解读浙江“阳光工程” Reading zhejiang“Sunshine project”

　　我省推行医疗服务阳光用药工程 Implementation of medical services in sunshine drug use project

　　医生连续两月“偏爱”同种药将被约谈 The doctor for two months“preference”The same medicine will be questioning

　　医院的9项指标须向社会公示 The hospital 9 index to the society should be published

　　去医院看门诊，医生开了什么药？看一次病需要花多少钱？医院使用的药物中，有多少是国家基本药物目录内的？每个住院病人平均要花多少钱，其中有多少是药钱？

Going to the hospital to see outpatient service，The doctor prescribed what medicine？See a disease to need much money？Hospital to use drugs，How much is the national basic drugs in the directory？Every hospital patients average how much cash to spend，How much is the medicine of money？

　　今年2月起，浙江省卫生厅根据省纪委、省监察厅、省政府纠风办统一部署推出了《医疗服务阳光用药工程实施方案》，对“阳光用药”作出明确规定。这份实施方案除规定让病人明明白白看病外，还明确医院的抗菌药物占药品使用比例、不合格处方率、大处方比例、抗菌药物在门诊处方的比例、平均住院日等9项指标均须向社会公示。

2 month this year，According to the provincial health bureau ShengJiWei zhejiang province、Province society、The provincial government JiuFengBan unified plan launched《The medical service sunshine drug use engineering implementation plan》，to“Sunshine drug use”Explicitly provided。The plan except the regulation clearly let patients outside to see a doctor，Clearly the hospital antimicrobial drug use of proportion、Unqualified prescription rates、DaChuFang proportion、In the outpatient service of antimicrobial prescription proportion、The day in hospital 9 indicators are to be made to the society。

　临床用药服务实现“三知道” Clinically, the service realize“Three know”

　　30多岁的小周牙龈上长了一个包，拖了近半年才去市一医院检查。“开始时感觉不痛，所以就没去理它了，但最近发现这个包越来越大。”小周刚说完，就受到医生的严肃批评：“你如果想保住这颗牙齿，就应该早点来。”

More than 30 years old of small weeks on gum has a bag，Drag the half-year to a city hospital inspection。“Began to feel pain，So I didn't go it alone，But recently found that this package is more and more big。”Small fatigued with，By the doctor's serious criticism：“If you want to keep the tooth，Should have come earlier。”

　　拍片观察后，医生耐心地向他解释：“你这颗牙齿有一半的神经坏死了，我要把这些坏死的神经抽出来，可能会有点痛，稍微忍一下。抽出来后，再把药和其他材料填进去。”医生告诉小周，起码要来四五次才能彻底解决问题。

Observed filming，The doctor patiently explained to him：“You this tooth half of the neural necrosis，I want to take these necrosis of nerve taken out，May hurt a little，Slightly endure a。Out after，Then put the medicine and other materials filled in。”The doctor told the weeks，At least wants to thoroughly solve the problem to four or five times。

　　“你的牙齿有点发炎，家里有没有头孢等消炎药？”医生问小周，他摇摇头。于是，医生给他开了一盒“头孢丙烯胶囊(福新王)”，一盒“替硝锉片(可立泰)”。

“Your teeth a little inflammation，Home cephalosporins have antiphlogistic medicine, etc？”The doctor asked the little weeks，He shook his head。so，The doctor gave him a a box“Cephalosporins propylene capsule(FuXin king)”，A box of“Nitrate of file for(But litai)”。

　　牙齿经过医生处理后，小周去窗口付了钱，拿到一张收费收据。这次看牙齿，他一共花了215元。收据上清清楚楚写明：检查费即口腔X线一次成像(1次)25元，治疗费190元，其中包括牙髓摘除术15元、根管预备30元、根管再治疗术135元、口腔局部冲洗上药10元。

Teeth after the doctor after treatment，Small weeks go to window to pay，To receive a fee receipt。This watch teeth，It had taken him 215 yuan。Clearly indicate the receipt：The inspection fee that oral X-ray a imaging(1)25 yuan，The 190 yuan，Including dental pulp enucleation 15 yuan、Root canal prepare 30 yuan、Root canal to healing 135 yuan、Oral local flush irrigation, 10 yuan。

　　“一张单子，哪些项目付多少钱，列得清清爽爽，让人心里有数。小时候也拔过牙，那时就告诉你交多少钱，收据上就一个金额，没有这么细。”小周告诉记者，“口腔科外面的墙上贴着价目表，写着各项收费，这样花钱明明白白，让病人放心。”

“A list，What are the projects pay，Column is relaxed to，Let people know better than I。When I was a child and a tooth pulled out，At that time will tell you pay the money，On receipt of an amount，Not so fine。”Small weeks told reporters，“Kouqiangke outside posted on the wall of the price list，Write each charge，Such spending clearly，Let the patient rest assured。”

　　据了解，为让病患更清楚地了解所用药物的价格，这次“阳光用药”工程中有一项，就是临床用药服务实现“三知道”，患者能从医师或药师的医疗和药事服务中知道所有药品的相关知识；能从医院公示载体和费用清单中知道药品的准确价格；能从卫生行政部门和医院的公示载体中知道相关医院合理用药的信息。

According to understand，To allow patients to a clearer understanding of the price of the drugs，the“Sunshine drug use”There is an engineering，Is the clinical application service realize“Three know”，Patients can from the physician or pharmacist medical and pharmacy practice that all related knowledge of drugs；From the carrier and the public can hospital fee list the exact value of know drugs；From the administrative department of public health and the public hospital in the carrier know relevant information of the rational use of drugs in the hospital。

　医生连续两月“偏爱”某药要被约谈 The doctor for two months“preference”Some medicine to be questioning

　　今年2月，金华永康唐先镇卫生院的盐酸氨溴索注射液的销售额是8514元。到了3月，该药物的销售额突然猛增至13387元，涨幅为57%左右。

February，The TangXian town the hospital yongkang hydrochloric acid ammonia bromine sales of the injection is 8514 yuan。In march，The drug sales suddenly shot up to 13387 yuan，At 57% or so。

　　前后两个月，这家卫生院的盐酸氨溴索注射液的使用量为什么突然增加？难道存在不合理用药的情况？

Two months before and after，The the hospital hydrochloric acid ammonia use of bromine cable injection why suddenly increased？There is no rational drug use？

　　该院的药师委员会及时介入进行分析，发现3月是流感高发期，发生呼吸道感染的病人特别多，而盐酸氨溴索注射液是一种化痰的药物，可以促进呼吸道内黏稠分泌物的排除及减少黏液的滞留，促进排痰，改善呼吸状况。“该药物除了以盐水的形式进行注射外，还可以作为喷雾使用，特别是用于小孩子比较多。”永康市卫生局的一位工作人员解释。

The hospital pharmacists committee analysis in time intervention，Find 3 month is flu almost two decades，The patient of respiratory infections occur much more special，And hydrochloric acid ammonia bromine cable injection is a kind of eliminating phlegm to drugs，Can promote sticky secretions in the respiratory tract and reduce the elimination of the stranded mucous，Promote row phlegm，Improve respiratory condition。“The drug in addition to the form of the salt water injection，Still can use as a spray，Especially for more children。”Yongkang health bureau a staff explained。

　　记者从浙江省卫生厅了解到，全省各级医院建立了关于用药的动态预警机制，加强对临床药物，尤其是抗菌药物使用的分类管理。每月或每两月，医院的药师委员会对本医院使用最多的前十名药物进行分析，如果发现某类药使用突然增多，或者某医生连续两个月都“偏爱”开某种药物，那么，使用该药物的医生将会被约谈，当面分析原因。

Reporters from zhejiang provincial health bureau to understand，The hospitals at all levels about the use of drug established dynamic early warning mechanism，To strengthen clinical drug，Especially of the antimicrobial use classification management。Monthly or every two months，The hospital pharmacists committee of the top 10 most use this hospital drugs for analysis，If found some kind of drug use increased suddenly，Or a doctor for two consecutive months“preference”Open a certain drug，so，Use of the drugs doctors would be questioning，Analysis reason to。

　“阳光用药”给老百姓看病带来更多实惠 “Sunshine drug use”People bring more benefits to see a doctor

　　省卫生厅表示，“阳光用药”可以解决“大处方、滥开药、开贵药”现象，可以使患者医药费用负担有效控制，给老百姓看病带来实惠。

Provincial health department said，“Sunshine drug use”Can solve“DaChuFang、Excessive prescriptions、Open your medicine”phenomenon，Can make a patient medical expense burden effective control，People bring benefits to see a doctor。

　　比如杭州江干区，全面推行“定药品比例、定处方金额、定输液组数、定抗生素使用比例”的阳光用药“四定控制法”，均次用药费由69.6元下降为47.81元，处方均值由129.16元下降为87.05元，药品比率由81.93%下降为72.88%，月均输液导致的投诉量由1.1起下降为0.49起。

For example JiangGanOu hangzhou，The full implementation of the“Calm drug proportion、Set prescription amount、Infusion set the number of groups、Set antibiotic use proportion”Sunshine drug use“Fixed control method”，All times with expenses for medicine from $69.6 reduced to 47.81 yuan，The mean prescription from $129.16 reduced to 87.05 yuan，Drug rate by 81.93% to 72.88%，The average monthly infusion number of complaints from 1.1 to 0.49 on the decline。

　　根据“阳光用药”的相关规定，实施“阳光用药”后，可以使医疗机构药品使用总量和结构合理。根据相关规定，国家和省增补的基本药物目录品种使用金额比例：三级甲等医院≥20%，三级乙等医院≥25%，二级甲等医院≥30%，二级乙等医院≥35%；药品收入占医疗收入比例：三级医院≤45%，二级医院≤50%；抗菌药物占药物使用比例：三级甲等医院≤23%，三级乙等医院≤25%，二级甲等医院≤28%，二级乙等医院≤30%。(记者 章高航)

According to“Sunshine drug use”Relevant provisions of the，implementation“Sunshine drug use”after，Can make medical institutions use drugs and reasonable structure total。According to relevant provisions，National and provincial supplemented the basic medicines directory varieties use amount proportion：Three level of first-class hospital quartile 20%，Level 3 b, 25% quartile hospital，Level 2 of first-class hospital quartile 30%，Level 2 b, 35% quartile hospital；Drug income accounts for medical income proportion：More than 45% of the third class hospitals，More than 50% of the second class hospitals；Antibacterial drugs account for drug use proportion：Three level of first-class hospital than 23%，Level 3 b, 25% or hospital，Level 2 of first-class hospital than 28%，Level 2 b, 30% or hospital。(Reporter GaoHang chapter)