential medicine lists is lower than the ideal situation. Policy recommendations: (1) PEMLs should be updated by the economic level of the provinces; (2) The relevant guidance is suggested, which should specify the amount and the classification management method of supplementary essential medicine to ensure the healthy development of the drug control; (3) Standardize the prescriptions by doctors; (4) Promote the implementation of the national essential medicine policy; (5) Establish a system of rational drug utilization for China.

研究目的： 通過對我國新、舊版基本藥物目錄進行比較研究，瞭解我國基本藥物的發 展，對《國家基本藥物目錄》的遴選、更新提供參考；通過對寧夏某二級醫院 各科室的處方資料進行收集，並採用世界衛生組織合理用藥國際網路推出的合 理用藥國際指標對處方進行合理用藥分析，對新醫改後合理用藥在基層的實施 現況做描述性研究，為基本藥物制度的實施和合理用藥的全面滲透實施提出建 議。 研究方法： 本研究先採用分層隨機抽樣法，從我國東、中、西 3 個地帶中，各隨機抽 取出台過新、舊兩版基本藥物增補目錄（PEML）的 3 個省作為研究對象。隨 機抽取到東部的浙江省、廣東省、江蘇省，中部的湖北省、山西省和江西省， 西部的重慶市、四川省和新疆維吾爾自治區。使用 Excel 2007 軟體，錄入並建 立資料庫，分析 NEML 和 9 省 PEML 藥品通用名資料。使用 SPSS 19.0 軟體， 對 9 省 PEML 增補藥品數量與人均 GDP 資料進行 Pearson 相關性檢驗。 另採用回顧性分析法，抽取並收集了寧夏某二級醫院 2014 年 4-8 月的所有 科室原始電子處方共 15798 張（即總處方數）：分別有兒科、婦科、內科、外 科（細分為外一科、外二科、普外科等）、中西醫科等共 8 個科室；患者中， 男性 7369 張，女性 8429 張；患者年齡範圍為 1 天到 90 歲；處方涵蓋各種病症。 根據《國家基本藥物目錄 2012 年版》和 2014 年寧夏最新基本藥物增補目錄 （《寧夏基本藥物目錄 2009 年版》）中所收錄的基本藥物，判斷該醫院處方所 使用的藥品是否為基本藥物。將處方中的一般項目（患者訊息，如姓名、性別、 年齡等，科室信息，主治醫生，日期等項目）及處方用藥情況（如藥品名稱、 規格、單價、數量、醫療總額等）全部錄入并建立數據庫，用軟件 Excel 2007 和 SPSS 19.0 進行處理和統計分析。根據世界衛生組織合理用藥國際網路提出 的合理用藥國際調研指標，對從該醫院收集來的處方進行合理用藥的現況描述 性研究。 研究結果： v 對我國新、舊版基本藥物目錄進行比較研究，發現省增補基本藥物數與該 省經濟水平關係無統計學意義。各省基本藥物增補目錄分級、分類有不同，中 成藥分類差異尤為明顯。 從基於處方分析的角度，描述性研究了寧夏某二級醫院合理用藥的情況。 結果顯示： （1）該醫院平均每張處方開具藥物品種數 3.1 種； （2）抗生素使用率為 31.96%，抗生素聯用率為 11.09%； （3）注射劑（不含預防注射/計畫免疫）使用率為 25.18%； （4）激素類藥物使用率為 5.18%； （5）基本藥物使用率為 46.49%。 結論與政策建議： 根據以上研究結果，發現： （1）PEML 的增補與該省經濟情況關係無統計學意義且目錄的分類、分級有較 大差異； （2）寧夏某二級醫院合理用藥情況有待改善：該院每張處方平均用藥品種數符 合國家《處方管理辦法》規定，但高於合理用藥國際指標平均參考值；抗生素 使用率高於合理用藥國際指標平均參考值；注射劑使用率高於合理用藥國際指 標平均參考值；基本藥物使用率有待提高。 相關政策建議： （1）PEML 增補數量應適應於當地經濟情況，適量增加； （2）PEML 需要統一的指導原則來進行規範； （3）規範醫生的處方行為； （4）深化推廣基本藥物制度； （5）建立我國合理用藥機制。