To investigate the accessibility and rationality of in-home self-medication among acute disease patients in Gansu, offering evidence for standardizing in-home medication, and improving accessibility and rationality of in-home self-medication in this group.

By use of multistage stratified random sampling, 1 080 households were selected from five cities in Gansu Province from June to December 2018. They were invited to attend a survey guided by the WHO Household Survey to Measure Access to and Use of Medicines for understanding the morbidity in household members in the past two weeks, use and accessibility of medicines for treating acute diseases using a questionnaire developed by our research team. The survey results were statistically analyzed. Spearman correlation analysis was used to analyze the correlation between acute diseases, accessibility and availability of medicines for treating acute diseases and the number of drugs and antibiotics.

Out of the 1 080 households, 1 071 (99.17%) effectively responded to the survey. The prevalence of acute diseases in family members living in these households in the past two weeks was 36.32% (389/1 071) . In this study, we only included the youngest family member with acutely disease in each household, that is, 389 cases in all. Of them, 350 (89.97%) had an acute upper respiratory infection; 355 (91.26%) had the behavior of seeing a doctor or buying drugs; 355 (91.26%) were on medication for treating acute diseases. Among all cases on medication, 279 (78.59%) used combination therapy, 93 (26.20%) had four or more medications simultaneously, and 151 (42.54%) were on antibiotics. Among all antibiotics users, 133 (79.17%) took antibiotics recommended by doctors, and 136 (80.95%) used β- Lactam antibiotics. In terms of medicine accessibility, 334 (85.86%) of acute disease patients were able to reach the nearest medical facility within 15 minutes; 354 (91.00%) and 329 (84.58%) reported that the required drugs were available at the public medical facilities and pharmacy, respectively. Among all cases on medication, 349 (98.31%) had medical insurance, but only 64 (18.34%) were reimbursed; 42 (11.83%) reported that the spending on medicines accounted for over 20% of the total household spending. There were statistically significant differences between patients in urban and rural areas at the avenues of seeing a doctor or buying drugs, types of antibiotics used, 15 minutes proximity to the nearest medical facility, accessibility to drugs at pharmacies, drug reimbursement rates, and spending over 20% of total household expenditure on drugs for acute illnesses (P<0.05) . Spearman correlation analysis showed that accessibility to drugs at the pharmacy was positively correlated with the number of drugs taken (r_s=0.145, P<0.05) .

The accessibility to drugs among acute diseases patients in Gansu Province is high. However, there are also issues among patients, including high prevalence of combination therapy and antibiotics intake, low proportion of patients who are reimbursed by medical insurance, as well as urban and rural differences in medicine accessibility. Therefore, to regulate residents' self-medication behaviors, it is suggested that relevant government departments give priority to actions to raise residents' awareness levels of rational medication and health insurance, medical professionals' capabilities and supervision of antibiotics use.

了解甘肃省急性病患者家庭用药合理性和药品可及性现况，为规范甘肃省急性病患者家庭用药行为，提高其用药合理性和药品可及性提供参考依据。

依据世界卫生组织（WHO）《药品可及性及药品使用情况入户调查指南》，拟定调查问卷。采取分层多阶段随机整群抽样法，于2018年6—12月选取甘肃省5市共1 080户家庭作为调查户，采用自设问卷对过去2周家庭成员患急性病情况、因患急性病服药情况及相关药品可及性状况等进行调查，并对调查结果进行分析。采用Spearman秩相关分析急性病患者患急性病情况、药品地理可及性、药品可获得性与其服用药品、抗菌药物数量间的相关性。

共发放问卷1 080份，回收有效问卷1 071份，有效问卷回收率为99.17%。调查结果显示，389户（36.32%）家庭过去两周有急性病患者。本研究选取每户中年龄最小的急性病患者进行调查，共纳入急性病患者389例。其中350例（89.97%）患急性上呼吸道感染，355例（91.26%）因患急性病产生就诊或购药行为，355例（91.26%）因患急性病服药。因患急性病服药的调查对象中，279例（78.59%）存在联合用药，93例（26.20%）同时服用≥4种药品，151例（42.54%）服用了抗菌药物。151例因急性病共使用168例次抗菌药物，其中133例次（79.17%）来自医生推荐，136例次（80.95%）为β-内酰胺类药物。药品可及性方面，334例（85.86%）急性病患者15 min以内能够到达最近的医疗服务机构；分别有354例（91.00%）、329例（84.58%）急性病患者认为其所需药品能在公立医疗机构、药店购得。355例因患急性病服药的调查对象中，349例（98.31%）有医保，其中仅有64例（18.34%）急性病药品费用医保予以报销；42例（11.83%）急性病药品支出在家庭总支出中的占比>20%。城、乡急性病患者就诊或购药渠道分布、抗菌药物使用类型、15 min以内能够到达最近的医疗服务机构者占比、所需药品能够在药店购得者占比、急性病药品费用医保予以报销者占比、急性病药品支出占家庭总支出>20%者占比比较，差异有统计学意义（P<0.05）。Spearman秩相关分析结果显示，所需药品能否在药店购得与急性病患者服用药品数量呈正相关（r_s=0.145，P<0.05）。

甘肃省急性病患者药品可及性较好，但存在联合用药情况普遍、抗菌药物使用率高和急性病药品费用获医保报销者比例偏低等问题，且城、乡急性病患者在药品可及性方面存在一定差异。建议相关部门重视对城、乡居民的合理用药知识与医保基本知识的普及，并通过提升医务人员专业能力、加强抗菌药物使用监管力度，最终规范居民的自我用药行为。