On December 29, the National Health Commission and other 5 departments issued the "Implementation Plan for Saving Drug Resources and Curbing Drug Waste", proposing that under the premise of ensuring the quality of drugs, reasonable packaging specifications should be used to actively purchase large-package drugs. For outpatient and emergency patients, if the large packaging of drugs is involved, the drug dismantling and dispensing service can be provided to reduce the loss of drugs and facilitate the use of patients.
In the current DRG payment model, controlling the cost of consumables is the key, so the implementation of drug packaging is inevitable and the future development trend. On December 30, Kang Zhen, executive vice chairman of the Rational Drug Use Committee of the China Association of Traditional Chinese Medicine, told the people's health client reporter that if in the future in community pharmacies, pharmacists will implement the dismantling and dispensing of drug business for outpatients' prescriptions for chronic diseases, and at the same time carry out drug management services, which can more accurately meet the drug needs of patients to a certain extent, not only reduce drug waste and patients' economic burden, but also greatly reduce medical insurance costs.
As early as the 80s of the 20th century, in the outpatient pharmacy of the hospital, the doctor prescribed the patient, the patient handed the prescription to the pharmacist, and after the pharmacist reviewed the prescription, he would hand over the prepared small paper bag medicine to the patient, and at the same time explain the medication, and the patient would take the pills on time after returning home. Such a scene was still relatively common at that time, but this practice gradually disappeared from the public eye after entering the 21st century, and was replaced by most drugs made into "fish bubble eyes", one board by one, not much in a box, but the packaging cost is a lot.
In 2013, the Health Times paid attention to the topic of drug waste, and during the two sessions in 2013, it launched a key report "Drug Waste is Shocking", when a survey showed that about 46% of netizens said that they waste 100 300 yuan of drugs every year, and conservatively estimated that the annual waste of drugs in families across the country was enough to exceed 10 billion yuan. Hospitals and pharmacies are unable to discount retail drugs, resulting in the sale of drugs in whole packages is the first reason for drug waste. At that time, Wen Jianmin, a member of the National Committee of the Chinese People's Political Consultative Conference (CPPCC) and a professor of orthopedics at Wangjing Hospital of the China Academy of Chinese Medical Sciences, submitted the "Proposal on Curbing Drug Waste" to the National Committee of the Chinese People's Political Consultative Conference (CPPCC) in 2013 on opposing drug waste, calling for small packaging of drugs, and dismantling sales. A number of experts appealed through the Health Times to pay attention to the situation of drug waste, implement multiple measures such as dismantling and dispensing drugs, and put an end to drug waste.
Previously, the regulations on drug dismantling and dispensing have always existed in the GSP management of pharmacies, but in fact they are rarely carried out, and there are many reasons behind this. In addition, almost all the drug packaging sold is a small package specification, but some drugs are specially produced in order to increase the sales of enterprises, but this is not the real clinical demand for large packaging. Kang Zhen said that when drugs are sold in parts, consumers will be reluctant to buy because they are worried about the quality and quality of drugs. For pharmacies, the sale of drugs in parts will actually reduce the sales volume itself. "In addition, the sales model of drug dismantling is very risky for the management of drugs, and the process of drug dismantling needs to have strict operating specifications and professional sense of responsibility, which may cause drug safety problems if you are not careful, and the cost is not low and the risk is greater. ”
The reporter learned that from 2000 to the present, the state has revised the "Drug Business Quality Management Standards" many times, which clearly stipulates that drug retail operations should include "drug sales". On January 4 this year, the General Department of the State Food and Drug Administration issued the "Notice on Strengthening the Quality Supervision of the Zeroing and Sales of Drugs for the Prevention and Control of the New Crown", which requires that the drug retail enterprises be supervised and guided in the dismantling and sales behavior, and urge the drug retail enterprises to establish and improve the quality management system and sales operation procedures for drug dismantling, equip the places and tools required for drug dismantling, and arrange specially trained personnel to carry out the dismantling work.
The reason why drugs have become small packages is because the ** of drugs has been rising. According to Kang Zhen, in the environment of bidding and price reduction, the strategy adopted by enterprises is to improve the relative drug ** by turning large packages of drugs into small packages. At present, the state advocates the use of drugs and encourages the use of large drug packaging models, which is not only to reduce the quality of drugs, but also to reduce the waste of various resources. "There are many drug consumables in small packages, and the medication of hospital inpatients often requires a certain amount of manpower, material and financial resources to disassemble and package, resulting in a waste of resources. Under the centralized bidding and procurement policy of national negotiations, enterprises are increasingly under the pressure of negotiating the cost of drugs, and in turn need to implement large drug packaging to reduce the cost of drugs in order to cope with the requirements of price reduction. ”
Kang Zhen said that at present, many patients prescribe or buy drugs as family backup medicines, some patients take medicine when they are sick, and no longer take medicine when the symptoms are relieved, and some patients stop taking medicine without authorization when they feel ineffective when they take half of the medicine. "In fact, there is still a lack of effective management of patients' medication by pharmacists, which not only affects the efficacy of patients' disease course, but also wastes a lot of resources. ”
Today, a proposal to curb drug waste has finally been introduced. "Judging from the document policy issued this time, the country really sees the waste of drugs. Kang Zhen said, however, there is still a way to go to do a good job in drug dismantling and dispensing. In addition, it is also necessary to improve the professional level of the entire pharmacist team in order to better control the rational use of drugs in clinical practice. In addition, the purpose of drug dismantling and dispensing is actually more to help patients with comorbidities and multiple drugs or patients with cognitive impairment, especially the elderly in nursing homes, to use drugs correctly and reasonably, so I think that the current community pharmacy should help nursing homes do this work, which is conducive to the drug safety of the elderly. However, it is also necessary to introduce relevant policies to promote the development of pharmacists and actively participate in the drug management of patients. ”