Self-medication is an increasingly frequent phenomenon worldwide and has an important influence on health.In this study,we analyzed the self-medication prevalence rate in Chinese middle-aged and elderly people,and exp...Self-medication is an increasingly frequent phenomenon worldwide and has an important influence on health.In this study,we analyzed the self-medication prevalence rate in Chinese middle-aged and elderly people,and explored the influence factors.The data from China Health and Retirement Longitudinal Study(CHARLS)in 2011,2013 and 2015 were used.Self-medication prevalence was calculated as the number of whole people divided by the number of people taking self-medication.The influence factors of self-medication were analyzed by panel data random effect model.We excluded observations with missing values in our analysis,leaving 16 962,17 876 and 19 572 observations in 2011,2013 and 2015,respectively.The average 3-year self-medication prevalence was 45.52%.Moreover,11.70%of respondents practiced self-medication with prescription medicine in 2011,2013 and 2015.Respondents living in non-rural areas(P=0.009)and western region(P=0.000)took more self-medication.Self-medication was a common phenomenon among middle-aged and elderly population in China.The government should strengthen the guidance for the middle-aged and elderly people who took more self-medication,such as those living in urban and western region.展开更多
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 c...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）.展开更多
Many patients with rare diseases not only suffer from more severe conditions but often receive less disease management, which is one significant public health concern globally. Few practice-based surveys focus on the ...Many patients with rare diseases not only suffer from more severe conditions but often receive less disease management, which is one significant public health concern globally. Few practice-based surveys focus on the care of patients with rare diseases. In the present study, we aimed to investigate medical service utilization, economic burden and health status of patients with rare diseases in China. A cross-sectional questionnaire survey focusing on patients with rare diseases was conducted. Descriptive analysis was conducted to examine the sociodemographic characteristics, medical service utilization, economic burden and health status. Logistic regression analysis was applied to explore influencing factors of self-rated health. A total of 982 patients with 81 types of diseases were included in this survey. We found that 58.2% of patients experienced misdiagnosis, and 35.2% of the patients were misdiagnosed for at least five times. Moreover, 65.8% of patients traveled to hospitals to seek medical services, and 92.1% of patients paid expenses for their treatment. However, only 1.3% of patients could afford their medical expenditure without debts, and 86.8% of patients regarded their health status as bad or moderate. Significant factors correlated with health status were economic status, gender, age, employment and household size. From this study, the accessibility of medical service utilization, the affordability of medical economic burden, and the condition of health status for patients with rare disease in China were considerably poor. Basic medical insurance did not play its role in improving the utilization of medical services and the affordability of medical costs. Social support should be encouraged to improve patients＇ health status.展开更多
Traditional Chinese medicines(TCMs)are commonly used in China,and some of them have been proved to be effective against infection caused by certain pathogenic bacteria.In the present study,we aimed to describe the tre...Traditional Chinese medicines(TCMs)are commonly used in China,and some of them have been proved to be effective against infection caused by certain pathogenic bacteria.In the present study,we aimed to describe the trends of antibacterial-effect traditional Chinese medicine(AeTCM)consumption and expenditure in secondary and tertiary hospitals in China using pharmaceutical sales data from January 2011 to December 2015.Aggregated monthly surveillance data on AeTCM sales in China’s hospitals were retrospectively analyzed.Population weighted daily define doses,which are the recommended daily amounts based on dosage regimen recommended in the manufacturers’instructions,were adopted.The AeTCM consumption was expressed in DDD per 1000 inhabitants per day(DID).The AeTCM expenditure was expressed in US dollars.A compound annual growth rate(CAGR)was used to describe the growth of AeTCM consumption and expenditure.A total of 1293 AeTCMs were matched and analyzed from 468 tertiary hospitals and 114 secondary hospitals from 28 provinces.The total AeTCM consumption and expenditure demonstrated a significant upward trend during the study period from 4.07 DID to 6.82 DID with a CAGR of 13.75%,and 839.75 million US dollars to 1276.82 million US dollars with a CAGR of 11.04%,respectively.Compared with eastern provinces,the consumption of AeTCMs was higher in the central and western provinces.Parenteral AeTCMs accounted for 7.20%of the total Ae TCM consumption,but nearly 45%of the total AeTCM expenditure.The AeTCM use in China demonstrated a rapid growth,which could be the result of the substitutional effect from antimicrobial stewardship and brought a potential risk of overuse.More studies are needed to further explore the potential efficacy of AeTCMs as an alternative approach towards infection treatment and to help confine antimicrobial resistance.展开更多
Irrational use of medicines is a major problem worldwide, and it is believed there would be positive correlation between the National Essential Medicines Policies(NEMPs) and the level of rational use of medicines(RUMs...Irrational use of medicines is a major problem worldwide, and it is believed there would be positive correlation between the National Essential Medicines Policies(NEMPs) and the level of rational use of medicines(RUMs). Though there is some early evidence on the NEMPs’ effects on RUMs in China, the evidence is scarce, and conclusions vary. In the present study, we aimed to evaluate the impacts of the NEMPs of China on the RUMs in the primary health care institutions(PHCs). A cross-sectional survey was conducted in 2010. A total of 201 PHCs from six provinces of China were selected, and 39 181 prescriptions were extracted from January to June, 2010. Six indicators were used and tested by independent-samples T test. We found that the average number of drugs per prescription in PHCs with NEMP implementation(the treatment group) was significantly higher than that of the group without NEMP implementation(the control group)(3.37 vs. 2.83, P<0.01). There was no significant difference in the average cost per prescription(81.43 vs. 75.02). The percentage of prescriptions, including an antibiotic(53.40% vs. 36.48%, P<0.01) or an injection(40.54% vs. 27.94%, P<0.01), was higher in the treatment group, and the percentage of drugs prescribed by general name was significantly lower(83.71% vs. 93.11%, P<0.01). For the percentage of drugs prescribed from essential medicines list, the treatment group exhibited the higher ratio(76.12% vs. 53.45%, P<0.01). From this study, the NEMPs were not likely to have a positive impact on RUMs. China still needed efforts to improve the selection, the absence of physicians’ active involvement, and the patients’ habits of irrational medication use.展开更多
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 20...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.展开更多
Drug product internationalization（DPI） can be affected by multiple firm-level factors. However, existing studies mainly focus on a single or several factors and the deviation generated by the factors＇ effects on ea...Drug product internationalization（DPI） can be affected by multiple firm-level factors. However, existing studies mainly focus on a single or several factors and the deviation generated by the factors＇ effects on each other has been neglected. We aimed to study the comprehensive influences of firm-level factors on Chinese pharmaceutical firms that chose the DPI mode. Student＇s t tests and Chi Square tests were used to explore the differences between firms with or without DPI modes. Then, logistic regression analysis was used to explore the comprehensive impacts of these 16 variables. Through empirical research, we found the factors influencing the DPI mode of Chinese pharmaceutical enterprises and the firm-level factors that influenced DPI mode selection. This study showed that the capacity of enterprise＇s innovation and knowledge absorption were related to the mode selection. Moreover, the education of the top management team significantly contributed to the DPI mode selection of pharmaceutical firms. This study also provided theoretical and empirical evidence for pharmaceutical enterprises when choosing their DPI mode. The internationalization of Chinese pharmaceutical firms remained at the early stage. However, the internationalization of drug products from China would affect the international pharmaceutical supply in the long term.展开更多
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 ...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.展开更多
To alleviate problems with access and affordability,six targeted anticancer medications(TAMs)were listed in the Provincial Reimbursement Drug List(PRDL)for the first time in Zhejiang,China in February 2015.In the pres...To alleviate problems with access and affordability,six targeted anticancer medications(TAMs)were listed in the Provincial Reimbursement Drug List(PRDL)for the first time in Zhejiang,China in February 2015.In the present study,we aimed to evaluate the implementation of the PRDL policy on TAMs use.Using the pharmaceutical procurement data of these six listed TAMs(study group)and four unlisted TAMs(control group)from 22 tertiary hospitals in Zhejiang,China dated between January 2014 and February 2017,interrupted time-series analysis was adopted to examine differences in the average hospital purchasing volume(HPV)and the average hospital purchasing spending(HPS)between the two groups.The average daily cost of listed TAMs in the study group was decreased after April 2015.After enlistment,the average HPV per month was significantly increased by 34.6 defined daily doses(DDDs)(P<0.001),and the average HPS per month was significantly increased by USD 6614.9(P<0.001)for the listed TAMs in the study group(n=6).Neither the average HPV nor the average HPS changed significantly for the unlisted TAMs in the control group(n=4).The PRDL policy showed positive effects on improving patients’affordability and promoting access to TAMs in Zhejiang.The government should conduct further price negotiations and include more TAMs with clinical benefits into reimbursement schemes to relieve patients’financial burden and promote access.展开更多
文摘Self-medication is an increasingly frequent phenomenon worldwide and has an important influence on health.In this study,we analyzed the self-medication prevalence rate in Chinese middle-aged and elderly people,and explored the influence factors.The data from China Health and Retirement Longitudinal Study(CHARLS)in 2011,2013 and 2015 were used.Self-medication prevalence was calculated as the number of whole people divided by the number of people taking self-medication.The influence factors of self-medication were analyzed by panel data random effect model.We excluded observations with missing values in our analysis,leaving 16 962,17 876 and 19 572 observations in 2011,2013 and 2015,respectively.The average 3-year self-medication prevalence was 45.52%.Moreover,11.70%of respondents practiced self-medication with prescription medicine in 2011,2013 and 2015.Respondents living in non-rural areas(P=0.009)and western region(P=0.000)took more self-medication.Self-medication was a common phenomenon among middle-aged and elderly population in China.The government should strengthen the guidance for the middle-aged and elderly people who took more self-medication,such as those living in urban and western region.
文摘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）.
文摘Many patients with rare diseases not only suffer from more severe conditions but often receive less disease management, which is one significant public health concern globally. Few practice-based surveys focus on the care of patients with rare diseases. In the present study, we aimed to investigate medical service utilization, economic burden and health status of patients with rare diseases in China. A cross-sectional questionnaire survey focusing on patients with rare diseases was conducted. Descriptive analysis was conducted to examine the sociodemographic characteristics, medical service utilization, economic burden and health status. Logistic regression analysis was applied to explore influencing factors of self-rated health. A total of 982 patients with 81 types of diseases were included in this survey. We found that 58.2% of patients experienced misdiagnosis, and 35.2% of the patients were misdiagnosed for at least five times. Moreover, 65.8% of patients traveled to hospitals to seek medical services, and 92.1% of patients paid expenses for their treatment. However, only 1.3% of patients could afford their medical expenditure without debts, and 86.8% of patients regarded their health status as bad or moderate. Significant factors correlated with health status were economic status, gender, age, employment and household size. From this study, the accessibility of medical service utilization, the affordability of medical economic burden, and the condition of health status for patients with rare disease in China were considerably poor. Basic medical insurance did not play its role in improving the utilization of medical services and the affordability of medical costs. Social support should be encouraged to improve patients＇ health status.
基金National Natural Science Foundation of China(Grant No.81973294,81861138048 and 71774005)China Medical Board(Grant No.17-270)。
文摘Traditional Chinese medicines(TCMs)are commonly used in China,and some of them have been proved to be effective against infection caused by certain pathogenic bacteria.In the present study,we aimed to describe the trends of antibacterial-effect traditional Chinese medicine(AeTCM)consumption and expenditure in secondary and tertiary hospitals in China using pharmaceutical sales data from January 2011 to December 2015.Aggregated monthly surveillance data on AeTCM sales in China’s hospitals were retrospectively analyzed.Population weighted daily define doses,which are the recommended daily amounts based on dosage regimen recommended in the manufacturers’instructions,were adopted.The AeTCM consumption was expressed in DDD per 1000 inhabitants per day(DID).The AeTCM expenditure was expressed in US dollars.A compound annual growth rate(CAGR)was used to describe the growth of AeTCM consumption and expenditure.A total of 1293 AeTCMs were matched and analyzed from 468 tertiary hospitals and 114 secondary hospitals from 28 provinces.The total AeTCM consumption and expenditure demonstrated a significant upward trend during the study period from 4.07 DID to 6.82 DID with a CAGR of 13.75%,and 839.75 million US dollars to 1276.82 million US dollars with a CAGR of 11.04%,respectively.Compared with eastern provinces,the consumption of AeTCMs was higher in the central and western provinces.Parenteral AeTCMs accounted for 7.20%of the total Ae TCM consumption,but nearly 45%of the total AeTCM expenditure.The AeTCM use in China demonstrated a rapid growth,which could be the result of the substitutional effect from antimicrobial stewardship and brought a potential risk of overuse.More studies are needed to further explore the potential efficacy of AeTCMs as an alternative approach towards infection treatment and to help confine antimicrobial resistance.
基金National Natural Science Foundation of China(Grant No.71303011,71774005)
文摘Irrational use of medicines is a major problem worldwide, and it is believed there would be positive correlation between the National Essential Medicines Policies(NEMPs) and the level of rational use of medicines(RUMs). Though there is some early evidence on the NEMPs’ effects on RUMs in China, the evidence is scarce, and conclusions vary. In the present study, we aimed to evaluate the impacts of the NEMPs of China on the RUMs in the primary health care institutions(PHCs). A cross-sectional survey was conducted in 2010. A total of 201 PHCs from six provinces of China were selected, and 39 181 prescriptions were extracted from January to June, 2010. Six indicators were used and tested by independent-samples T test. We found that the average number of drugs per prescription in PHCs with NEMP implementation(the treatment group) was significantly higher than that of the group without NEMP implementation(the control group)(3.37 vs. 2.83, P<0.01). There was no significant difference in the average cost per prescription(81.43 vs. 75.02). The percentage of prescriptions, including an antibiotic(53.40% vs. 36.48%, P<0.01) or an injection(40.54% vs. 27.94%, P<0.01), was higher in the treatment group, and the percentage of drugs prescribed by general name was significantly lower(83.71% vs. 93.11%, P<0.01). For the percentage of drugs prescribed from essential medicines list, the treatment group exhibited the higher ratio(76.12% vs. 53.45%, P<0.01). From this study, the NEMPs were not likely to have a positive impact on RUMs. China still needed efforts to improve the selection, the absence of physicians’ active involvement, and the patients’ habits of irrational medication use.
文摘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.
文摘Drug product internationalization（DPI） can be affected by multiple firm-level factors. However, existing studies mainly focus on a single or several factors and the deviation generated by the factors＇ effects on each other has been neglected. We aimed to study the comprehensive influences of firm-level factors on Chinese pharmaceutical firms that chose the DPI mode. Student＇s t tests and Chi Square tests were used to explore the differences between firms with or without DPI modes. Then, logistic regression analysis was used to explore the comprehensive impacts of these 16 variables. Through empirical research, we found the factors influencing the DPI mode of Chinese pharmaceutical enterprises and the firm-level factors that influenced DPI mode selection. This study showed that the capacity of enterprise＇s innovation and knowledge absorption were related to the mode selection. Moreover, the education of the top management team significantly contributed to the DPI mode selection of pharmaceutical firms. This study also provided theoretical and empirical evidence for pharmaceutical enterprises when choosing their DPI mode. The internationalization of Chinese pharmaceutical firms remained at the early stage. However, the internationalization of drug products from China would affect the international pharmaceutical supply in the long term.
基金the Health and Family Planning Commission of Sanming for their support and cooperation
文摘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.
文摘To alleviate problems with access and affordability,six targeted anticancer medications(TAMs)were listed in the Provincial Reimbursement Drug List(PRDL)for the first time in Zhejiang,China in February 2015.In the present study,we aimed to evaluate the implementation of the PRDL policy on TAMs use.Using the pharmaceutical procurement data of these six listed TAMs(study group)and four unlisted TAMs(control group)from 22 tertiary hospitals in Zhejiang,China dated between January 2014 and February 2017,interrupted time-series analysis was adopted to examine differences in the average hospital purchasing volume(HPV)and the average hospital purchasing spending(HPS)between the two groups.The average daily cost of listed TAMs in the study group was decreased after April 2015.After enlistment,the average HPV per month was significantly increased by 34.6 defined daily doses(DDDs)(P<0.001),and the average HPS per month was significantly increased by USD 6614.9(P<0.001)for the listed TAMs in the study group(n=6).Neither the average HPV nor the average HPS changed significantly for the unlisted TAMs in the control group(n=4).The PRDL policy showed positive effects on improving patients’affordability and promoting access to TAMs in Zhejiang.The government should conduct further price negotiations and include more TAMs with clinical benefits into reimbursement schemes to relieve patients’financial burden and promote access.
