Zhongguo quanke yixue (Mar 2022)
The Availability of Essential Medicines and Diagnostic Devices for Chronic Obstructive Pulmonary Disease in Primary Care
Abstract
BackgroundChina has seen a significantly increased prevalence of chronic obstructive pulmonary disease (COPD) recently. But primary care institutions, the main "battlefield" for containing COPD, have shown relatively weak capabilities for the diagnosis and treatment of disease. As there are relatively few large-scale investigations and studies on medicines and diagnostic devices for COPD in primary care, we conducted this study to further understand the weaknesses of current COPD containment in primary care, by which the gap in related research may be made up.ObjectiveTo understand the allocation and availability rate of essential medicines for COPD, and availability rate of spirometer as well as the implementation of pulmonary function tests in primary care.MethodsFrom February to March 2021, a multi-stage cluster sampling was adopted to select 8 176 community (township) health centers from 31 provinces of China to attend a survey. The rates of availability and allocation of each of the 16 essential medicines for COPD in the 2018 National Essential Medicines List were calculated to estimate the categories and number of these medicines in primary care institutions. The rate of availability of spirometer in these institutions was estimated. And the rate of implementation of pulmonary function tests in these institutions was estimated.ResultsAltogether, 7 458 (91.22%) institutions who gave effective responses to the survey were included for analysis, including 5 901 (79.12%) township health centers, and 1 557 (20.88%) community health centers. Among the 16 essential medicines for COPD, less than 8 were available in 6 538 (87.66%) institutions, at least 1 inhaled antiasthmatic medicines were available in 4 992 (66.00%) institutions, and long-acting inhaled antiasthmatic medicines were available in 814 (10.91%) institutions. The average availability rate of 16 essential medicines for COPD was 33.30%. The highest ranked three medicines in terms of availability rate were ambroxol〔85.28% (6 360/7 458) 〕, aminophylline〔81.17% (6 054/7 458) 〕 and compound licorice〔74.48% (5 555/7 458) 〕. And the relatively low-ranked three were fluticasone propionate 〔4.89% (365/7 458) 〕, tiotropium bromide〔6.25% (466/7 458) 〕, budesonide forterol〔8.61% (642/7 458) 〕. The average availability rate of 6 inhaled antiasthmatic medicines in community health centers was 28.31%, and that in township health centers was 4.81%. The average availability rate of 2 long-acting inhaled antiasthmatic medicines in community health centers was 16.18%, and that in township health centers was 5.12%. The average availability rate of spirometers in primary care institutions was 8.94% (667/7 458) . The average availability rate of spirometers in community health centers was higher than that of township health centers〔18.56% (289/1 557) vs 6.41% (378/5 901) , P<0.05〕. Pulmonary function tests were implemented in 10.82% (807/7 458) of the institutions. The rate of community health centers was higher than that of township health centers in terms of offering pulmonary function testing services〔13.81% (215/1 557) vs 10.03% (592/5 901) , P<0.05〕.ConclusionThe available essential medicines for COPD in these primary care institutions were insufficient with unbalanced distribution. Most of available medicines were oral preparations, and inhaled antiasthmatic medicines, especially long-acting inhaled antiasthmatic medicines, were poorly available. Moreover, the availability rate of spirometers and the implementation rate of pulmonary function tests were both relatively low. All these factors negatively influence early screening for and management of COPD in primary care. In view of this, it is recommended that increasing the availability levels of inhaled antiasthmatic medicines and portable spirometers, and the application of pulmonary function tests in primary care, as well as primary care physicians asompetencies and initiatives for the prevention, diagnosis, treatment and rehabilitation of COPD with the delivery of the national essential publish health services for COPD as the starting point of enhancement trainings.
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