Php11 Review of Adjustment of Essential Medicine List at Provincial Level in China

Abstract

OBJECTIVES: Deaths due to opioid over-dosage have increased over the last decade and now represent the most frequent cause of death due to poisoning. This study examined the temporal association between prescription opioid use between 2000 and 2005 and the number of opioid-poisoning deaths. METHODS: The number of annual opioid-poisoning deaths from 2000-05 was obtained from the National Vital Statistics System multiple causes of injury mortality files (Warner 2009). Data for annual prescription opioid use was obtained from a published study that reported opioid use from 2.7 to 3.8 million enrollees annually using the HealthCore Blue Cross and Blue Shield national commercial insurance plans (Sullivan 2008). The temporal relationship between several opioid use measures and the number of opioid deaths/year was studied using ordinary least square regression. RESULTS: The cumulative opioid dose among all recipients increased from 204 mgs morphine equivalents/enrollee/year to 371 mgs and among opioid users with a non-cancer pain diagnosis from 2473 mgs to 3406 mgs. During this period, the number of yearly opioid deaths increased from 4,419 in 2000 to 10,947 in 2005. There was a significant linear relationship between the cumulative yearly opioid dose/enrollee/year and the number of opioid-poisoning deaths (pϽ0.0001, R 2 ϭ0.98). A significant positive linear relationship was also observed between the number of annual opioid-related deaths and opioid use measures of cumulative yearly opioid dose (pϽ0.0001, R 2 ϭ0.98), opioid dose/prescription (pϭ0.0053, R 2 ϭ0.88) and mean days-supplied of opioids/year (pϽ0.0001, R 2 ϭ0.99). CONCLUSIONS: A strong linear relationship between opioid-poisoning deaths and several prescription opioid use measures suggests that the acquisition of prescribed opioids through legal channels is associated with the national opioid mortality rate. This calls for added vigilance on the part of prescribers and policy makers to ensure safe use of opioid analgesics. Further research is warranted to confirm these correlations.

Health system reform in rural China: Voices of healthworkers and service-users

“…Most doctors we interviewed supported the principle of the essential drug list, and said it had reduced unnecessary prescribing, though actual behaviours could not be verified. In fact, in studies which have investigated changes in prescribing practices, there has been only a small reduction in actual numbers of drugs prescribed since the introduction of the list (Li et al, 2013;Shi et al, 2011) though these studies were carried-out perhaps too early in the reform process to demonstrate an impact. But it is perhaps not surprising that lack of financial incentives alone will not immediately change decades of doctors' prescribing habits, nor patients' expectations of several prescribed drugs.…”

“…But it is perhaps not surprising that lack of financial incentives alone will not immediately change decades of doctors' prescribing habits, nor patients' expectations of several prescribed drugs. Now that profit is no longer an incentive in prescribing, this is the perfect time, not only to re-educate doctors on evidence-based prescribing, (such training has taken place in some areas) (Li et al, 2013;Shi et al, 2011;Tian et al, 2012), but also to educate the general public on the dangers of excessive drug use, and the desirability of self-care for minor conditions. But there are other problems with the essential drug list noted by both doctors and service users.…”

Evaluation, in three provinces, of the introduction and impact of China’s National Essential Medicines Scheme

“…However, the official documents for this reform provide only guiding principles that encourage the local adaptation and piloting of the NEMS, 21,22 including the use of the National Essential Drugs List (now widely augmented 14,23 ) and strategies to compensate health-care providers for income lost as a result of the zeromark-up policy.…”

“…23 A senior official in China, while noting that numerous health authorities have deemed the standard National Essential Drugs List to be inadequate, has rightly questioned the concept of such a list if drugs can be added to it without limit. 30 Given China's decentralized health system, it may be difficult to ensure that affordability and medically appropriate treatment are maintained following the local adaptation of the National Essential Drugs List.…”

Perceived impacts of the national essential medicines system: a cross-sectional survey of health workers in urban community health services in China

“…Doctors have to struggle between the demands of consumers and the restrictions of prescriptions imposed by the NEMP. 28 A study in three rural counties in western China reported that 30% of the prescription medicines in common use were not covered by the EML, whereas 30% of the medicines listed were rarely prescribed by physicians. 24 …”