Abstract: Objective　To investigate the status of rational drug use in highly focused areas during the comprehensive reform of primary care system in China.Methods　By stratified multistage random sampling，from 34 highly focused districts/counties，102 grassroots medical institutions were selected，and from each of these institutions，about 100 prescriptions were sampled in 2014，and in April or May 2016.Ration drug use was assessed by average number of drugs per prescription，percentage of antibiotic prescriptions，percentage of intravenous prescriptions，percentage of hormone prescriptions，and average cost per prescription for drugs.Results　In the sampled institutions in 2016，the average number of drugs per prescription （2.20 vs 2.52），percentage of antibiotic prescriptions （27.72% vs 34.62%）and percentage of intravenous prescriptions （19.82% vs 24.41%） showed significant decrease，while the average cost per prescription for drugs demonstrated significant increase （74.4 yuan vs 66.5 yuan） compared with 2014 （P<0.05）.In 2016，the average number of drugs per prescription in grassroots medical institutions was greatest in Chengdu （3.79） and Sanming （2.72），and least in Zhenjiang （1.59） and Jilin （1.61）.The percentage of antibiotic prescriptions in grassroots medical institutions was greatest in Chifeng （42.5%） and Nanchang（39.9%），and least in Shanghai（8.0%） and Beijing （13.0%）.The highest proportion of intravenous injection use was found in Chifeng，of 46.0%；Chengdu，Shanghai，Beijing ，Xiangtan and Sanming ranked the last five all below 10.0% .Grassroots medical institutions in Jilin had the highest percentage of hormone prescriptions（37.3%），while those in Shanghai （0.3%），and Beijing （0.8%） had the least.With regard to the average cost per prescription for drugs，the highest-ranked city was Beijing （219.1 yuan），while the three lowest-ranked cities were Guiyang，Xining and Linyi （all less than 30.0 yuan）.Conclusion　As a whole，rational drug use in primary care improved significantly.However，irrational drug use was also found in some of the sampled areas.Therefore，multiple targeted measures should be taken to promote rational drug use in primary care.

Key words: Health care reform, Rational use of prescriptions, Community health services

摘要： 目的　了解基层卫生综合改革重点联系点合理用药情况。方法　采用多阶段分层随机抽样的方法，在34个重点联系区县抽取102个基层医疗卫生机构，每所基层医疗卫生机构抽取2014年和2016年4月或5月内的100张左右处方。选用每处方用药种数、抗生素使用比例、静脉注射剂使用比例、激素使用比例及次均处方金额评价合理用药情况。结果　2016年与2014年相比，重点联系点每处方平均用药种数从2.52种下降到2.20种，抗生素使用比例从34.62%下降到27.72%，静脉注射剂使用比例从24.41%下降到19.82%，次均处方金额从66.5元增加到74.4元，差异有统计学意义（P<0.05）。2016年重点联系点每处方平均用药种数排序前2位的城市是成都市和三明市，分别为3.79种和2.72种；排序后2位的城市是镇江市和吉林市，分别为1.59种和1.61种。抗生素使用比例排序前2位的城市是赤峰市和南昌市，分别为42.5%和39.9%；排序后2位的城市是上海市和北京市，分别为8.0%和13.0%。静脉注射剂使用比例最高的城市是赤峰市，为46.0%；排序后5位的城市是成都市、上海市、北京市、湘潭市及三明市，均低于10.0%。激素使用比例最高的城市是吉林市，为37.3%；排序后2位的城市是北京市和上海市，分别为0.3%和0.8%。次均处方金额最高的城市是北京市，为219.1元；排序后2位的城市是贵阳市和临沂市，均少于30.0元。结论　基层合理用药情况总体上明显改善，但部分重点联系点仍存在不合理用药的情况，应该继续多措并举推进基层合理用药。

关键词: 卫生保健改革, 合理用药, 社区卫生服务