The effect of essential medicines programme on rational use of medicines in China

Gong, Yanhong; Yang, Chen; Yin, Xiaoxv; Zhu, Min; Yang, Hongming; Li, Yongbin; Liu, Liqun; Dong, Xiaoxin; Cao, Shiyi; Lu, Zuxun

doi:10.1093/heapol/czv008

Cited by 28 publications

(30 citation statements)

References 24 publications

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“…There was a slight increase (2%) in the use of injections for the patients with bronchitis. A lack of proper compensation mechanism is often blamed for the shortage of achievements of China’s National Essential Medicines Program (NEMP)3334. When the 15% markup policy for prescribed medicines was abandoned as part of the NEMP, health care providers had to shift their attention to services that could make up the loss (because of the shortage of government funding)35.…”

Section: Discussionmentioning

confidence: 99%

Public reporting as a prescriptions quality improvement measure in primary care settings in China: variations in effects associated with diagnoses

Tang

Liu

Zhang

2016

Sci Rep

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The overprovision and irrational use of antibiotics and injections are a major public health concern. Public reporting has been adopted as a strategy to encourage good prescribing practices. This study evaluated the effects of public reporting on antibiotic and injection prescriptions in urban and rural primary care settings in Hubei province, China. A randomized control trial was conducted, with 10 primary care institutions being subject to public reporting and another 10 serving as controls. Prescription indicators were publicly reported monthly over a one-year period. Prescriptions for bronchitis, gastritis and hypertension before and after the intervention were collected. Difference-in-difference tests were performed to estimate the effect size of the intervention on five prescription indicators: percentage of prescriptions containing antibiotics; percentage of prescriptions containing two or more antibiotics; percentage of prescriptions containing injections; percentage of prescriptions containing antibiotic injections; and average prescription cost. Public reporting had varied effects on prescriptions for different diagnoses. It reduced antibiotic prescribing for gastritis. Prescriptions containing injections, especially antibiotic injections, also declined, but only for gastritis. A reduction of prescription costs was noted for bronchitis and gastritis. Public reporting has the potential to encourage good prescribing practices. Its effects vary with different disease conditions.

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Section: Discussionmentioning

confidence: 99%

Public reporting as a prescriptions quality improvement measure in primary care settings in China: variations in effects associated with diagnoses

Tang

Liu

Zhang

2016

Sci Rep

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“…Differences in research conclusions may be due to the use of data from different regions, research period or study design. But overall, these findings have demonstrated that the NEMP interventions are effective: the availability of essential medicines had improved,56 57 but remains at a low level58 59 and had a problem of regional inequity60; drug prices were reduced significantly,57 61–63 and the affordability of essential medicines has improved57 59 60; and the rational use of medicine has effectively improved, but remained poor 56 64–67. In the subjective questionnaire surveys, patients were satisfied with the price and quality of essential medicines 68.…”

Section: Coverage Of Health Servicesmentioning

confidence: 97%

Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China

et al. 2020

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Universal health coverage (UHC) has been identified as a priority for the global health agenda. In 2009, the Chinese government launched a new round of healthcare reform towards UHC, aiming to provide universal coverage of basic healthcare by the end of 2020. We conducted a secondary data analysis and combined it with a literature review, analysing the overview of UHC in China with regard to financial protection, coverage of health services and the reported coverage of the WHO and the World Bank UHC indicators. The results include the following: out-of-pocket expenditures as a percentage of current health expenditures in China have dropped dramatically from 60.13% in 2000 to 35.91% in 2016; the health insurance coverage of the total population jumped from 22.1% in 2003 to 95.1% in 2013; the average life expectancy increased from 72.0 to 76.4, maternal mortality dropped from 59 to 29 per 100 000 live births, the under-5 mortality rate dropped from 36.8 to 9.3 per 1000 live births, and neonatal mortality dropped from 21.4 to 4.7 per 1000 live births between 2000 and 2017; and so on. Our findings show that while China appears to be well on the path to UHC, there are identifiable gaps in service quality and a requirement for ongoing strengthening of financial protections. Some of the key challenges remain to be faced, such as the fragmented and inequitable health delivery system, and the increasing demand for high-quality and value-based service delivery. Given that China has committed to achieving UHC and ‘Healthy China 2030’, the evidence from this study can be suggestive of furthering on in the UHC journey and taking the policy steps necessary to secure change.

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“…[ 46 ] Gong et al . [ 47 ] note that despite improvements in rational medicine use after implementing China's national essential medicines programme, irrational medicine use was still high and called for, among other interventions, review of clinical guidelines which could be one of the underlying causes. An initiative of Medicines Utilization Research in Africa (MURIA) is a great development to stimulate research and act on recommendations for improving rational medicine use.…”

Section: Discussionmentioning

confidence: 99%

Alignment of standard treatment guidelines with medicine use indicators in a limited‐resource setting: findings and implications

Kagoya

Rennie

Kibuule

et al. 2020

J Pharm Health Serv Res

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Background Standard treatment guidelines (STGs) are a critical public health tool for promoting rational use of medicines. No studies have evaluated alignment of STGs with medicine use indicators especially in low and-middle-income countries (LMICs) with disproportionate burden of disease and irrational medicine use. Objective To determine the level of alignment of Namibia's STGs with WHO medicine use indicators. Methods A descriptive policy analysis of alignment of Namibia's STGs and WHO medicine use indicators. Thirty-two conditions/diseases prevalent and managed at primary healthcare level were included in the study of alignment of the STGs with two WHO medicine use indicators in terms of average number of medicines/condition (polypharmacy, WHO target <2) and antibiotic prescribing (WHO target <30%) after adjusting for estimated encounters per condition. Data were analyzed using (SPSSv24 software, IBM Corporation, NY) to determine frequencies, percentages and means. Key findings Of the 32 conditions/diseases studied, 41% had three or more medicines per condition indicated in the STGs. The weighted minimum and maximum average number of medicines/condition/encounter in the STGs were 2.62 and 2.78 respectively. Antibiotics were indicated for 72% (weighted per encounter = 75%) of the 32 conditions. Conditions/diseases of the urogenital system had the highest antibiotics indicated in the STGs (100%); respiratory (80%); ENT (80%); gastrointestinal (33%) before weighting conditions for estimated patient encounters, while ENT conditions had the highest antibiotics (32%) after weighting. Conclusions Alignment of Namibia STGs and medicine use targets is sub-optimal. The STGs have a high indication of antibiotics and polypharmacy. Misalignment is the main contributor to sub-optimal medicine use indicators with respect to average number of medicines and antibiotics. Countries should review their STGs and align with medicine use indicators to enhance rational medicine use and fight antimicrobial resistance. This article provides guidance for aligning STGs with medicine use indicators.

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The effect of essential medicines programme on rational use of medicines in China

Cited by 28 publications

References 24 publications

Public reporting as a prescriptions quality improvement measure in primary care settings in China: variations in effects associated with diagnoses

Public reporting as a prescriptions quality improvement measure in primary care settings in China: variations in effects associated with diagnoses

Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China

Alignment of standard treatment guidelines with medicine use indicators in a limited‐resource setting: findings and implications

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