An analysis on the factors associated with reuse of insulin pen needles in type 2 diabetic patients in China

Incorrect injection technique of insulin is a common problem worldwide,which can reduce the efficacy of insulin therapy and lead to poor glucose control.A cross-sectional,multiple-center survey from 44 hospitals was conducted from Nov.2015 to Dec.2015.Non-parametric Kruskal–Wallis analysis of variance and Mann-Whitney U test were used for multi-parametric analysis.Multivariable logistic regressions were performed to identify the factors associated with independent variables.Overall,a single needle was used at an average of 3.79 times,with the highest of 60 times.Analysis across all study participants showed that the frequency of a single needle was positively correlated with age（P = 0.029）,duration of diabetes（P≤0.001） and number of complications（P≤0.001）.Multivariable logistic regressions analysis of insulin pen needle reuse and needle compliance showed that age,income,education,marital status,duration of diabetes,quality of life and cost of drug were significantly related to needle reuse.From this survey,we found that reuse of insulin pen needle was common in China.Frequency of needle reuse was related to the patients＇ demographic characteristics（income level,age,region,education,employment status and self-care）,health-related variables（duration of diabetes,number of complications and EQ-5 D index scores） and utilization of health services（clinical visits,hospitalization and cost of medications）.

Impact of the zero-markup drug policy on volume of medical service:based on 57 county hospitals of China

In the present study,we aimed to assess the long-term impact of zero-markup drug policy on volume of medical service in county hospitals of China.This study used 57 county hospitals’records of medical service from 2011 to 2015,and a fixed effect model was applied to examine the impact of the zero-markup drug policy on volume of medical service.The outcome indicators included the number of patient visits,the number of prescriptions,the number of discharged patients,the length of stay,the number of patients who had surgeries and the number of patients who had CT or MRI,monthly.The number of hospitals which implemented the zero-markup drug policy was increased continuously.By the end of 2015,41 hospitals(71.9%)implemented this policy.The panel regression showed that most indicators were insignificantly decreased,including the number of patient visits(P<0.01),the length of stay(P<0.05),the number of patients who had surgeries(P<0.01)and the number of patients who had CT or MRI(P<0.01).However,the number of prescriptions and the number of discharged patients were not significantly changed.The implementation of the zero-markup drug policy might affect the reduction of the volume of medical service in county-level hospitals and the reason needs to be clarified in future studies.

Trends on medicine use in county public hospitals in Sanming,China from 2011 to 2017

Sanming model in healthcare reform has attracted much attention due to its comprehensive and efficient exploration,while its impact on physicians’prescribing behavior remains unknown.In the present study,we aimed to evaluate the impact of Sanming reform on physicians’medicine use in county-level public hospitals.We collected outpatient prescriptions in the internal medicine and pediatric departments from nine county public hospitals in Sanming from January 2011 to December 2017.We used six prescribing indicators to analyze physicians’medicine use.The Mann-Kendall test was used to examine trends in the study outcomes.A total of 1577904 outpatient prescriptions were included in this study.The average prescription rate of antibiotics and combined antibiotics were 57.5%and 12.2%in 2011,respectively,which were declined to 28.2%(P=0.007)and 2.9%(P=0.003)in 2017,respectively.The average prescription rate of injection was 30.2%in 2011 and declined to 5.3%(P=0.003)in 2017.As for the subgroup analysis of the internal medicine and pediatric departments,the average prescription rate of antibiotics was 39.3%and 71.4%in 2011,respectively,which was declined to 10.2%(P=0.003)and 47.3%(P=0.035)in 2017,respectively.The average prescription rate of combined antibiotics was 15.9%and 9.4%in 2011,respectively,which was declined to 2.9%(P=0.003)and 2.9%(P=0.016),respectively.The average prescription rate of injection was 17.8%and 39.6%in 2011,respectively,which was declined to 1.9%(P=0.003)and 9.0%(P=0.003),respectively.Our study showed a significant decreasing trend in antibiotic use in county-level public hospitals after the Sanming healthcare reform,indicating that the reform successfully promoted the appropriate use of medicine to some extent.