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Investigation report of medical institutions 1 Drug supervision in rural medical institutions is an important part of our daily supervision and an important link to ensure the safety of farmers' drug use. However, in the practice of drug supervision, the management of pharmaceutical affairs in rural medical institutions is very weak, and the unqualified rate of drug sampling inspection is significantly higher than that of drug trading enterprises in county towns. Moreover, it is also a frequent area of counterfeit and inferior drugs, and there are many cases of illegal acts being investigated, which is not only the focus of our drug supervision work, but also the hot issue of pharmaceutical affairs management research. According to several years of drugs
Based on the supervision practice, this paper discusses some views and experiences on the difficulties and countermeasures of drug supervision in rural medical institutions.
First, the current situation and analysis of pharmaceutical affairs management in rural medical institutions
There are 23 township hospitals, 3 16 village clinics and individual clinics in our county. It is distributed in rural areas 16 townships and 187 natural villages. Due to the influence of local economy, the economic foundation of these township hospitals, village clinics and individual clinics is relatively weak, and some of them can't even pay their employees' salaries, and their hardware facilities are extremely scarce, so they are maintaining the status quo. In this case, the pharmaceutical affairs management in rural medical institutions is difficult to meet the requirements of the government and people, which also brings great difficulties to our drug supervision. First of all, the pharmacy management function of rural medical institutions can not meet the requirements. Due to the limitation of the scale and personnel of township medical institutions, pharmaceutical personnel are deficient in pharmaceutical affairs management, some do not have pharmaceutical affairs management qualifications, some have low qualification ability, and their knowledge of drug maintenance, evaluation, preparation distribution and special drug management can not meet the specified requirements, resulting in incomplete pharmaceutical affairs management functions and only simple pharmaceutical affairs management responsibilities. Second, non-pharmaceutical professionals account for a certain proportion of pharmaceutical technicians, with low academic qualifications and low professional quality, and some pharmaceutical personnel hold several positions. This situation is particularly prominent in rural medical institutions. Third, the drug management system is not perfect. The quality of pharmaceutical affairs management depends on the effective implementation of scientific and sound management system. Most of the construction of pharmacy management system in rural medical institutions has not been put on the agenda. In fact, the pharmaceutical affairs management system of individual primary medical institutions is in a dispensable state, lacking both external pressure and internal motivation. Even the "incoming inspection and acceptance system" and "drug storage system" clearly stipulated in the Drug Administration Law have not been implemented in a considerable number of rural medical institutions, which has brought hidden dangers to the safe use of drugs. Fourth, the management level of pharmacies is low. In daily supervision, the level of pharmaceutical affairs management in rural medical institutions is obviously lower than that in large-scale comprehensive medical institutions and pharmaceutical trading enterprises. The technical level, legal awareness and quality awareness of drug-related personnel in rural medical institutions are generally low. Hospitals often only pay attention to the quantity management of drugs in and out, pay attention to the economic benefits of drugs, and ignore the quality management of drugs, and invest less in pharmacies, drug warehouses and facilities. The hardware of pharmacies and drug storerooms in many rural medical institutions is not as good as that of ordinary pharmacies, and the level of system and software construction is low, which can not meet the basic requirements of ensuring the safety and effectiveness of clinical medication. Fifth, the conditions of drug maintenance and storage facilities are poor, and the drug storage facilities in rural medical institutions can be described as "simple". First, the pharmacy is in poor condition, and there are no heat insulation devices, indoor air conditioners, curtains, exhaust fans, rat prevention devices and other facilities. Drugs are in direct contact with the ground or walls, and it is easy to absorb moisture and mold in wet and rainy seasons. In some medical institutions, especially village health clinics and individual clinics, all kinds of drugs are randomly placed and not classified as required, which is easy to be confused; Second, the cold storage is insufficient. 80% of medical institutions in the county have no cold storage, and the area of cold storage is not suitable for the scale of drug use, and the air conditioner has been closed for a long time, which can not play its due role. Third, the refrigeration equipment is not complete. Only medical institutions above the township level are equipped with refrigerators. 95% of village-level medical institutions do not have refrigerators, and those with refrigerators are mixed in the family. Some drugs that need to be refrigerated, such as placenta injection, are also stored at room temperature. The refrigerators in medical institutions above the township level are not used or not enough, and the refrigerators have not played their due role; Fourth, the storage vessels of traditional Chinese medicine are simple. It is common to pack traditional Chinese medicine in cartons, bamboo baskets and sacks, which leads to moisture absorption and mildew of traditional Chinese medicine pieces; Fifth, the thermometer is not fully equipped. Most medical institutions are not equipped with thermometers, and some are equipped with thermometers, and there is no record. When the temperature and humidity exceed the specified range, no measures are taken, and the temperature and humidity control becomes an empty talk; Sixth, some medical institutions lack drying, fumigation and other traditional Chinese medicine maintenance facilities; Seventh, dispensing drugs does not follow the principle of first-in first-out, which is arbitrary, leading to the discovery of expired drugs. Sixth, the drug procurement channels are not standardized and the quality risks are high. Because there is no system constraint, driven by economic interests, some medical units are willing to risk being investigated to purchase drugs from unlicensed operators, especially rural individual clinics, and the channels for drug procurement are chaotic. However, the sources of drugs provided by unlicensed operators are complex, the storage and maintenance conditions are poor, and there are no corresponding measures to ensure the quality of drugs, which is difficult to ensure, and there are great security risks. Because there is no quality acceptance system for purchased drugs, it is difficult to trace back to the source once the drugs have quality problems.
Second, the root cause of the status quo
There are many reasons for the relative confusion of drug management in rural medical institutions, which can be summarized as follows.
1, laws and regulations are not perfect. The Drug Administration Law and the Regulations for the Implementation of the Drug Administration Law clearly stipulate that pharmaceutical production enterprises and pharmaceutical trading enterprises that fail to implement gsp in accordance with the provisions shall be given a warning and ordered to make corrections within a time limit; If the circumstances are serious, the Drug Business License shall be revoked. By then, the access conditions for medical institutions to obtain drug use qualifications are different from those for pharmaceutical trading enterprises. Medical institutions can use drugs as long as they are approved by the administrative department of health and issued with the Practice License of Medical Institutions, and the scope of drug use is wide, and they can share three types of medical devices. Although the Regulations on the Administration of Medical Institutions have corresponding requirements on the facilities, equipment, professional health technicians and rules and regulations for applying for the practice registration of medical institutions, there are no specific detailed provisions, so the health administrative department
Before the issuance of the Practice License for Medical Institutions, on-site acceptance was rarely organized. To operate a pharmacy, the legal representative is required to have a high school education or above, and at the same time, there must be two technicians with the title of pharmacist or above, and they must pass gsp certification. In addition, general retail pharmacies must have two pharmaceutical technicians with the title of pharmacist or above in order to obtain the qualifications for operating three types of medical devices. So few people bid for pharmacies in rural areas, and many people bid for individual clinics. In addition, the scope of drugs used by medical institutions is stipulated by laws and regulations.
The rules are not clear. Article 27 of the Measures for the Supervision and Administration of Drug Circulation (Provisional) stipulates that "individual doctors and individual clinics in cities and towns may not set up pharmacies or engage in drug purchase and sale activities. In reality, self-employed doctors and clinics in cities and towns generally open pharmacies. Although the relevant explanations clarify the difference between villages and towns, there is no clear stipulation in laws and regulations on how to distinguish pharmacies from medicine cabinets, so how to punish violations of Article 27 is difficult to operate in reality.
2, do not pay attention to drug management, facilities and equipment investment is not enough. Rural medical institutions have always only paid attention to the renewal of medical equipment and the improvement of medical technology, and only adopted a coping attitude towards drug management. On the one hand, some medical institutions believe that the improvement of medical level and reputation depends entirely on the renewal of medical equipment and the improvement of medical technology of medical staff, and the management of drugs has no obvious direct impact on this. In particular, the funds of township hospitals are already in short supply, and the investment in drug management is not as fast as that in medical equipment. It costs thousands of dollars a year to buy an air conditioner in township medical institutions, and the value of drugs stored is only a few hundred dollars, which is not economical. The price of drugs that need to be kept in a cool cold storage in village clinics is only a few yuan. Even if they are seized by the drug supervision department, the amount of punishment is far less than the required investment; On the other hand, some people regard pharmacy as an auxiliary department, and the investment in capital and technology is obviously insufficient; Furthermore, in reality, the disputes caused by the use of drugs (even counterfeit and inferior drugs) by medical institutions are far less than those caused by other medical accidents. The above are the main factors that directly lead to insufficient attention to drug management and insufficient investment in facilities and equipment in medical institutions. In addition, rural medical institutions do not attach importance to the training of pharmaceutical practitioners. Every year, apart from the limited initial and intermediate training for pharmaceutical personnel, pharmaceutical personnel are rarely organized to carry out training on pharmaceutical knowledge and laws and regulations, which leads to the lack of professional knowledge and drug management knowledge of pharmaceutical personnel, the overall quality is low, and some pharmaceutical technicians lack professionalism and necessary professional ethics.
3. We still have the problem of insufficient supervision. Due to the short establishment of the drug supervision and administration department, few personnel, insufficient funds and backward law enforcement equipment, the supervision coverage has been affected. There are 23 township hospitals, 187 village clinics and 3 16 individual clinics in xx county, which are scattered and the frequency of supervision and inspection is less than twice a year, which is also the objective reason for poor supervision.
Third, countermeasures and suggestions to strengthen the management of pharmaceutical affairs in rural medical institutions
1. Bring pharmaceutical affairs management in rural medical institutions into the legal track. The problems mentioned above in the pharmacy management of rural medical institutions must be managed by a sound legal system. As we all know, medicine is a special commodity that directly affects people's health, and it is also one of the commodities strictly managed by laws and regulations. The current Drug Administration Law implements a strict market access system for the production and operation of drugs. Only when the legal conditions are met can a legal "license" be obtained. Because the market attribute of medical institutions in China has not been confirmed at the legal level for a long time, it still belongs to the nature of "using" units, so the "drug use" of medical institutions does not need to obtain the License, certification standards and gsp certification standards of pharmaceutical companies, and bears more than 80% of drug terminal consumption. It should be said that large general hospitals have formed many effective and successful experiences and practices in the construction of pharmacy management system for many years. However, the starting point of pharmacy management in a large number of rural medical institutions is low, and the implementation of the system is almost unwritten, let alone the implementation and guarantee of the system, which directly leads to the randomness, passivity and weakening of pharmacy management in rural medical institutions, resulting in a low level or even a negative cycle. In the practice of supervision, some rural medical institutions lack controllable drug quality assurance measures, and illegal acts are repeatedly prohibited. One of the main reasons is that the management of pharmaceutical affairs is not standardized and lacks the necessary system guarantee. The author believes that at this stage, it is urgent to establish a rural medical pharmacy management system. On the one hand, we must resolutely implement pharmaceutical laws and regulations and clearly stipulate relevant systems, such as the acceptance system of drugs purchased by medical institutions, the purchase and sale record system, and the drug storage system. On the other hand, it is necessary to proceed from reality, mobilize the enthusiasm of rural medical institutions, and formulate a set of management systems suitable for the characteristics of drug use in medical institutions in this region with reference to gsp certification standards of drug trading enterprises, such as procurement approval system, prescription deployment system, drug disassembly management system, drug quality post system, and drug quality accountability system.
At present, the legal system of pharmaceutical affairs management in medical institutions is not perfect. To strengthen and promote the pharmaceutical affairs management in rural medical institutions, we must rely on various forces, take effective measures, mobilize the enthusiasm and initiative of all parties, especially coordinate with the government and health administrative departments, and use legal, policy, self-discipline and economic means to effectively strengthen the pharmaceutical affairs management in primary medical institutions, and gradually move toward the track of legalization, standardization and science.
Investigation report of medical institutions 2 How to effectively supervise the new rural cooperative medical system is related to the vital interests of the people and whether the new rural cooperative medical system can develop healthily. Health supervision in Heilongjiang province is a newly established department, which was established with the development of forms. In order to do a good job in the supervision of the new rural cooperative medical institutions in the province, our department continued to explore and study, and from March 22 to March 3 1 organized personnel to investigate in three counties and three townships of Hailun City, Suiling County and Lanxi County. The research team visited the county health bureau, the county people's hospital and the township health center to understand the situation. The investigation report is as follows:
First, the basic situation of new rural cooperative medical care
After several years of exploration, Helen City, Suiling County and Lanxi County have initially established an effective management system and operation mechanism, and the compensation policy has been gradually improved, the compensation level has been gradually improved, the reimbursement procedures have been gradually simplified, the supervision ability has been gradually strengthened, the use of funds is reasonable and safe, the trust of farmers has been significantly improved, and the enthusiasm of farmers for participation has been continuously improved.
1, the basic situation of Helen.
Under the careful guidance of the Provincial Health Department and Suihua Health Bureau, and with the great attention of Helen Municipal Party Committee and Municipal Government, the new rural cooperative medical system in our city has achieved remarkable results by increasing payment, strengthening supervision measures and strict verification procedures. There are 28 designated cooperative medical institutions, including 23 townships. In 20xx, the number of participants reached 4006 18, and the participation rate reached 98%. Farmers' participation fund 1, 20 1, 000 yuan, and the total cooperative medical care fund reached 60.09 million yuan. * * Write off the medical expenses of 46 1.30 participating patients of 59.95 million yuan, including 58.36 million yuan for hospitalization and 0/.59 million yuan for outpatient service. The actual hospitalization rate is 45% at the provincial level and 59.95 million at the municipal level.
The fund is 60.09 million yuan. Up to now, the total amount of written-off capital is130,000 yuan.
2. The basic situation of Suiling County.
In 20xx, the registered population of agriculture in the county was 177337, the resident population of farmers was 140565, and the number of participants in the new rural cooperative medical system was 146638. The participation rate was 104 according to the resident population. 32%。 In order to achieve the goal of 98% participation rate in 20xx proposed by provinces and cities, the main leaders of the county government and the county magistrate in charge personally held a meeting of the heads of the new rural cooperative medical system to implement the tasks of the new rural cooperative medical system. The Health Bureau and the county joint management office personally went deep into the countryside to answer the policy questions of the new rural cooperative medical system face to face with farmers. The county's participation rate has achieved gratifying results. In order to make the participating farmers get the party's policy of benefiting the people, according to the requirements of provinces and cities for the new rural cooperative medical system, our county scientifically and reasonably formulated the compensation scheme, which ensured the more standardized and safe use and management of the new rural cooperative medical system funds.
3. Basic situation of Huoxing Township in Lanxi County.
Spark township area ***5 administrative villages, 32 natural villages; There are more than 3,300 villagers, and the permanent population is about10.5 million; * * * There are 5 village clinics, 18 village doctors. The participation rate of farmers in the township reached 100%. In the lobby of the township health center, the publicity column of the new rural cooperative medical system and the consultation telephone number jointly organized by farmers are hung, but the basic information of the specific patients is not publicized. All participants hold the new rural cooperative medical certificate, and all bills are machine-printed receipts during verification. The files for reimbursement of participating farmers are basically complete.
Second, the existing problems
Through the investigation, we can see that there are some management problems while we have made achievements.
1. This survey found that some cities have not applied for cooperative medical certificates for participating farmers so far, and some have applied for them without receiving receipts, but there are no photos and other materials, which brings inconvenience to the identification of the true identity of participating farmers. Some designated institutions are formed only by the oral statements of participating farmers, and the phenomenon of impersonation cannot be eliminated.
2. There are problems in the management organization of county agricultural cooperatives, and the technical structure of members is unreasonable. Due to the lack of talents in some aspects, there are technical problems in the supervision of designated medical care, such as reviewing cases and what kind of patients should be hospitalized and discharged. Because there is no independent office funds, the daily supervision of the new rural cooperative medical system is far away, and the supervision of designated medical institutions is not in place.
3. There are problems in designated medical institutions. The medical records of designated medical institutions are not standardized, the signs and processes are not open, and the prices of basic drugs are not open. There are also phenomena such as opening human prescriptions, large prescriptions, and discharging with drugs beyond the standard. In some hospitals, the phenomenon of "minor illness and great care" and "short illness and long management" is more prominent.
4. Participating in farmers' personal problems, some use loopholes in hospital management to make fake medical records to defraud insurance, and some directly sell fake medical bills to farmers to facilitate farmers to go home for reimbursement. In addition, the phenomenon of collusion between doctors and patients to defraud cooperative medical fund is also serious. For example, the patient's admission procedures are not standardized, the procedures are not standardized, and the identity is difficult to verify. In addition, some village Committee leaders proved unrealistic, which made it difficult to identify the nature of trauma patients and caused unnecessary losses to the new rural cooperative medical fund.
5. After the implementation of "government-led, provincial centralized online drug procurement", due to the construction of distribution system, distribution cost, supervision and other reasons, some township hospitals reported that basic drugs could not meet the demand, some patients had to go to county hospitals for treatment, and transportation and accommodation expenses increased the burden on some farmers.
6, the new rural cooperative medical network information transmission platform, some counties have not yet been established.
7. The management personnel of township designated medical institutions lack training.
Third, the countermeasures and suggestions to solve
First of all, it is necessary to clarify the contents of tripartite supervision among management institutions, designated medical institutions and patients, and carry out various forms of supervision such as legal supervision, audit supervision, democratic supervision, social supervision and special supervision for key issues such as fund management and standardizing the behavior of designated medical institutions.
1, strengthen the supervision of management institutions. Enrich the supervision power and improve the supervision ability. The province should strengthen training, so that supervisors of some supervision departments can master policies and prevent violations. The key to the safe, standardized and effective use of the new rural cooperative medical fund lies in the standardized management and strict audit of local, especially county and township related departments and institutions. With the full coverage of the new rural cooperative medical system and the improvement of fund-raising level, it is necessary to take strengthening the supervision of the new rural cooperative medical fund as a long-term and huge task, strengthen the supervision and inspection of fund management and use, comprehensively strengthen the supervision of fund raising, storage and disbursement, ensure the safe management and standardized operation of the fund, ensure that the fund is fully used for farmers, and effectively improve the medical security level of farmers.
2, strengthen the supervision of designated medical institutions. Strictly implement the provisions of the Measures for the Administration of New Rural Cooperative Medical Care in Heilongjiang Province, strengthen the supervision of designated medical institutions at all levels, increase the control of medical expenses, improve the management of limited charges for single diseases, strictly check the hospitalization times and average hospitalization expenses of designated medical institutions, strictly control medical expenses, reduce the burden on farmers, reduce unnecessary expenses of the new rural cooperative medical fund, and improve the efficiency of fund use. In addition, it is necessary to improve the evaluation system of medical records and prescriptions, regularly extract medical records and prescriptions from designated medical institutions, and concentrate on their evaluation by the expert Committee of the new rural cooperative medical system to further standardize medical service behavior.
3. Participating in the management of farmers. First of all, the designated medical institutions should identify the participating farmers; Second, the agricultural association strictly examines the people who go out. Third, the whole province should apply for unified certificates for participants in order to confirm their true and false identities.
4. Strengthen the construction of supervision team. It is suggested that the relevant state departments should formulate the personnel and staffing requirements of the new rural cooperative medical system at the provincial, municipal and county levels as soon as possible, and strengthen the handling and management capabilities.
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5. Strengthen the professional training of supervisors and agents and improve the service level.
6, increase the construction of new rural cooperative medical network information platform, and gradually realize the online audit, online monitoring, online information summary and timely early warning report of new rural cooperative medical funds in provinces, cities and counties, so as to better supervise the use of funds. Establish a one-stop synchronous settlement platform for reimbursement of new rural cooperative medical system and medical assistance funds of civil affairs departments.
7, as soon as possible, the introduction of new rural cooperative medical management regulations, so that the new rural cooperative medical management has laws to follow, rules to follow, and strengthen supervision.
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