The impact of the National Essential Medicines Policy on prescribing behaviours in primary care facilities in Hubei province of China

Yang, Lianping; Liu, George; Ferrier, Adamm; Zhou, Wei; Zhang, Xiaopeng

doi:10.1093/heapol/czs116

Cited by 96 publications

(103 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, providers' accounts suggested that financial considerations in different healthcare institutions were not in line with the policies' focus, with evidence that making profits from antibiotic prescriptions was still regarded as a factor related to the use of antibiotics in CHIs. These findings are similar to studies undertaken in various provinces in China, which noted that the EDL and ZMU policies had no effect on the inappropriate use of antibiotics among primary care institutions [52][53][54], even in the period after the introduction of 2011 reform [51,55,56].…”

Section: Discussionsupporting

confidence: 88%

Healthcare Providers’ Accounts of Influences of Antibiotic-Related Reforms on their Behavior with Respect to the Use of Antibiotics for Children: A Qualitative Study in China

Zhang¹,

Graham²,

White³

2018

PHOA

View full text Add to dashboard Cite

Purpose: High and inappropriate pediatric use of antibiotics by healthcare providers is a key driver of antibiotic resistance in China. The Chinese government initiated a programme of antibiotic-related reforms in 2011 after a wider healthcare reform in 2009. However, very few studies shed light on the influence of these reforms on providers' antibiotic-related behavior; only one qualitative study of providers' perspectives and experiences has been undertaken. Therefore, our qualitative study aims to explore the influence of the 2009 and 2011 reforms on providers' pediatric antibiotic use.Methods: Qualitative interviews were conducted with 26 providers in Taiyuan city, a typical Chinese city in central China in 2016. Interviews were transcribed verbatim, translated from Chinese to English, and analyzed using framework analysis. Results:Healthcare providers described how their behavior was influenced by the availability of diagnostic testing. They also pointed to financial considerations and pressures, as well as other healthcare institutions within China's healthcare system that influence their antibiotic-related behavior. Conclusions:As far as we are aware, this is the first city-based qualitative study in China providing evidence of the influences of the 2009 and 2011 reforms on providers' antibiotic-related behavior. It points to issues around the enforcement of antibiotic-related reforms in community health institutions and retail pharmacies, and highlights the importance of understanding the reforms' influences on provider behavior within China's healthcare system as a whole.

show abstract

Section: Discussionsupporting

confidence: 88%

Healthcare Providers’ Accounts of Influences of Antibiotic-Related Reforms on their Behavior with Respect to the Use of Antibiotics for Children: A Qualitative Study in China

Zhang¹,

Graham²,

White³

2018

PHOA

View full text Add to dashboard Cite

show abstract

“…Misaligned economic incentive for health providers is the main contributor to the overprescribing of antibiotics in China. Although China has implemented a zero drug profit policy since 2009, which aimed at removing profits on drug sales of health facilities, the connection between drug companies and individual doctors still contributes to this problem [18,19]. Compared with more developed regions, healthcare providers in less developed regions had lower incomes, experienced relaxed regulations, and were more likely to profit from overprescribing antibiotics [7,15,20].…”

Section: Discussionmentioning

confidence: 99%

Antibiotic misuse among university students in developed and less developed regions of China: a cross-sectional survey

Peng

Wang

et al. 2018

Global Health Action

View full text Add to dashboard Cite

Background: Antimicrobial resistance (AMR) is a great threat to public health. The primary cause of AMR is human antibiotic misuse. Little is known about regional differences of antibiotic misuse behaviours in China. Objectives: To explore the antibiotic misuse behaviours among university students in western and eastern China and find out the regional differences. Methods: Participants were recruited from universities in less developed Guizhou Province and developed Zhejiang Province using a cluster random sampling method. A self-administered questionnaire was designed to collect data, and the χ2 test and logistic regression were adopted to assess the associations between region and antibiotic misuse behaviours. Results: A total of 2073 university students from Guizhou and 1922 from Zhejiang completed questionnaires. Students in Guizhou had lower household income, parents’ education, and urban residence proportion than those in Zhejiang. Compared with those in Zhejiang, students in Guizhou had higher antibiotic use prescribed by doctors (79.8% vs 56.2%) and self-medication with antibiotics (33.0% vs 16.1%). Students in Guizhou were more likely to buy over-the-counter antibiotics without prescriptions (73.9% vs 63.4%), ask for antibiotics from doctors (21.4% vs 15.6%), and use antibiotics prophylactically (29.9% vs 15.7%). Adjusted models showed that the less developed region was significantly associated with higher antibiotic misuse behaviours. Conclusions: Misuse of antibiotics by well-educated young adults was very high in two regions but most serious in the less developed one. Campaigns are urgently needed to promote appropriate antibiotic use especially in less developed regions.

show abstract

“…In a quasi-experimental survey analysis of 55,800 prescriptions in primary care facilities in Hubei province, implementation of the EDL decreased the average cost per prescription [from 26.67 RMB to 44.67 RMB ($4.13-$6.93)] but did not reduce either prescription of antibiotics or parenteral drug delivery (79). Although early studies suggest decreases in inpatient spending due to EDL implementation (92), later studies suggest an increase in overall spending.…”

Section: Impact Of Reformsmentioning

confidence: 99%

China's Health Reform Update

Liu

Vortherms

Hong

2017

Annu. Rev. Public Health

214

215

View full text Add to dashboard Cite

China experienced both economic and epistemological transitions within the past few decades, greatly increasing demand for accessible and affordable health care. These shifts put significant pressure on the existing outdated, highly centralized bureaucratic system. Adjusting to growing demands, the government has pursued a new round of health reforms since the late 2000s; the main goals are to reform health care financing, essential drug policies, and public hospitals. Health care financing reform led to universal basic medical insurance, whereas the public hospital reform required more complex measures ranging from changes in regulatory, operational, and service delivery settings to personnel management. This article reviews these major policy changes and the literature-based evidence of the effects of reforms on cost, access, and quality of care. It then highlights the outlook for future reforms. We argue that a better understanding of the unintended consequences of reform policies and of how practitioners' and patients' interests can be better aligned is essential for reforms to succeed.

show abstract

The impact of the National Essential Medicines Policy on prescribing behaviours in primary care facilities in Hubei province of China

Cited by 96 publications

References 29 publications

Healthcare Providers’ Accounts of Influences of Antibiotic-Related Reforms on their Behavior with Respect to the Use of Antibiotics for Children: A Qualitative Study in China

Healthcare Providers’ Accounts of Influences of Antibiotic-Related Reforms on their Behavior with Respect to the Use of Antibiotics for Children: A Qualitative Study in China

Antibiotic misuse among university students in developed and less developed regions of China: a cross-sectional survey

China's Health Reform Update

Contact Info

Product

Resources

About