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首页> 外文期刊>The Internet Journal of Pharmacology >Why Health Care Managers Are Reluctant To Rational Use Of Medicines? Case Study In A Regional Hospital Morocco
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Why Health Care Managers Are Reluctant To Rational Use Of Medicines? Case Study In A Regional Hospital Morocco

机译：为什么医护人员不愿合理使用药物？摩洛哥地方医院的案例研究

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Background: Irrational medicine use is a major health problem. It is responsible for low medical care quality and squandering of valuable resources in low and middle income countries. In Morocco, the ministry of health implemented rational medicine use policy in order to optimize drug usage and ensure access to medicine for deprived population. To what extend hospitals have implemented rational medicine use strategy? What are the major facilitators and barriers to its implementation?Method: We have conducted an in dept qualitative case study using document analysis and semi structured interviews with health care managers at strategic, tactical and operational level.Results: Implementation gap between policy of rational use of medicines and the actual practices in hospitals is partly due to the lack of information management systems, low commitment of professionals and non effective institutional communication. Main facilitating factors are technical support from Ministry level executives and the institutionalization of medicine committee.Conclusion: In order to improve rational medicines use it is necessary to institutionalize medicine committee in hospitals and trigger change through communicating and implementation of medicine related information management system. Background Medicines are a major building block of health systems according to its therapeutic impact and economic costs. Moreover, patients consider medicines as major determinant of health system’s trustworthiness (1)(2)(3). Rational medicine use is a cost effective strategy that ensures effective and secure medical prescriptions, optimize resources utilization and enhance quality of care and health promotion (3)(4). Though, irrational medicine use is a major public health issue according to its frequency, socioeconomic cost and severity (5). In 2010, The World Health Organization (WHO) estimates to 50% the frequency of irrational medicine use which has an impact on population access to medicine (6)(7). Irrational medicine use is responsible for antibiotic resistances, iatrogenic effects, financial resource’s squandering and reduction of deprived population access to medicine (8–14)Thus, the WHO urges government to implement strategies in order to optimize medicine usage and reduce social, economic, and health consequences of irrational medicine use (5,7,15–19)In order to ensure accessibility and availability of medicines, the ministry of health in Morocco has implemented several strategies through an insurance scheme for economically deprived population (RAMED[1]), increasing budget which represents actually 31,7% of global health expenditures (National Health Account 2010), promoting generic medicine policies and joint purchasing of medicines, legislation of medicine use in hospitals and specific ministerial circular of rational medicine use (N° 146/DHSA).(20–22). Nevertheless, irrational medicine use still problematic in Moroccan healthcare facilities which reinforce social exclusion for populations with limited resources (48, 6% household care expenditures) insufficient prescription of generic medicines in public hospitals and resistance of professionals to comply with these legal norms. Therefore, public hospitals and pharmacies are suffering from medicine logistic management issues such as (expiry, shortage and storage saturation) (20,22–26).How could we explain lack of compliance of public hospitals professionals to rational medicine use strategy?We conducted a case study research in a regional hospital to assess to what extend rational medicine practices are implemented (Circular N°146/DHSA) and to analyze contextual factors that enable or limit rational drug strategy implementation.Our study has practical and theoretical implications. It provides theoretical foundations of organizational, political, psychological levers and barriers of the implementation of rational medicine usage in public hospitals. In practice, it will provide hospital managers with
机译：背景：不合理用药是一个主要的健康问题。它造成了低质量的医疗服务，并浪费了中低收入国家的宝贵资源。在摩洛哥，卫生部实施了合理的药物使用政策，以优化药物使用并确保贫困人口获得药物。医院在何种程度上实施了合理用药策略？方法的主要推动因素和障碍是什么？方法：我们在战略，战术和运营层面使用文档分析和半结构化访谈与卫生保健经理进行了定性的案例研究结果：合理使用政策之间的实施差距医院的药品和实际操作情况的部分原因是缺乏信息管理系统，专业人员敬业度低和无效的机构沟通。主要的促进因素是部级管理人员的技术支持和医学委员会的制度化。结论：为了改善合理的药物使用，有必要使医院的医学委员会制度化，并通过与医学有关的信息管理系统的沟通和实施来触发变革。背景技术根据药物的治疗效果和经济成本，它们是卫生系统的重要组成部分。此外，患者将药物视为卫生系统可信赖性的主要决定因素（1）（2）（3）。合理用药是一种具有成本效益的策略，可确保有效和安全的医疗处方，优化资源利用并提高护理和健康促进质量（3）（4）。但是，根据使用频率，社会经济成本和严重性，不合理用药是一个主要的公共卫生问题（5）。在2010年，世界卫生组织（WHO）估计使用不合理药物的频率会增加50％，这会影响人们获得药物的机会（6）（7）。不合理用药会造成抗生素耐药性，医源性影响，浪费财政资源并减少穷人获得药物的机会（8-14），因此，世卫组织敦促政府实施战略，以优化药物使用并减少社会，经济和社会负担。不合理用药的健康后果（5,7,15-19）为了确保药品的可及性和可用性，摩洛哥卫生部通过一项针对经济贫困人口的保险计划实施了若干战略（RAMED [1]），增加预算，实际上占全球卫生支出的31.7％（2010年国家卫生帐目），促进仿制药政策和药品的共同购买，医院用药立法以及合理用药的特定部长级通告（第146 / DHSA号） ）。（20-22）。然而，摩洛哥医疗机构中的不合理用药仍然存在问题，这对于资源有限（48％，6％的家庭护理支出），公共医院处方药不足和专业人员抵抗遵守这些法律规范的人群而言，加剧了社会排斥。因此，公立医院和药房正面临着药品物流管理问题，例如（过期，短缺和存储饱和）（20,22–26）。我们如何解释公立医院专业人员对合理用药策略的依从性不足？在一家地区医院进行案例研究，以评估实施合理药物实践的范围（第N°146 / DHSA号通告），并分析可实现或限制合理药物策略实施的背景因素。我们的研究具有实际和理论意义。它提供了组织，政治，心理杠杆的理论基础，以及在公立医院实施合理用药的障碍。实际上，它将为医院管理人员提供

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