Whether medicine supply is really meeting primary health care needs—a mixed-methods study in Shandong Province, China

Abstract

Background With the ageing population, the increasing prevalence of chronic non-communicable diseases, and the diversified needs for primary health care (PHC) medicines, it is necessary to rethink the functional role of the supply of PHC medicines. This study aims to comprehensively evaluate the supply of PHC medicines and the status of meeting PHC medicine needs. Methods We did a mixed-methods study to evaluate the supply of PHC medicines in Shandong Province. In the qualitative study, semi-structured interviews were conducted with the pharmacy managers, physicians, and patients in county hospitals, township hospitals, and village clinics; in the quantitative study, survey questionnaires were distributed to county hospitals, township hospitals, and patients, and a prescription review was performed in township hospitals. A senior pharmacist from a tertiary hospital accompanied us on a visit to inspect the PHC pharmacies. These quantitative assessments were triangulated with qualitative pharmacy managers, physicians, and patients and discussions. Results The supply of PHC medicines based on the existing medicines list was relatively good, and shortages occurred sporadically and locally, resulting a minor impact on clinical medication. 211 county hospitals and 1,581 township hospitals participated in the survey, revealing an average annual frequency of medicine shortages of 8.6 times for county hospitals and 5.7 times for township hospitals. Nonetheless, off-list medicines were in short supply, failing to meet patients’ need as determined by health outcome. Of the 6,323 patient medication surveys, 945 (14.9%) indicated medicine shortages, with half of these attributable to organizations lacking required medicines. On average, the prescription qualified rate of 37 township hospitals was 72.2%. The study revealed the need to optimize the list of PHC medicines and strengthen the capacity of healthcare services. Conclusions The discrepancy between patients’ need for PHC medicine and present medicine supply is noteworthy. The supply of PHC medicines should shift its focus from providing medicines based solely on an existing list to prioritizing health outcomes to adequately meet patient medicine needs. Integrated health care may be a novel strategy to establish unified medicines lists and achieve uniform pharmaceutical services in PHC.