Source: People's Daily - People's Daily
Long-term prescription refers to a prescription that is appropriately increased by qualified physicians to eligible patients with chronic diseases in accordance with regulations. In recent years, under the social background of disease spectrum conversion and population aging, the population with chronic diseases in China is expanding, and the demand for long-term prescriptions is increasing.
Chronic diseases are also known as chronic noncommunicable diseases. According to the "Report on the Status of Nutrition and Chronic Diseases of Chinese Residents (2020)" released by the National Health Commission, compared with 2015, the prevalence of hypertension, diabetes, hypercholesterolemia, chronic obstructive pulmonary disease and cancer incidence in China has increased. Chronic diseases such as hypertension, diabetes, cerebrovascular disease, coronary heart disease, chronic lung disease, chronic renal insufficiency, etc., will affect the organs and functions of the body and damage health with the development of the disease. Patients with chronic diseases need long-term treatment to improve the quality of life. Under the control of treatment methods such as regular examination and timely medication, patients with chronic diseases who are in a stable period only need to follow up and prescribe drugs regularly.
According to the "Prescription Management Measures" promulgated by China in 2007, prescriptions generally must not exceed 7 days of dosage; for some chronic diseases, geriatric diseases or special circumstances, the prescription dosage can be appropriately extended, but the physician should indicate the reason. In 2015, the General Office of the State Council issued the Guiding Opinions on Promoting the Construction of a Graded Diagnosis and Treatment System, and in 2018, the National Health Commission and the State Administration of Traditional Chinese Medicine jointly issued the Opinions on Accelerating the High-quality Development of Pharmaceutical Services, which clearly stated that long-term prescriptions can be prescribed to patients with chronic diseases. In practice, some localities have also formulated policies to provide long-term prescription management for chronic diseases, which are welcomed by patients. In August this year, the General Office of the National Health Commission and the Office of the National Medical Insurance Bureau issued the Notice on Printing and Distributing Long-term Prescription Management Specifications (Trial), proposing to implement a long-term prescription policy for eligible patients with chronic diseases. According to the document, patients can be prescribed chronic disease medication in primary medical and health institutions; the amount of long-term prescription is generally within 4 weeks, and the maximum is not more than 12 weeks.
Experience has shown that long-term prescription is generally suitable for patients with chronic diseases with clear clinical diagnosis, stable medication regimen, good compliance, stable disease control, and long-term drug therapy. According to the regulations, in the future, long-term prescriptions can be issued in grass-roots medical and health institutions, which are not suitable for diagnosis and treatment at the grass-roots level, issued by medical institutions at or above the second level, and the first long-term prescription should, in principle, be issued by physicians with intermediate or higher professional titles in medical institutions at or above the second level who have a professional title related to the disease; in terms of the scope of drugs, it is relaxed to the general drugs commonly used for the treatment of chronic diseases, and medical insurance is reimbursed according to the policy, and the number and amount of single prescriptions are not restricted; the grass-roots medical institutions can also share and circulate long-term prescriptions with higher-level hospitals. Previously, a large number of patients with chronic diseases went to large hospitals to regularly see doctors and prescribe prescriptions to buy drugs, and the frequency of medical treatment was relatively high, which was one of the factors that caused overcrowding in large hospitals. At the same time, the cost of patients is also relatively high, and the proportion of reimbursement is not as high as that of primary medical institutions. Decentralizing long-term prescribing authority to the grassroots can help achieve graded care, improve access to medicines, and reduce the burden on patients.
Facing the future, we should also focus on improving supporting measures and incentive methods, so that grass-roots medical institutions can prescribe reasonable long-term prescriptions, and provide guarantees in terms of quality and pharmaceutical management to ensure that long-term prescriptions are safe and effective. In recent years, many places have established urban medical associations and county medical communities, and implemented the contract service of grass-roots family doctors, which is conducive to strengthening the guidance of grass-roots medical institutions in the consortium, which is conducive to quality control of long-term prescriptions and follow-up management of long-term prescription patients. For example, thanks to the construction of a close-knit medical federation and a medical community, Sanming City in Fujian Province, Shenzhen City in Guangdong Province and other places have explored the establishment of a mechanism for package payment, balance retention, reasonable overexpenditure sharing mechanism, efficient use of medical insurance funds and basic public health service funds, and encouraged grass-roots medical institutions to strengthen the management of chronic disease patients and improve service quality, ensuring the safety and effectiveness of long-term prescriptions. Relevant experience is worth referencing.
Small prescriptions are related to the health of the whole people. Safe and effective long-term prescriptions protect the health of the majority of patients and protect the happy life of the masses. Only by establishing a sound guarantee mechanism and taking advantage of the situation can we better benefit the masses and help the construction of a healthy China.
People's Daily (04 November 2021 05 edition)