Page 58 - 中国全科医学2022-04

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3.West China School of Pharmacy，Sichuan University，Chengdu 610041，China
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Corresponding authors：WANG Xiaohui，Lecturer，Master supervisor；E-mail：wangxiaohui@lzu.edu.cn
HU Ming，Professor，Master supervisor；E-mail：huming@scu.edu.cn
【Abstract】 Background Self-medication behavior often occurs in acutely ill patients，which may lead to a greatly
increased risk of adverse drug events. There are few surveys on the accessibility and rationality of in-home self-medication among
acute disease patients against a background of implementing multiple policies associated with China's healthcare reform initiated in
2009，and the available surveys mainly focus on central and eastern China. Objective To investigate the accessibility and rationality
of in-home self-medication among acute disease patients in Gansu，offering evidence for standardizing in-home medication，and
improving accessibility and rationality of in-home self-medication in this group. Methods By use of multistage stratified random
sampling，1 080 households were selected from five cities in Gansu Province from June to December 2018. They were invited to
attend a survey guided by the WHO Household Survey to Measure Access to and Use of Medicines for understanding the morbidity
in household members in the past two weeks，use and accessibility of medicines for treating acute diseases using a questionnaire
developed by our research team. The survey results were statistically analyzed. Spearman correlation analysis was used to analyze the
correlation between acute diseases，accessibility and availability of medicines for treating acute diseases and the number of drugs
and antibiotics. Results Out of the 1 080 households，1 071（99.17%）effectively responded to the survey. The prevalence of
acute diseases in family members living in these households in the past two weeks was 36.32%（389/1 071）. In this study，we only
included the youngest family member with acutely disease in each household，that is，389 cases in all. Of them，350（89.97%）
had an acute upper respiratory infection；355（91.26%）had the behavior of seeing a doctor or buying drugs；355（91.26%）were
on medication for treating acute diseases. Among all cases on medication，279（78.59%）used combination therapy，93（26.20%）
had four or more medications simultaneously，and 151（42.54%）were on antibiotics. Among all antibiotics users，133（79.17%）
took antibiotics recommended by doctors，and 136（80.95%）used β- Lactam antibiotics. In terms of medicine accessibility，
334（85.86%）of acute disease patients were able to reach the nearest medical facility within 15 minutes；354（91.00%）and 329
（84.58%）reported that the required drugs were available at the public medical facilities and pharmacy，respectively. Among all
cases on medication，349（98.31%）had medical insurance，but only 64（18.34%）were reimbursed；42（11.83%） reported
that the spending on medicines accounted for over 20% of the total household spending. There were statistically significant differences
between patients in urban and rural areas at the avenues of seeing a doctor or buying drugs，types of antibiotics used，15 minutes
proximity to the nearest medical facility，accessibility to drugs at pharmacies，drug reimbursement rates，and spending over 20% of
total household expenditure on drugs for acute illnesses（P<0.05）. Spearman correlation analysis showed that accessibility to drugs
at the pharmacy was positively correlated with the number of drugs taken（r s =0.145，P<0.05）. Conclusion The accessibility
to drugs among acute diseases patients in Gansu Province is high. However，there are also issues among patients，including high
prevalence of combination therapy and antibiotics intake，low proportion of patients who are reimbursed by medical insurance，
as well as urban and rural differences in medicine accessibility. Therefore，to regulate residents' self-medication behaviors，it is
suggested that relevant government departments give priority to actions to raise residents' awareness levels of rational medication and
health insurance，medical professionals' capabilities and supervision of antibiotics use.
【Key words】 Acute disease；Family medication；Rationality；Accessibility；Gansu

急性病指发病急剧、病情变化迅速的疾病，包括流 源的严重浪费、耐药菌株的日益增多及其耐药程度不断
行性感冒、急性上呼吸道感染和急性胃肠道感染等急 增强 ［10］ 。药品可及性指患者能安全和切实地获得适当、
性感染性疾病 ［1-2］ 。我国急性病发病率较高，2013 年 高质量、文化上可接受、经济上可负担的药品，并方便
我国急性上呼吸道感染和急性胃炎两周患病率分别为 地获得合理使用药品相关信息的机会 ［11］ 。2015 年，首
34.4% 和 7.5% ［3］ ，2015 年我国流行性感冒总发病率为 批国家药品价格谈判试点工作正式展开，旨在提高药品
14.37% ［4］ 。当患上述急性病时，如症状不严重，多数 可及性，切实增强群众对医药卫生体制改革的认同感和
患者会选择自我用药或在医生指导下用药治疗 ［5-6］ 。但 获得感 ［12］ 。研究发现，当前我国药品可及性不断提升，
由于患者缺乏医学专业知识，且不同学历和专业背景的 但仍存在药品价格较高、基本药物短缺或供应不足、医
医生在用药安全意识上存在差距 ［2，7］ ，急性病患者家 保实际报销水平偏低和药品供应渠道较窄等问题 ［13-14］ 。
庭用药中常出现抗菌药物使用率较高、药物用法和用量 了解急性病患者家庭用药现状，发现和分析急性病患者
不当等不合理用药行为 ［7-9］ 。不合理用药行为在导致药 家庭用药中存在的问题，并制定针对性的策略，对于提
物不良反应和药源性疾病发生的同时，也会导致医药资 高急性病患者家庭用药合理性和药品可及性显得尤为重