Urban-rural inequality regarding drug prescriptions in primary care facilities – a pre-post comparison of the National Essential Medicines Scheme of China

International Journal for Equity in Health

Ju Sun²  Zhiyong Liu¹  J. Adamm Ferrier³  Chaojie Liu³  Qiang Yao² 

[1] School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, Hubei, China;School of Political Science and Public Administration, Wuhan University, Wuhan 430072, Hubei, China;School of Psychology and Public Health, La Trobe University, Melbourne 3086, VIC, Australia

关键词: China;    Inequalities;    Essential medicines;    Physician’s practice patterns;    Primary health care;   

Others  :  1222804
DOI  :  10.1186/s12939-015-0186-7

 received in 2015-02-26, accepted in 2015-07-17,  发布年份 2015

【 摘 要 】

Objective

To assess the impact of the National Essential Medicines Scheme (NEMS) with respect to urban-rural inequalities regarding drug prescriptions in primary care facilities.

Methods

A stratified two-stage random sampling strategy was used to sample 23,040 prescriptions from 192 primary care facilities from 2009 to 2010. Difference-in-Difference (DID) analyses were performed to test the association between NEMS and urban-rural gaps in prescription patterns. Between-Group Variance and Theil Index were calculated to measure urban-rural absolute and relative disparities in drug prescriptions.

Results

The use of the Essential Medicines List (EML) achieved a compliance rate of up to 90 % in both urban and rural facilities. An overall reduction of average prescription cost improved economic access to drugs for patients in both areas. However, we observed an increased urban-rural disparity in average expenditure per prescription. The rate of antibiotics and glucocorticoids prescription remained high, despite a reduced disparity between urban and rural facilities. The average incidence of antibiotic prescription increased slightly in urban facilities (62 to 63 %) and reduced in rural facilities (67 % to 66 %). The urban-rural disparity in the use of parenteral administration (injections and infusions) increased, albeit at a high level in both areas (44 %-52 %).

Conclusion

NEMS interventions are effective in reducing the overall average prescription costs. Despite the increased use of the EML, indicator performances with respect to rational drug prescribing and use remain poor and exceed the WHO/INRUD recommended cutoff values and worldwide benchmarks. There is an increased gap between urban and rural areas in the use of parenteral administration and expenditure per prescription.

【 授权许可】

   
2015 Yao et al.

【 图 表 】

Fig. 1.

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【 参考文献 】

• [1]Promoting rational use of medicines: core components. WHO Policy Perspect Med. 2002; 5:1-6.
• [2]World Health Organization. The Rational use of drugs: report of the conference of experts, Nairobi, 25-29 November 1985. World Health Organization; 1987. http://apps. who.int/medicinedocs/en/d/Js17054e/ webcite
• [3]Gopalakrishnan S, Ganeshkumar P, Katta A. Assessment of prescribing practices among urban and rural general practitioners in Tamil Nadu. Indian J Pharmacol. 2013; 45:252.
• [4]De Vries T, Henning RH, Hogerzeil H, Fresle D. Guide to good prescribing. World Health Organization, Geneva; 1994.
• [5]Abula T, Desta Z, Yohannes AG. Prescribing pattern of drugs in medical wards of three hospitals in northwest Ethiopia. J Ethiop Med Pract. 2004; 4:8-13.
• [6]Shankar PR. Medicines use in primary care in developing and transitional countries: Fact Book summarizing results from studies reported between 1990 and 2006. Bull World Health Organ. 2009; 87:804.
• [7]Yang L, Liu C, Ferrier JA, Zhou W, Zhang X. The impact of the National Essential Medicines Policy on prescribing behaviours in primary care facilities in Hubei province of China. Health Policy Plan. 2013; 28:750-60.
• [8]The Pursuit of Responsible Use of Medicines: Sharing and Learning from Country Experiences. 2012.
• [9]The world medicines situation. World Health Organization, Geneva; 2004.
• [10]Dong L, Yan H, Wang D. Antibiotic prescribing patterns in village health clinics across 10 provinces of Western China. J Antimicrob Chemother. 2008; 62:410-5.
• [11]Sivagnanam G, Mohanasundaram J, Thirumalaikolundusubramanian P, Raaj AA, Namasivayam K, Rajaram S. A survey on current attitude of practicing physicians upon usage of antimicrobial agents in southern part of India. Medscape Gen Med. 2004, 6(2).
• [12]Li Y, Xu J, Wang F, Wang B, Liu L, Hou W et al.. Overprescribing in China, driven by financial incentives, results in very high use of antibiotics, injections, and corticosteroids. Health Aff (Millwood). 2012; 31:1075-82.
• [13]Pavin M, Nurgozhin T, Hafner G, Yusufy F, Laing R. Prescribing practices of rural primary health care physicians in Uzbekistan. Trop Med Int Health. 2003; 8:182-90.
• [14]Dong L, Yan H, Wang D. Drug prescribing indicators in village health clinics across 10 provinces of Western China. Fam Pract. 2011; 28:63-7.
• [15]Chen W, Tang S, Sun J, Ross-Degnan D, Wagner AK. Availability and use of essential medicines in China: manufacturing, supply, and prescribing in Shandong and Gansu provinces. BMC Health Serv Res. 2010; 10:211. BioMed Central Full Text
• [16]Holloway K, Van Dijk L. The World Medicines Situation 2011-Rational use of medicines. WHO, Geneva; 2011.
• [17]Guan X, Liang H, Xue Y, Shi L. An analysis of China's national essential medicines policy. J Public Health Policy. 2011; 32:305-19.
• [18]State Council of People's Republic of China. Current major project on health care system reform (2009–2011). (published Apr 8, 2009, accessed Dec 8, 2013). 2009 [cited 2013 8 Dec]; Available from:. http://www. gov.cn/test/2009-04/08/content_1280057.htm webcite
• [19]Jiang Q, Yu BN, Ying G, Liao J, Gan H, Blanchard J et al.. Outpatient prescription practices in rural township health centers in Sichuan Province, China. BMC Health Serv Res. 2012; 12:324. BioMed Central Full Text
• [20]Yip WC, Hsiao WC, Chen W, Hu S, Ma J, Maynard A. Early appraisal of China's huge and complex health-care reforms. Lancet. 2012; 379:833-42.
• [21]Dong L, Wang D, Gao J, Yan H. Doctor's injection prescribing and its correlates in village health clinics across 10 Provinces of Western China. J Public Health (Oxf). 2011; 33:565-70.
• [22]Dong L, Yan H, Wang D. Polypharmacy and its correlates in village health clinics across 10 provinces of Western China. J Epidemiol Community Health. 2010; 64:549-53.
• [23]Reynolds L, McKee M. Factors influencing antibiotic prescribing in China: an exploratory analysis. Health Policy. 2009; 90:32-6.
• [24]Reynolds L, McKee M. Serve the people or close the sale? Profit-driven overuse of injections and infusions in China's market-based healthcare system. Int J Health Plann Manage. 2011; 26:449-70.
• [25]Eggleston K, Ling L, Qingyue M, Lindelow M, Wagstaff A. Health service delivery in China: a literature review. Health Econ. 2008; 17:149-65.
• [26]Cao Y, Wang Y, Zheng L, Yanwen L. Towards a Confucian approach to health care allocation in China: a dynamic geography. In China: Bioethics, Trust, and The Challenge Of The Market. Springer; 2008: 27-38.
• [27]How to investigate drug use in health facilities: selected drug use indicators. World Health Organization, Geneva; 1993.
• [28]Pan X, Fang J, Sun Z. Sample size estimation. In: Health statistics. People's Medical Publishing House, Beijing; 2003: p.139.
• [29]Ross-Degnan D, Laing R, Quick J, Mohamed Ali H, Ofori-Adjei D, Salako L et al.. A strategy for promoting improved pharmaceutical use: the International Network for Rational Use of Drugs. Soc Sci Med. 1992; 35:1329-41.
• [30]Chakravarty SR. The variance as a subgroup decomposable measure of inequality. Soc Indicators Res. 2001; 53:79-95.
• [31]Sen A. On economic inequality. Oxford University Press, New York; 1973.
• [32]Theil H. Economics and information theory. North-Holland Pub. Co.; Rand McNally, Amsterdam, Chicago; 1967.
• [33]Firebaugh G, ebrary Inc. The new geography of global income inequality. pp. xiii, 257 p. Cambridge, Mass.: Harvard University Press,; 2003:xiii, 257 p.
• [34]World Health Organization. Handbook on health inequality monitoring with a special focus on low-and middle-income countries. World Health Organization; 2013. http://apps. who.int/medicinedocs/en/d/Js17054e/ webcite
• [35]Harper S, Lynch J. Selected Comparisons of Measures of Health Disparities Using Databases Containing Data Relevant to Healthy People 2010 Cancer-Related Goals. 2010.
• [36]StataCorp L P. Stata data analysis and statistical Software [J]. Special Edition Release; 2007. p. 10.
• [37]Breen N, Scott S, Percy-Laurry A, Lewis D, Glasgow R. Health disparities calculator: a methodologically rigorous tool for analyzing inequalities in population health. American journal of public health. 2014;104(9):1589–1591.
• [38]Li Y, Ying C, Sufang G, Brant P, Bin L, Hipgrave D. Evaluation, in three provinces, of the introduction and impact of China's National Essential Medicines Scheme. Bull World Health Organ. 2013; 91:184-94.
• [39]Holloway K, Ivanovska V, Wagner A, Vialle‐Valentin C, Ross‐Degnan D. Have we improved use of medicines in developing and transitional countries and do we know how to? Two decades of evidence. Trop Med Int Health. 2013; 18:656-64.
• [40]Desalegn AA. Assessment of drug use pattern using WHO prescribing indicators at Hawassa University teaching and referral hospital, south Ethiopia: a cross-sectional study. Bmc Health Serv Res. 2013, 13.
• [41]Sketris IS, Langille IE, Lummis HL. Strategic opportunities for effective optimal prescribing and medication management. Can J Clin Pharmacol. 2008; 16:e103-25.
• [42]Francke AL, Smit MC, de Veer AJ, Mistiaen P. Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Med Inform Decis Mak. 2008; 8:38. BioMed Central Full Text
• [43]Siddiqi K, Newell J, Robinson M. Getting evidence into practice: what works in developing countries? International J Qual Health Care. 2005; 17:447-54.
• [44]Le Grand A, Hogerzeil HV, Haaijer-Ruskamp FM. Intervention research in rational use of drugs: a review. Health Policy Plan. 1999; 14:89-102.
• [45]Quick JD, Laing RO, Ross-Degnan DG. Intervention research to promote clinically effective and economically efficient use of pharmaceuticals: the International Network for Rational Use of Drugs. J Clin Epidemiol. 1991; 44 Suppl 2:57S-65.