中文摘要：

目的探讨基本药物制度背景下山东省乡镇卫生院慢性病患者处方合理用药情况。方法 2013年8月对基本药物制度实施前后山东省37家乡镇卫生院的慢性病患者处方进行收集,对其单张处方用药品种数、抗生素处方、注射剂处方以及处方书写清晰性和完整性等合理用药情况进行比较分析,并运用秩和比（RSR）与聚类分析相结合的方法对慢性病患者处方用药合理性进行综合评价。结果基本药物制度实施后,抗生素处方比例由34.0%（50/147）降至20.5%（60/292）、书写清晰处方比例由79.6%（117/147）升至90.4%（264/292）,差异均有统计学意义（P〈0.05）;而虽然单张处方药品种数超过5种的处方比例由21.1%（31/147）降至18.5%（54/292）、注射剂处方比例由33.3%（49/147）降至27.4%（80/292）、书写完整处方比例由20.4%（30/147）升至28.4%（83/292）,但差异均无统计学意义（P〉0.05）。在得分聚类中,慢性病患者处方的用药合理性大部分得分在＂中＂及以上（RSR用药≥0.399）,共占79.4%（232/292）。结论基本药物制度实施后,乡镇卫生院慢性病患者处方合理用药情况有所改善,并且处方用药合理性总体较为合理,但仍需进一步提升。

英文摘要：

Objective To investigate the rational drug use in the prescriptions for chronic patients in rural health centers of Shandong Province under the essential medicine system. Methods In August 2013,we collected the prescriptions for chronic patients in 37 rural health centers of Shandong Province before and after the implementation of essential medicine system. Several aspects concerning with rational drug use were analyzed, including the number of drug categories of each prescription, antibiotics prescription, injection prescription, the clarity of prescription writing and the completeness of prescription content. RSR and clustering analysis were jointly employed to make comprehensive evaluation of the rational drug use in the prescriptions for chronic patients. Results After the implementation of essential medicine system, the proportion of antibiotics prescriptions decreased from 34. 0%（ 50 /147） to 20. 5%（ 60 /292）,and the proportion of prescriptions with clear writing improved from 79. 6%（ 117 /147） to 90. 4%（ 264 /292）,with the differences both significantly different（ P〈0. 05）;the proportion of prescriptions with more than five drug categories decreased from 21. 1%（ 31 /147） to 18. 5%（ 54 /292）,the proportion of injection prescriptions decreased from 33. 3%（ 49 /147） to 27. 4%（ 80 /292）,and the proportion of prescriptions with complete content increased from 20. 4%（ 30 /147） to 28. 4%（ 83 /292）,while the three changes were not significant（ P〉0. 05）. From the RSR and clustering analysis, we knew that the rational drug use scores of most prescriptions reached ＂ middle level＂（ RSRdrug use≥0. 399）,with a proportion of 79. 4%（ 232 /292）. Conclusion After the implementation of the essential medicine system,rational drug use in the prescriptions for chronic patients in rural health centers has improved,and the prescriptions are mostly with rational drug use,while it still needs further improvement.