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2021 ◽  
Vol 12 ◽  
Zhuoxian Li ◽  
Chaojie Liu ◽  
Keyuan Zuo ◽  
Junjie Liu ◽  
Yuqing Tang

Background: Pharmaceutical expenditure has been increasing worldwide. Many countries have attempted to contain the increase through collective bargaining, including in China. In 2015, the Chinese government introduced a new policy to empower regional governments to reduce pharmaceutical prices through its existing tendering system which enables a lower price for products with higher procurement volumes. Xiangyang municipality in Hubei province took a lead in piloting this initiative.Objectives: This study aimed to evaluate the effects of the volume-price contract initiative on pharmaceutical price procured by the public hospitals in Xiangyang.Methods: A retrospective comparative design was adopted. The price of cardiovascular medicines (349 products under 164 International Nonproprietary Names) procured by the public hospitals in Xiangyang was compared with those procured in Yichang municipality in Hubei. A total of 15,921 procurement records over the period from January 2017 to December 2018 were examined (Xiangyang started the volume-price contract initiative in January 2018). Generalized linear regression models with a difference-in-differences approach which could reflect the differences between the two cities between January 2018 and December 2018 were established to test the effects of the volume-price contract initiative on pharmaceutical prices.Results: On average, the procurement price for cardiovascular medicines adjusted by defined daily dosage in Xiangyang dropped by 41.51%, compared with a 0.22% decrease in Yichang. The difference-in-differences results showed that the volume-price contract initiative resulted in a 36.24% drop (p = 0.006) in the price (30.23% for the original brands, p = 0.008), in addition to the therapeutic competition effect (31.61% reduction in the price, p = 0.002). The top 100 domestic suppliers were highly responsive to the initiative (82.80% drop in the price, p = 0.001).Conclusion: The volume-price contract initiative has the potential to bring down the price of pharmaceutical supplies. Higher responses from the domestic suppliers are evident.

2021 ◽  
Abdilahi Ibrahim Muse ◽  
Mohamed Omar Osman ◽  
Girma Tadesse Wedajo ◽  
Kalkidan Hassen Abate ◽  
Ahmed Mohammed Ibrahim ◽  

Abstract Background and AimUnder normal circumstances, a urine albumin excretion of 5-10 mg/L is considered to be normal. Micro-albuminuria is, however, defined as a level of albumin in the urine that is between 20 mcg/min, and 200 mcg/min (30-300mg/24h) with normal urine flow of 1 ml/min.The aim of this study is to assess the prevalence of micro-albuminuria and associated factors among adult type two diabetes mellitus clients in public hospitals of Jigjiga town, Somali region, Ethiopia, from April 1 to July15, 2020Methods: Institutional based cross-sectional study design was used from April 1 to July 15, 2020. A pre-tested structured questionnaire was used to collect a data from 204 Type 2 diabetes mellitus patients visiting at Karamara general and Jigjiga University referral hospitals for follow up. Descriptive statistics was computed. Logistic regression model was used to identify covariates using SPSS version 20. The direction and strength of statistical association was measured by odds ratio with 95 % CI and a P-value < 0.05 was considered as statistically significant.Results: The prevalence of micro-albuminuria was 48.0% with [95% CI (41.2, 54.9)] Duration of DM between 11-20 years [AOR=3.71; 95% CI (1.45, 9.49)] Family history of hypertension [AOR=2.24; 95% CI: (1.02, 4.70)] Systolic blood pressure [AOR=3.36; 95% CI:(1.39, 8.13)], Low density lipoprotein [AOR=5.60; 95%CI: (2.22,14.11)] High density lipoprotein [AOR=5.210;95%CI:(2.067,13.131)] and Glycated hemoglobin [AOR = 3.246; 95% CI (1.356, 7.78)] were significantly associated with micro-albuminuriaConclusion: There is a significant level of micro-albuminuria among type 2 diabetes mellitus patients. Effective secondary prevention program directed on blood glucose and lipid with steps to improve blood pressure are critical in undertaking in the setting and regular screening of micro-albuminuria is needed so that an early preventive and treatment measures against its burden are put in place.

2021 ◽  
Vol 1 (3) ◽  
pp. 26-40
Henry Samuel Edosomwan ◽  
Tochukwu Matthew Oguegbe ◽  
Chiyem Lucky Nwanzu ◽  
Chiamaka O. Joe-Akunne

Purpose: The study explored the relationship between supportive supervision and empathic behavior and the indirect effect of occupational self-efficacy (OSE) among healthcare professionals in public hospitals in Delta State, Nigeria. Design/Methodology: The study is a quantitative cross-sectional survey, and the correlational design was adopted. Through convenience and systematic sampling, data were obtained from 127 healthcare professionals (doctors and nurses) from public hospitals. The sample consisted of 127 healthcare professionals with a mean age of 33.91 (SD, 5.64). Regression analysis via Model 4 of Hayes' PROCESS Macro was used to analyze the direct and indirect effect model with the help of the IBM-SPSS version 23. Findings: The study's findings indicated that supportive supervision and OSE positively and significantly predicted empathic behavior among healthcare professionals. The results further indicated that OSE mediated the relationship between supportive supervision and empathic behavior. Practical Implications: Based on the research findings, it is recommended that public healthcare administrators and managers should ensure that employees who handle direct patient care in public hospitals receive enough training in enhancing their skills, professional development and provided with enough supportive supervision in the workplace to foster empathic concern for their patients. Originality/Value: The research findings enhance and add new knowledge to the empathic behavior literature by investigating supportive supervision and OSE as predictors and checking for the mediating role of OSE.

2021 ◽  
Vol 11 (1) ◽  
Qi Feng ◽  
Man Fung Tsoi ◽  
Yue Fei ◽  
Ching Lung Cheung ◽  
Bernard M. Y. Cheung

AbstractPrevious studies have shown that ticagrelor reduced risk of pneumonia in patients with acute coronary syndrome (ACS) compared to clopidogrel, however, its effect in patients with non-ACS cardiovascular diseases remains uncertain. The aim was to investigate the effect of ticagrelor on pneumonia and pneumonia-specific death compared to clopidogrel in non-ACS patients in Hong Kong. This was a population-based cohort study. We included consecutive patients using ticagrelor or clopidogrel admitted for non-ACS conditions in Hong Kong public hospitals from March 2012 to September 2019. Patients using both drugs were excluded. The outcomes of interest were incident pneumonia, all-cause death, and pneumonia-specific death. Multivariable survival analysis models were used to estimate the effects [hazard ratio (HR) and 95% confidence interval (CI)]. Propensity score matching, adjustment and weighting were performed as sensitivity analyses. In total, 90,154 patients were included (mean age 70.66 years, males 61.7%). The majority of them (97.2%) used clopidogrel. Ticagrelor was associated with a lower risk of incident pneumonia [0.59 (0.46–0.75)], all-cause death [0.83 (0.73–0.93)] and pneumonia-specific death [0.49 (0.36–0.67)]. Sensitivity analyses yielded similar results. Ticagrelor was associated with lower risk of all-cause death, pneumonia-specific death, and incident pneumonia in patients with non-ACS cardiovascular conditions, consistent with previous evidence in patients with ACS. This additional effect of anti-pneumonia should be considered when choosing a proper P2Y12 inhibitor for patients with high risk of pneumonia.

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258092
Ritbano Ahmed Abdo ◽  
Hassen Mosa Halil ◽  
Biruk Assefa Kebede ◽  
Abebe Alemu Anshebo ◽  
Minychil Demelash Ayalew ◽  

Background Health system responsiveness refers to non-financial, non-clinical qualities of care that reflect respect for human dignity and interpersonal aspects of the care process. The non-clinical aspects of the health system are therefore essential to the provision of services to patients. Therefore, the main purpose of this study was to assess the responsiveness in maternity care, domain performance and factors associated with responsiveness in maternity care in the Hadiya Zone public Hospitals in Southern Ethiopia. Methods A hospital-based cross-sectional study was employed on 413 participants using a systematic sampling technique from 1 July to 1 August 2020. An exit interviewer–administered questionnaire was used to collect data. EpiData (version 3.1) and SPSS (version 24) software were used for data entry and analysis, respectively. Bivariate and multivariable logistic regression were computed to identify the associated factors of health system responsiveness in maternity care at 95% CI. Results The findings indicated that 53.0% of users gave high ratings for responsiveness in delivery care. In the multivariable logistic regression analysis, mothers aged ≥ 35 (AOR = 0.4; 95% CI = 0.1–0.9), urban resident (AOR = 2.5; 95% CI = 1.5–4.8), obstetrics complications during the current pregnancy (AOR = 2.1; 95% CI = 1.1–3.0), and caesarean delivery (AOR = 0.4; 95% CI = 0.2–0.7) were factors associated with poor ratings for responsiveness in maternity care. Conclusion In the hospitals under investigation, responsiveness in maternity care was found to be good. The findings of this study suggest that the ministry of health and regional health bureau needs to pay attention to health system responsiveness as an indicator of the quality of maternity care.

Deldar Morad Abdulah ◽  
Sherzad Khudeida Suleman

Azene Bantie Wubie ◽  
Girum Sebsibe Teshome ◽  
Wudie Eneyew Ayele ◽  
Fikirtemariam Abebe ◽  
Tewodros Mulugeta Nigussie ◽  

2021 ◽  
Vol 21 (1) ◽  
Angela Kairu ◽  
Stacey Orangi ◽  
Boniface Mbuthia ◽  
Joanne Ondera ◽  
Nirmala Ravishankar ◽  

Abstract Background How health facilities are financed affects their performance and health system goals. We examined how health facilities in the public sector are financed in Kenya, within the context of a devolved health system. Methods We carried out a cross-sectional study in five purposely selected counties in Kenya, using a mixed methods approach. We collected data using document reviews and in-depth interviews (no = 20). In each county, we interviewed county department of health managers and health facility managers from two and one purposely selected public hospitals and health center respectively. We analyzed qualitive data using thematic analysis and conducted descriptive analysis of quantitative data. Results Planning and budgeting: Planning and budgeting processes by hospitals and health centers were not standardized across counties. Budgets were not transparent and credible, but rather were regarded as “wish lists” since they did not translate to actual resources. Sources of funds: Public hospitals relied on user fees, while health centers relied on donor funds as their main sources of funding. Funding flows: Hospitals in four of the five study counties had no financial autonomy. Health centers in all study counties had financial autonomy. Flow of funds to hospitals and health centers in all study counties was characterized by unpredictability of amounts and timing. Health facility expenditure: Staff salaries accounted for over 80% of health facility expenditure. This crowded out other expenditure and led to frequent stock outs of essential health commodities. Conclusion The national and county government should consider improving health facility financing in Kenya by 1) standardizing budgeting and planning processes, 2) transitioning public facility financing away from a reliance on user fees and donor funding 3) reforming public finance management laws and carry out political engagement to facilitate direct facility financing and financial autonomy of public hospitals, and 4) assess health facility resource needs to guide appropriate levels resource allocation.

Y Ke ◽  
S Chew ◽  
E Seet ◽  
WY Wong ◽  
V Lim ◽  

Introduction: Post-anaesthesia care unit (PACU) delirium affects 5%–45% of patients after surgery and is associated with postoperative delirium and increased mortality. Up to 40% of PACU delirium is preventable but it remains under-recognised due to a lack of awareness for its diagnosis. Nursing Delirium Screening Scale (Nu-DESC) has been validated in diagnosing PACU delirium but is not routine locally. This study aim was to use the Nu-DESC to establish the incidence and risk factors of PACU delirium in patients undergoing non-cardiac surgery in the surgical population. Methods: With IRB approval and informed consent, we conducted an audit of eligible patients undergoing major surgery in three major public hospitals in Singapore over one week. Patients were assessed for delirium 30–60 minutes following their arrival in the PACU using the Nu-DESC with a score of ≥ 2 as indicative of delirium. Results: A total of 478 patients were assessed. The overall incidence rate of PACU delirium was 18/478 (3.8%) and 9/146 (6.2%) in patients over 65 years old. PACU delirium was more common in females, patients with malignancy and those who underwent longer operations. Logistic Regression analysis showed that the use of BIS (p < 0.001) and the presence of malignancy (p<0.001) were significantly associated with a higher incidence of PACU delirium. Conclusion: In this first local study, the incidence of PACU delirium was 3.8%, with the incidence increasing to 6.2% in those older than 65 years old. Understanding these risk factors will form the basis for which protocols can be established to optimise resource management and prevent long term morbidities and mortality of PACU delirium.

Mwaka A. Kakolwa ◽  
Susannah L. Woodd ◽  
Alexander M. Aiken ◽  
Fatuma Manzi ◽  
Giorgia Gon ◽  

Abstract Background Overuse of antibiotics is a major challenge and undermines measures to control drug resistance worldwide. Postnatal women and newborns are at risk of infections and are often prescribed prophylactic antibiotics although there is no evidence to support their universal use in either group. Methods We performed point prevalence surveys in three hospitals in Dar es Salaam, Tanzania, in 2018 to collect descriptive data on antibiotic use and infections, in maternity and neonatal wards. Results Prescribing of antibiotics was high in all three hospitals ranging from 90% (43/48) to 100% (34/34) in women after cesarean section, from 1.4% (1/73) to 63% (30/48) in women after vaginal delivery, and from 89% (76/85) to 100% (77/77) in neonates. The most common reason for prescribing antibiotics was medical prophylaxis in both maternity and neonatal wards. Conclusions We observed substantial overuse of antibiotics in postnatal women and newborns. This calls for urgent antibiotic stewardship programs in Tanzanian hospitals to curb this inappropriate use and limit the spread of antimicrobial resistance.

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