Objective: This study aims to analyze the outpatient prescriptions in primary rural health institutions in western China to reveal the feature and disadvantages of utilization of Chinese patent medicines in rural areas.Methods: A total of 14336 prescriptions were selected from 132 health institutions in rural areas of 7 provinces in western China in 2011.The utilization of Chinese patent medicines is described and compared to the health institutions in different levels and different provinces/autonomous regions.Results: The prescriptions of Chinese patent medicines accounted for 62.47% of the total prescriptions in rural health facilities.The proportion of county, township and village medical institutions was 49.76%, 56.96% and 71.51% respectively.86.84% of the Chinese patent medicines prescriptions were prescribed by physicians without traditional Chinese medicine background, while only 13.16% of them were traditional Chinese medicine physicians.The number of varieties of Chinese patent medicines in a single prescription in county, township and village health institutions were 1.38, 1.91 and 2.54, respectively and the average drug costs of every prescription in these health institutions were 52.20 yuan, 21.89 yuan and 19.37 yuan, respectively.Conclusions: There are differences in the utilization of Chinese patent medicines in outpatient prescriptions of rural health institutions in western China.The hospitals in higher medical level use more Chinese patent medicines.The drug cost of the prescription of county health institutions is higher than that of township and village hospitals.This study suggests that health policy should be adjusted based on the specific needs and characteristics of rural health institutions at a different level and should be implemented in the management of prescription in quality control.