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Wu Y, Han X, Qiu J. Impacts of the Zero-Markup Drug Policy on Hospitalization Expenses of Patients with Stroke in Western China: An Interrupted Time Series Analysis. Risk Manag Healthc Policy 2024; 17:777-788. [PMID: 38584876 PMCID: PMC10999200 DOI: 10.2147/rmhp.s456977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/23/2024] [Indexed: 04/09/2024] Open
Abstract
Background In 2016, an innovative medical pricing reform called zero-markup drug policy (ZMDP) was implemented in selected pilot cities in China, which focuses on curbing the unreasonable growth of medical expenses. This study aimed to evaluate the impacts of ZMDP on medical expenditure of stroke in western China. Methods The quantitative data of inpatients diagnosed with stroke was extracted from the medical insurance system in 7 tertiary public hospitals. An interrupted time series (ITS) was used to analyze the instantaneous level and long-term trend changes of hospitalization expenses per visit from January 2015 to November 2018. Results A total of 22,407 stroke inpatients were extracted. The total hospitalization expense per visit had the highest proportion of 20,000 CNY and above (33.66%). After the ZMDP, the median total hospitalization expense and western medicine expense per visit decreased by 631.74 CNY and 966.35 CNY, respectively (P <0.001). Before the policy, the total hospitalization expense, traditional Chinese medicine (TCM) expense, examination expense, treatment expense, laboratory expense and surgical expense per visit showed upward trends (P<0.05), while the anesthesia expense per visit showed a downward trend (P<0.001). When the policy was implemented, the anesthesia expense per visit instantaneously increased by 91.70% (P<0.001). After the policy, the total hospitalization expense, western medicine expense, TCM expense, treatment expense and surgical expense per visit changed from upward trends to downward trends (P<0.05). The anesthesia expense per visit changed from a downward trend to an upward trend (P<0.001), and the examination expense per visit maintained an upward trend (P=0.005). Conclusion The economic burden of stroke inpatients decreased significantly with the implementation of the ZMDP, especially for the drug expenses. The medical service expenses increased significantly, reflecting the improvement in the value of medical staff's technical labor. However, the unexpected increase in the examination expenses was likely to be associated with the unreasonable medical compensation mechanism.
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Affiliation(s)
- Yanghaotian Wu
- Department of Social Medicine and Health Service Management, School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
- Department of Social Medicine, School of Public Health, Southwest Medical University, Luzhou, People’s Republic of China
- Institute of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China
| | - Xuemei Han
- Institute of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China
| | - Jingfu Qiu
- Department of Social Medicine and Health Service Management, School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
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Yang R, Li Q, Hayat K, Zhai P, Liu W, Chen C, Saeed A, Chang J, Li P, Du Q, Xu S, Wen J, Fang Y. Views of Pharmacists and Government Representatives Toward the Pilot Chief Pharmacist System in Chinese Hospitals: A Multicenter Exploratory Qualitative Study. Front Public Health 2022; 10:895649. [PMID: 35784261 PMCID: PMC9240424 DOI: 10.3389/fpubh.2022.895649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background In China, the pharmacy departments of most hospitals have changed their main focus from drug procurement and distribution to providing pharmaceutical care services. Various regions of China have successively implemented the pilot Chief Pharmacist System (CPS) to help improve pharmaceutical care services and rational drug use in hospitals. This study was designed to explore the perspectives of pharmacists and government officials on CPS, including the advantages and barriers to the successful implementation of CPS. Methods A qualitative study, based on semi-structured interviews, was conducted from October 1, 2018 to March 1, 2019. The interview data were gathered from 18 pharmacy staff and government representatives working in five distinct regions of China using purposive sampling. A thematic analysis approach and NVivo version 12 Plus was utilized to code and analysis of all interviews. Results Five broad themes were identified: the role of the chief pharmacist; their attitudes toward the CPS; the advantages and results of the CPS; the barriers toward CPS; and their suggestions toward CPS. Most of the participants believed that the chief pharmacist played a vital role in a hospital. Under CPS, the hospital pharmacy department pays more attention to prescription review, medication monitoring, and pharmaceutical consultation. However, an insufficient number of pharmacy personnel, unclear authority, and inadequate salaries were the main barriers to the implementation of the CPS. Conclusion The attitudes of most of the participants were found to be positive toward CPS in China. The CPS can enhance the prestige of the hospital pharmacy department, improve the quality of hospital pharmaceutical care services, and promote rational drug use. Nevertheless, certain barriers highlighted in this study should be addressed promptly.
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Affiliation(s)
- Ruomeng Yang
- Department of Industrial Economics and Trade, School of Economics and Finance, Xi'an Jiaotong University, Xi'an, China
| | - Qian Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Panpan Zhai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Wenchen Liu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Chen Chen
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Amna Saeed
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Pengchao Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Qianqian Du
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Sen Xu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Jun Wen
- Department of Industrial Economics and Trade, School of Economics and Finance, Xi'an Jiaotong University, Xi'an, China
- Jun Wen
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
- *Correspondence: Yu Fang
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Fang Q, Shang D, Zhang Y, Geng X, Liu F, Zhang Q, Wang X. Will the zero-margin drug policy reduce the economic burden of stroke patients in China? J Glob Health 2021; 11:08007. [PMID: 34671464 PMCID: PMC8501452 DOI: 10.7189/jogh.11.08007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background China is facing a more severe stroke challenge. In 2017, China fully implemented the zero-margin drug policy (ZMDP), cancelling 15% of drug markups in public hospitals. Based on the “System of Health Accounts 2011” (SHA 2011), this paper explores the changes in the economic burden of stroke in China after implementing ZMDP to provide an accurate reference for policymakers. Methods Stroke patients from 2016 to 2018 were selected by multistage stratification probability-proportional random sampling in Shanxi Province. A total of 223 187 samples were included. Regression discontinuity design (RDD) was used to measure the change of drug proportion and cost. Sensitivity analysis and subgroup analysis were implied to determine the stability of the results. Results The current curative expenditure on stroke from 2016 to 2018 was 4374.69, 3727.22, and 3752.52 million Chinese Yuan (CNY). About 90% of the cost occurred during hospitalization, and 60% in general hospitals. After the implementation of ZMDP, the drug proportion from 46.54% (interquartile range (IQR) = 37.10%, 55.14%) in 2016 to 36.40% (IQR = 25.82%, 48.58%) in 2018, and average hospitalization cost per stay was from 7950.02 (IQR = 4938.76, 12 639.90) CNY in 2016 to 7362.08 (IQR = 4892.82, 11 501.40) CNY in 2018. RDD showed the drug proportion decreased by 2.76% (95% confidence interval (CI) = 1.17%, 4.35%, P = 0.001), and the expense decreased by 4698.34 (95% CI = 3047.59, 6349.09, P < 0.001) CNY. Conclusions The economic burden of stroke patients in China was severe. ZMDP played a noticeable effect in reducing drug proportion and hospitalization costs. The Chinese government should continue to implement relevant policies to control stroke costs according to regional and population characteristics.
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Affiliation(s)
- Quan Fang
- College of Health Management, China Medical University, Shenyang, Liaoning, China
| | - Degao Shang
- Liaoning Province Center for Disease Control and Prevention, Shenyang, Liaoning, China
| | - Yunxia Zhang
- Institute for Shanxi Medical Institution Administration, Taiyuan, Shanxi, China
| | - Xinli Geng
- Institute for Shanxi Medical Institution Administration, Taiyuan, Shanxi, China
| | - Fang Liu
- College of Health Management, China Medical University, Shenyang, Liaoning, China
| | - Qin Zhang
- College of Health Management, China Medical University, Shenyang, Liaoning, China.,Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xin Wang
- College of Health Management, China Medical University, Shenyang, Liaoning, China.,Research Center for Health Development - Liaoning New Type Think Tank for University, Shenyang, Liaoning, China
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Chen L, Feng P, Shaver L, Wang Z. Maternal mortality ratio in China from 1990 to 2019: trends, causes and correlations. BMC Public Health 2021; 21:1536. [PMID: 34380436 PMCID: PMC8359022 DOI: 10.1186/s12889-021-11557-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 07/27/2021] [Indexed: 02/08/2023] Open
Abstract
Background Maternal mortality ratio is an important indicator to evaluate the health status in developing countries. Previous studies on maternal mortality ratio in China were limited to certain areas or short periods of time, and there was a lack of research on correlations with public health funding. This study aimed to assess the trends in the maternal mortality ratio, the causes of maternal death, and the correlations between maternal mortality ratio and total health financing composition in China from 1990 to 2019. Methods Data in this longitudinal study were collected from the China Health Statistics Yearbooks (1991–2020) and China Statistical Yearbook 2020. Linear regression analysis was used to assess the trends in the maternal mortality ratio in China. Pearson correlation analysis was used to assess the correlations between national maternal mortality ratio and total health financing composition. Results The yearly trends of the national, rural and urban maternal mortality ratio were − 2.290 (p < 0.01), − 3.167 (p < 0.01), and − 0.901 (p < 0.01), respectively. The gap in maternal mortality ratio between urban and rural areas has narrowed. Obstetric hemorrhage was the leading cause of maternal death. The mortalities ratios for the main causes of maternal death all decreased in China from 1990 to 2019. The hospital delivery rate in China increased, with almost all pregnant women giving birth in hospitals in 2019. Government health expenditure as a proportion of total health expenditure was negatively correlated with the maternal mortality ratio (r = − 0.667, p < 0.01), and out-of-pocket health expenditure as a proportion of total health expenditure was positively correlated with the maternal mortality ratio (r = 0.516, p < 0.01). Conclusion China has made remarkable progress in improving maternal survival, especially in rural areas. The maternal mortality ratio in China showed a downward trend over time. To further reduce the maternal mortality ratio, China should take effective measures to prevent obstetric hemorrhage, increase the quality of obstetric care, improve the efficiency and fairness of the government health funding, reduce income inequality, and strengthen the medical security system.
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Affiliation(s)
- Lu Chen
- Division of Prevention and Community Health, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, no. 15 (Lin), Fengcunxili, Mentougou District, Beijing, 102308, China
| | - Penghui Feng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Lance Shaver
- Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Zengwu Wang
- Division of Prevention and Community Health, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, no. 15 (Lin), Fengcunxili, Mentougou District, Beijing, 102308, China.
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The Impact of China's Zero Markup Drug Policy on Hospitalization Expenses for Inpatients in Tertiary Public Hospitals: Evidence Based on Quantile Difference-in-Difference Models. Healthcare (Basel) 2021; 9:healthcare9070908. [PMID: 34356286 PMCID: PMC8307609 DOI: 10.3390/healthcare9070908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: The aim of this study was to determine the impact of the Zero Markup drug (ZMD) policy on hospitalization expenses for inpatients in tertiary Chinese hospitals. Methods: Using the administrative data from hospital electronic health records (EHRs) between 2015 and 2017, we implemented the quantile difference-in-differences (QDID) estimators to evaluate the impact of the ZMD policy on hospitalization expenses while controlling for patient-level and hospital-level characteristics. Results: According to the QDID models, the introduction of ZMD policy significantly induced lower drug costs for all inpatients especially at the 50th (-USD 507.84 (SE = USD 90.91), 75th (-USD 844.77 (SE = USD 149.70), and 90th (-USD 1400.00 (SE = USD 209.97)) percentiles of the overall distributions. However, the total hospitalization, diagnostic, treatment, material and services expenses for inpatients were significantly higher for the treated group than the control group. This tendency was more pronounced for inpatients in tertiary hospitals with lower expenses (in the 10th, 25th and 50th percentiles). Conclusion: The implementation of ZMD policy alone may not be enough to change the medical service providers’ profit-driven behavior. The targeted supervision of hospital costs by the Chinese health administration department should be strengthened to avoid unreasonable hospital charges.
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Liu M, Jia M, Lin Q, Zhu J, Wang D. Effects of Chinese medical pricing reform on the structure of hospital revenue and healthcare expenditure in county hospital: an interrupted time series analysis. BMC Health Serv Res 2021; 21:385. [PMID: 33902578 PMCID: PMC8077778 DOI: 10.1186/s12913-021-06388-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background China has initiated a medical pricing reform to combat the overuse of drugs and relieve the financial burden of patients. This paper aims to analyze the effect of medical pricing reform on revenue structure and healthcare expenditure of county public hospitals in Guangdong province. Methods Based on the monthly data from January 2013 to August 2019, we use interrupted time series design to evaluate the effects of medical pricing reform on healthcare expenditure in both outpatients and inpatients. A counterfactual is also established to examine the net effect of the policy. Results The proportion of drug revenue decreased from 35 % to 2015 to 29.7 % in 2019, and the revenue from medical services and inspection increased 3.2 and 3 % respectively. Meanwhile, the increasing trend of total expenditure and its main components is slowed down, especially the drug expense and medical consumable expense for inpatients after the Zero Mark-up Drug policy (coefficient = -18.76, p < 0.01; coefficient = -13.41, p < 0.01, respectively). However, the growth of inspection expense for outpatients continues to increase, while the healthcare expenditure for inpatients experiences an instant increase after the Zero Mark-up Medical Consumables policy. In terms of the net effect, most of healthcare expenditure in both outpatient and inpatient experienced a negative net growth from 2015 to 2019. Conclusions The medical pricing reform is a valuable attempt in controlling the unreasonable increase of medical expenses. In the meantime, the unexpected increase in inspection expenditure and insufficient compensation from medical service adjustment should draw the attention of the policymakers.
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Affiliation(s)
- Mengling Liu
- School of Health Management, Southern Medical University, No.1023 Shatai Road, 510515, Guangzhou, China
| | - Mingyuan Jia
- School of Economics and Management, South China Normal University, No. 55 Zhongshan Road, 510631, Guangzhou, China
| | - Qian Lin
- Nanfang Hospital, Southern Medical University, No.1838 Guangzhou North Road, 510515, Guangzhou, China
| | - Jiawei Zhu
- Department of Occupational Health and Occupational Medicine, Guangdong Province Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, No.1023 Shatai Road, 510515, Guangzhou, China
| | - Dong Wang
- School of Health Management, Southern Medical University, No.1023 Shatai Road, 510515, Guangzhou, China.
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Huang J, Dai T. Public hospital reforms in China: the perspective of hospital directors. BMC Health Serv Res 2019; 19:142. [PMID: 30819157 PMCID: PMC6393992 DOI: 10.1186/s12913-019-3954-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/18/2019] [Indexed: 01/20/2023] Open
Abstract
Background To understand the attitudes and opinions of directors of large public hospitals in China on reform policies of public hospital. Method A cross-sectional survey utilizing questionnaires of the Survey of Attitudes to Public Hospital Reform by Directors was conducted in 2014. The respondents were randomly selected in 100 tertiary public hospitals in 62 cities of 31 provinces in China by stratified multistage random cluster sampling method. 178 directors and associate directors working in tertiary public hospitals were involved. Standard descriptive statistics were used to describe and summarize the data. Results The measure of increasing government subsidies ranked first in the list of concerns expressed by responders (N = 149, 83.7%); while implementing clinical pathways ranked lowest in the list of concerns (N = 34, 19.7%). More associate directors (N = 64, 70.3%) were concerned over the measures of removing drug mark-ups than directors (N = 45, 51.7%) (χ2 = 6.49, p = 0.01). In addition, 75.8% of responders were concerned over the policy of salary system reform, while only 14.5% of them were satisfied with their current income level. What’s more, more than half responders were concerned over the policy of adjusting pricing policies (N = 127, 71.4%) and removing drug markups (N = 109, 61.2%). Conclusion In healthcare reform, the financial security for the hospitals should be considered as a priority by the policy-makers, without the reform goals cannot be achieved. Thus, an incentive mechanism needs to be established in China to guide the director to focus on the medical quality.
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Affiliation(s)
- Ju Huang
- The Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), No.3 Yabao Road, Chaoyang District, Beijing, People's Republic of China, 100020
| | - Tao Dai
- The Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), No.3 Yabao Road, Chaoyang District, Beijing, People's Republic of China, 100020.
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Yang C, Shen Q, Cai W, Zhu W, Li Z, Wu L, Fang Y. Impact of the zero-markup drug policy on hospitalisation expenditure in western rural China: an interrupted time series analysis. Trop Med Int Health 2016; 22:180-186. [DOI: 10.1111/tmi.12817] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy; School of Pharmacy; Xi'an Jiaotong University; Xi'an China
- Center for Drug Safety and Policy Research; Xi'an Jiaotong University; Xi'an China
| | - Qian Shen
- Department of Pharmacy Administration and Clinical Pharmacy; School of Pharmacy; Xi'an Jiaotong University; Xi'an China
- Center for Drug Safety and Policy Research; Xi'an Jiaotong University; Xi'an China
| | - Wenfang Cai
- Department of Pharmacy Administration and Clinical Pharmacy; School of Pharmacy; Xi'an Jiaotong University; Xi'an China
- Center for Drug Safety and Policy Research; Xi'an Jiaotong University; Xi'an China
| | - Wenwen Zhu
- Department of Pharmacy Administration and Clinical Pharmacy; School of Pharmacy; Xi'an Jiaotong University; Xi'an China
- Center for Drug Safety and Policy Research; Xi'an Jiaotong University; Xi'an China
| | - Zongjie Li
- Department of Pharmacy Administration and Clinical Pharmacy; School of Pharmacy; Xi'an Jiaotong University; Xi'an China
- Center for Drug Safety and Policy Research; Xi'an Jiaotong University; Xi'an China
| | - Lina Wu
- Department of Pharmacy Administration and Clinical Pharmacy; School of Pharmacy; Xi'an Jiaotong University; Xi'an China
- Center for Drug Safety and Policy Research; Xi'an Jiaotong University; Xi'an China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy; School of Pharmacy; Xi'an Jiaotong University; Xi'an China
- Center for Drug Safety and Policy Research; Xi'an Jiaotong University; Xi'an China
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