scholarly journals The impact of National Centralized Drug Procurement policy on the use of policy-related original and generic drugs in public medical institutions in China: A difference-in-difference analysis based on national database

2021 ◽  
Author(s):  
Jing Wang ◽  
Ying Yang ◽  
Luxinyi Xu ◽  
Yuan Shen ◽  
Xiaotong Wen ◽  
...  
Keyword(s):  
Generic Drugs ◽  
National Database ◽  
Quality Level ◽  
Difference In Difference ◽  
P Values ◽  
Drug Procurement ◽  
Information Platform ◽  
Defined Daily Doses ◽  
Medical Institutions ◽  
The Impact

Objective: To evaluate the impact of the first round of the National Centralized Drug Procurement (NCDP) pilot (referred to as "4+7" policy) on the use of policy-related original and generic drugs. Methods: Drug purchase data from the China Drug Supply Information Platform (CDSIP) database were used, involving nine "4+7" pilot cities and 12 non-pilot provinces in China. "4+7" policy-related drugs were included, which consisted of 25 "4+7" List drugs and 97 alternative drugs that have an alternative relationship with "4+7" List drugs in clinical use. "4+7" List drugs were divided into bid-winning and non-winning products according to the bidding results. Purchase volume, purchase expenditures, daily costs were selected as outcome variables, and were measured using Defined Daily Doses (DDDs), Chinese Yuan (CNY), and Defined Daily Drug cost (DDDc), respectively. Difference-in-Difference (DID) method was employed to estimate the net effect of policy impact. Results: After policy intervention, the DDDs of original drugs among "4+7" List drugs significantly reduced by 124.59%, while generic drugs increased by 52.12% (all p-values <0.01). 17.08% of the original drugs in DDDs were substituted by generic drugs. Prominent reductions of 121.69% and 80.54% were observed in the expenditure of original and generic drugs, with a total cost-saving of 5036.78 million CNY for "4+7" List drugs. The DDDc of bid-winning original and generic drugs, as well as non-winning original drugs, significantly decreased by 33.20%, 75.74%, and 5.35% (all p-values <0.01), while the DDDc of non-winning generic drugs significantly increased by 73.66% (p<0.001). The use proportion of bid-winning products and non-winning original drugs raised prominently from 39.66% to 91.93% Conclusions: "4+7" policy promoted the substitution use of generic drugs against original drugs, which conducive to drug costs saving. The overall quality level of drug use of public medical institutions significantly increased after "4+7" policy, especially in primary medical institutions.

scholarly journals Impact of Volume-Based Drug Procurement Policy on Drug Use Structure of Chinese Public Medical Institutions: A Difference-in-Difference Analysis of Nine Pilot Cities and Twelve Non-pilot Provinces

2021 ◽  
Author(s):  
Jiancheng Lu ◽  
Ying Yang ◽  
Hongfei Long ◽  
Jing Wang ◽  
Yuan Shen ◽  
...  
Keyword(s):  
Mainland China ◽  
Outcome Variable ◽  
Chinese Government ◽  
Policy Intervention ◽  
Difference In Difference ◽  
Drug Procurement ◽  
Period 2 ◽  
Medical Institutions ◽  
The Impact ◽  
Alternative Drugs

Abstract Background In 2019, the Chinese government implemented the first round pilot of volume-based drug procurement in 4 municipalities and 7 sub-provincial cities, i.e. “4+7” policy. This study evaluated the impact of “4+7” policy on the use structure of policy-related drugs. Methods Data of China Drug Supply Information Platform (CDSIP) database was used, covering 18,636 public medical institutions from 9 pilot cities and 12 non-pilot provinces in mainland China. “4+7” policy-related drugs were selected as study samples, including 25 drugs in the “4+7” procurement List and 83 alternative drugs that have an alternative relationship with “4+7” List drugs. “4+7” List drugs were divided into bid-winning and bid-non-winning products. Drug Structure Index (DSI) was employed as the outcome variable, and higher DSI refers to the use proportion of higher-DDDc (Defined Daily Drug cost) drugs increased. Difference-in-difference (DID) method was employed to estimate the net effect of “4+7” policy. Results After policy intervention, the DSI of bid-winning drugs significantly decreased (β=-0.233, p<0.0001), while non-winning drugs (β = 0.177, p<0.001) and “4+7” List drugs (β = 0.050, p<0.01) increased. No significant change was found for the overall DSI of alternative drugs (β = 0.013, p>0.05), while a remarkable increase was found in primary healthcare settings (β = 0.033, p<0.05). In three post-“4+7” periods, the increments of DSI for non-winning products were 17.54% (period 1), 18.35% (period 2), and 19.66% (period 3). The DSI of “4+7” List drugs significantly increased in post-“4+7” period 2 and 3 (all p-values<0.05). Conclusions The use proportion of higher-DDDc bid-winning drugs significantly decreased after policy intervention. However, among drugs not involved by NCDP policy, the use proportion of higher-DDDc drugs significantly increased after policy intervention, moreover, the increment was more pronounced at the later periods of policy implementation. The clinical use monitoring and the physician’s prescription behavior supervision should be strengthened.

scholarly journals The impact of “4+7” volume based drugs procurement on the volume, expenditures, and daily costs of antihypertensive drugs in Shenzhen, China: a interrupted time series analysis

2021 ◽  
Author(s):  
Ying Yang ◽  
Ruiwen Tong ◽  
Shicheng Yin ◽  
Lining Mao ◽  
Luxinyi Xu ◽  
...  
Keyword(s):  
Time Series ◽  
Antihypertensive Drugs ◽  
Linear Regression Analysis ◽  
Interrupted Time Series ◽  
Chinese Government ◽  
Policy Intervention ◽  
Interrupted Time Series Analysis ◽  
Drug Procurement ◽  
Defined Daily Doses ◽  
The Impact

Abstract Background: On January 2019, Chinese government implemented the first round of the National Centralized Drug Procurement (NCDP) pilot of 25 drugs in 4 municipalities and 7 sub-provincial cities in mainland China, referred to as “4+7” policy. In the “4+7” policy, 7 antihypertensive drugs were included. This study was conducted to evaluate the impact of “4+7” policy on the use of policy-related antihypertensive drugs. Method: This study applied single-group Interrupted Time Series (ITS) design. We used drug purchasing data from the Centralized Drug Procurement Survey in Shenzhen 2019, covering 24 months from January 2018 to December 2019. Antihypertensive drugs related to “4+7” policy were selected as study samples, including 7 antihypertensive drugs in the “4+7” List and 17 antihypertensive drugs that have an alternative relationship with the “4+7” List drugs in clinical use. Purchase volume, expenditures, and daily costs were selected as outcome variables, and were measured using Defined Daily Doses (DDDs), Chinese Yuan (CNY), and Defined Daily Drug cost (DDDc), respectively. Segmented linear regression analysis was employed to examine the change of outcome variables before and after the policy intervention. Results: As of December 31, 2019, the completion rate of the agreed purchase volume of the 7 bid-winning antihypertensive drugs reached 173.42% in Shenzhen. After “4+7” policy, the DDDc of bid-winning antihypertensive drugs significantly decreased by 63.79% (-1.30 CNY, 95% CI= -1.43 to -1.18, p<0.001), while the DDDc of non-winning (0.28 CNY, 95% CI= 0.11 to 0.46, p<0.01) and alternative (0.14 CNY, 95% CI= 0.03 to 0.25, p<0.05) antihypertensive drugs increased markedly. The volume of bid-winning antihypertensive drugs significantly increased by 1311.76% (3.12 million DDD, 95% CI= 2.14 to 4.10, p<0.001). The overall costs of the seven “4+7” List antihypertensive drugs significantly declined by 101.34% (-5.96 million CNY, 95% CI= -7.87 to -4.04, p<0.001) after policy intervention, with an absolute reduction of 36.37 million CNY compared with the pre-“4+7” period. Conclusion: An overall satisfying implementation effect was observed in Shenzhen. A preliminary positive policy effect of price cut and cost-saving was observed in the antihypertensive drug category. However, the DDDc of non-winning and alternative drugs increased after policy intervention, suggesting that the price monitoring and drug use management regarding NCDP policy-related drugs should be strengthened. Keywords: National Centralized Drug Procurement (NCDP); "4+7"; volume-based procurement; antihypertensive drugs; China

scholarly journals Implementation and Impact of National Centralized Drug Procurement Policy in China: Evidence from the National Drug Procurement Database

2021 ◽  
Author(s):  
Jiancheng Lu ◽  
Ying Yang ◽  
Xiaotong Wen ◽  
Jing Wang ◽  
Yuan Shen ◽  
...  
Keyword(s):  
Interrupted Time Series ◽  
Completion Rate ◽  
Chinese Government ◽  
Clinical Use ◽  
Drug Procurement ◽  
Information Platform ◽  
Defined Daily Doses ◽  
National Drug ◽  
Implementation Progress ◽  
Supply Information

Abstract Background Chinese government implemented the first round of National Centralized Drug Procurement pilot in 4 municipalities and 7 sub-provincial cities in 2019, so called "4 + 7" policy. This study evaluated the implementation and impact of “4 + 7” policy. Methods This study used drug purchase data from China Drug Supply Information Platform (CDSIP) database. “4 + 7” policy-related drugs were selected as study samples, including 25 drugs in the “4 + 7” List and 92 alternative drugs that have an alternative relationship with “4 + 7” List drugs in clinical use. “4 + 7” List drugs were divided into bid-winning and non-winning products. We applied Defined Daily Doses (DDDs), DDDs per 1000 inhabitants per day (DID), purchase expenditures, and Defined Daily Drug cost (DDDc) as outcome variables. Interrupted time-series was adopted to quantity policy effect. Results As of December 2019, the completion rate of overall bid-winning drugs in 9 pilot cities reached 154.40%, and the completion rate of 25 bid-winning drugs ranged between 74.77% and 477.75%. After policy intervention, the DID of bid-winning drugs, “4 + 7” List drugs, alterative drugs, as well as the overall policy-related drugs increased by 545.18%, 14.03%, 12.21%, and 13.04% in pilot cities. Bid-winning drugs significantly increased 132.84 million DDDs (p < 0.001) in volume and 48.95 million CNY (p < 0.05) in expenditures, and dropped 6.35 CNY (p < 0.001) in DDDc. The volume proportion of bid-winning products increased from 12.67–71.66%. The DDDc of non-winning drugs increased 0.94 CNY (p < 0.001). Overall, the DDDc of policy-related drugs dropped 1.38 CNY (p < 0.001), and the expenditures decreased 634.68 million CNY (p < 0.001). Conclusion An overall satisfying implementation progress of “4 + 7” policy was observed in pilot cities. The policy alleviated the medication burdens of patients, which is supported by the significant reduction in DDDc and costs of policy-related drugs. The accessibility and consumption of policy-related drugs improved. However, monitoring regarding the clinical use of policy-related drugs will still be necessary in the future.

scholarly journals Effect of population inflow and outflow between rural and urban areas on regional antimicrobial use surveillance

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248338
Author(s):  
Ryuji Koizumi ◽  
Yoshiki Kusama ◽  
Yuichi Muraki ◽  
Masahiro Ishikane ◽  
Daisuke Yamasaki ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Antimicrobial Stewardship ◽  
Urban Areas ◽  
Regional Level ◽  
National Database ◽  
Antimicrobial Use ◽  
Population Mobility ◽  
Defined Daily Doses ◽  
The Mean ◽  
The Impact

Purpose Regional-level measures can complement national antimicrobial stewardship programs. In Japan, sub-prefectural regions called secondary medical areas (SMAs) provide general inpatient care within their borders, and regional antimicrobial stewardship measures are frequently implemented at this level. There is therefore a need to conduct antimicrobial use (AMU) surveillance at this level to ascertain antimicrobial consumption. However, AMU estimates are generally standardized to residence-based nighttime populations, which do not account for population mobility across regional borders. We examined the impact of population in/outflow on SMA-level AMU estimates by comparing the differences between standardization using daytime and nighttime populations. Methods We obtained AMU information from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. AMU was quantified at the prefectural and SMA levels using the number of defined daily doses (DDDs) divided by (a) 1,000 nighttime population per day or (b) 1,000 daytime population per day. We identified and characterized the discrepancies between the two types of estimates at the prefectural and SMA levels. Results The national AMU was 17.21 DDDs per 1,000 population per day. The mean (95% confidence interval) prefectural-level DDDs per 1,000 nighttime and daytime population per day were 17.27 (14.10, 20.44) and 17.41 (14.30, 20.53), respectively. The mean (95% confidence interval) SMA-level DDDs per 1,000 nighttime and daytime population per day were 16.12 (9.84, 22.41) and 16.41 (10.57, 22.26), respectively. The nighttime population-standardized estimates were generally higher than the daytime population-standardized estimates in urban areas, but lower in the adjacent suburbs. Large differences were observed in the main metropolitan hubs in eastern and western Japan. Conclusion Regional-level AMU estimates, especially of smaller regions such as SMAs, are susceptible to the use of different populations for standardization. This finding indicates that AMU standardization based on population values is not suitable for AMU estimates in small regions.

State Medical Board Disciplinary Hearings as Tools for Teaching Professionalism in Medical Education

2011 ◽  
Vol 97 (3) ◽  
pp. 8-12
Author(s):  
Onelia G. Lage ◽  
Sydney F. Pomenti ◽  
Edwin Hayes ◽  
Kristen Barrie ◽  
Nancy Baker
Keyword(s):  
Medical Students ◽  
Ethics Education ◽  
Faculty Members ◽  
Specific Method ◽  
Pilot Studies ◽  
Medical Board ◽  
Medical Institutions ◽  
State Medical Boards ◽  
State Medical Board ◽  
The Impact

ABSTRACT This article proposes a partnership of state medical boards with medical schools to supplement professionalism and ethics education for medical students, residents, physicians and faculty members of medical institutions. The importance of professionalism has been recognized by several studies, but a specific method of teaching and developing professionalism has yet to emerge. Studies suggest that there is an association between a lack of professionalism in medical school and future disciplinary actions by medical boards. However, there has been little collaboration between these institutions in addressing unprofessional behaviors. One collaborative concept that holds promise, however, is the idea of inviting medical students to attend physician disciplinary hearings. Students and physicians alike report that watching a hearing can significantly impact attitudes about professionalism as a part of medical practice. While formal research is scarce, the positive response of individual students who experience disciplinary hearings firsthand suggests that further pilot studies may be useful. Presented in this paper are the perspectives of three individuals — a medical student, a faculty member and a medical board chair — who discuss the impact and potential of attending disciplinary hearings in developing professionalism and ethics. Also included is a review of the current literature.

Self-assessment by medical workers of the degree of influence of working conditions on the development of occupational diseases

2019 ◽  
pp. 463-467 ◽  
Author(s):  
N. N. Petrukhin ◽  
O. N. Andreenko ◽  
I. V. Boyko ◽  
S. V. Grebenkov
Keyword(s):  
Health Care ◽  
Working Conditions ◽  
Occupational Diseases ◽  
Health Workers ◽  
Medical Personnel ◽  
Long Term Memory ◽  
Self Assessment ◽  
Medical Institutions ◽  
Care Workers ◽  
The Impact

Introduction. The activities of health workers are associated with the impact of many harmful factors that lead to loss of health. Compared with other professional groups, health care workers are ill longer and harder, which may be due to polymorbidity pathology.The aim of the study based on the survey data to study the representation of health workers about working conditions and to identify their impact on the formation of occupational diseases.Materials and methods. In order to get a real idea of the attitude of medical workers to their working conditions in 2018, an anonymous survey was conducted of 1129 doctors and 776 employees of secondary and junior medical personnel working in health care institutions in St. Petersburg, Moscow, Krasnoyarsk, Vologda and Orel.Results. Research of working conditions and health of physicians allowed to establish that work in medical institutions imposes considerable requirements to an organism of working, its physical condition and endurance, volume of operational and long-term memory, ability to resist to mental, moral and ethical overloads.Conclusions: The most important method of combating the development of occupational diseases is their prevention. Organizational and preventive measures should be aimed primarily at monitoring the working conditions and health of medical staff .

Healthcare System in the Arctic Zone of Russia. Known and Emerging Issues and Solutions to Them

2019 ◽  
pp. 3-20
Author(s):  
V.N. Leksin
Keyword(s):  
Metallurgical Industry ◽  
Healthcare Services ◽  
The Arctic ◽  
Russian Arctic ◽  
Arctic Zone ◽  
Shift Workers ◽  
The North ◽  
Medical Institutions ◽  
Emerging Issues ◽  
The Impact

The impact on healthcare organization on the territory of Russian Arctic of unique natural and climatic, demographic, ethnic, settlement and professional factors of influencing the health of population, constantly or temporarily living on this territory is studied. The necessity is substantiated of various forms and resource provision with healthcare services such real and potential patients of Arctic medical institutions, as representatives of indigenous small peoples of the North, workers of mining and metallurgical industry, military personnel, sailors and shift workers. In this connection a correction of a number of All-Russian normative acts is proposed.

Comparison of a preferred versus non-preferred waterpipe tobacco flavour: subjective experience, smoking behaviour and toxicant exposure

2017 ◽  
Vol 27 (3) ◽  
pp. 319-324 ◽  
Author(s):  
Eleanor L Leavens ◽  
Leslie M Driskill ◽  
Neil Molina ◽  
Thomas Eissenberg ◽  
Alan Shihadeh ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Subjective Experience ◽  
Smoking Behaviour ◽  
Toxicant Exposure ◽  
P Values ◽  
Smoking Topography ◽  
Exhaled Carbon Monoxide ◽  
Continued Use ◽  
The Impact ◽  
Survey Questionnaires

IntroductionOne possible reason for the rapid proliferation of waterpipe (WP) smoking is the pervasive use of flavoured WP tobacco. To begin to understand the impact of WP tobacco flavours, the current study examined the impact of a preferred WP tobacco flavour compared with a non-preferred tobacco flavoured control on user’s smoking behaviour, toxicant exposure and subjective smoking experience.MethodThirty-six current WP smokers completed two, 45-minute ad libitum smoking sessions (preferred flavour vs non-preferred tobacco flavour control) in a randomised cross-over design. Participants completed survey questionnaires assessing subjective smoking experience, exhaled carbon monoxide (eCO) testing, and provided blood samples for monitoring plasma nicotine. WP smoking topography was measured continuously throughout the smoking session.ResultsWhile participants reported an enhanced subjective smoking experience including greater interest in continued use, greater pleasure derived from smoking, increased liking and enjoyment, and willingness to continue use after smoking their preferred WP tobacco flavour (p values <0.05), no significant differences were observed in nicotine and carbon monoxide boost between flavour preparations. Greater average puff volume (p=0.018) was observed during the non-preferred flavour session. While not significant, measures of flow rate, interpuff interval (IPI), and total number of puffs were trending towards significance (p values <0.10), with decreased IPI and greater total number of puffs during the preferred flavour session.DiscussionThe current study is the first to examine flavours in WP smoking by measuring preferred versus control preparations to understand the impact on subjective experience, smoking behaviour and toxicant exposure. The pattern of results suggests that even this relatively minor manipulation resulted in significant changes in subjective experience. These results indicate a possible need for regulations restricting flavours in WP tobacco as with combustible cigarettes.

scholarly journals Antimicrobial Consumption among 66 Acute Care Hospitals in Catalonia: Impact of the COVID-19 Pandemic

Antibiotics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 943
Author(s):  
Santiago Grau ◽  
Sergi Hernández ◽  
Daniel Echeverría-Esnal ◽  
Alexander Almendral ◽  
Ricard Ferrer ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Acute Care ◽  
Antimicrobial Consumption ◽  
Trend Pattern ◽  
Defined Daily Doses ◽  
Bed Days ◽  
Antifungal Consumption ◽  
Antibacterial And Antifungal ◽  
Antifungal Use ◽  
The Impact

Background: Antimicrobials have been widely used during the COVID-19 pandemic. This study aimed to analyze the impact of the COVID-19 pandemic on the antimicrobial consumption of 66 hospitals in Catalonia. Methods: Adult antibacterial and antimycotic consumption was calculated as defined daily doses (DDD)/100 bed-days and DDD/100 discharges. Firstly, overall and ICU consumption in 2019 and 2020 were compared. Secondly, observed ICU 2020 consumptions were compared with non-COVID-19 2020 estimated consumptions (based on the trend from 2008–2019). Results: Overall, antibacterial consumption increased by 2.31% and 4.15% DDD/100 bed-days and DDD/100 discharges, respectively. Azithromycin (105.4% and 109.08% DDD/100 bed-days and DDD/100 discharges, respectively) and ceftriaxone (25.72% and 27.97% DDD/100 bed-days and DDD/100 discharges, respectively) mainly accounted for this finding. Likewise, antifungal consumption increased by 10.25% DDD/100 bed-days and 12.22% DDD/100 discharges, mainly due to echinocandins or amphotericin B. ICU antibacterial and antimycotic consumption decreased by 1.28% and 4.35% DDD/100 bed-days, respectively. On the contrary, antibacterial and antifungal use, expressed in DDD/100 discharges, increased by 23.42% and 19.58%. Azithromycin (275.09%), ceftriaxone (55.11%), cefepime (106.35%), vancomycin (29.81%), linezolid (31.28%), amphotericin B (87.98%), and voriconazole (96.17%) use changed the most. Observed consumption of amphotericin B, azithromycin, caspofungin, ceftriaxone, vancomycin, and voriconazole were higher than estimated values. Conclusions: The consumption indicators for most antimicrobials deviated from the expected trend pattern. A worrisome increase in antibacterial and antifungal consumption was observed in ICUs in Catalonia.

T3 Are Burns a Chronic Condition: Examining Physical and Mental Functioning up to 20 Years After Injury

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S2-S3
Author(s):  
Callie Abouzeid ◽  
Audrey E Wolfe ◽  
Gretchen J Carrougher ◽  
Nicole S Gibran ◽  
Radha K Holavanahalli ◽  
...  
Keyword(s):  
Mental Health ◽  
Hospital Stay ◽  
National Database ◽  
Time Points ◽  
Patient Reported ◽  
Burn Survivors ◽  
Population Demographic ◽  
The Impact ◽  
Over Time

Abstract Introduction Burn survivors often face many long-term physical and psychological symptoms associated with their injury. To date, however, few studies have examined the impact of burn injuries on quality of life beyond 2 years post-injury. The purpose of this study is to examine the physical and mental well-being of burn survivors up to 20 years after injury. Methods Data from the Burn Model System National Database (1997–2020) were analyzed. Patient-reported outcome measures were collected at discharge with a recall of preinjury status, and then at 5, 10, 15, and 20 years after injury. Outcomes examined were the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Short Form-12. Trajectories were developed using linear mixed methods model with repeated measures of PCS and MCS scores over time and controlling for demographic and clinical variables. The model fitted score trajectory was generated with 95% confidence intervals to demonstrate score changes over time and associations with covariates. Results The study population included 420 adult burn survivors with a mean age of 42.4 years. The population was mainly male (66%) and white (76.4%) with a mean burn size of 21.5% and length of hospital stay of 31.3 days. Higher PCS scores were associated with follow-up time points closer to injury, shorter hospital stay, and younger age. Similarly, higher MCS scores were associated with earlier follow-up time points, shorter hospital stay, female gender, and non-perineal burns. MCS trajectories are demonstrated in the Figure. Conclusions Burn survivors’ physical and mental health worsened over time. Such a trend is different from previous reported results for mental health in the general population. Demographic and clinical predictors of recovery over time are identified.

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