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Feelemyer J, Braithwaite RS, Zhou Q, Cleland CM, Manandhar-Sasaki P, Wilton L, Ritchie A, Collins LM, Gwadz MV. Empirical Development of a Behavioral Intervention for African American/Black and Latino Persons with Unsuppressed HIV Viral Load Levels: An Application of the Multiphase Optimization Strategy (MOST) Using Cost-Effectiveness as an Optimization Objective. AIDS Behav 2024; 28:2378-2390. [PMID: 38662280 DOI: 10.1007/s10461-024-04335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 04/26/2024]
Abstract
We used results from an optimization randomized controlled trial which tested five behavioral intervention components to support HIV antiretroviral adherence/HIV viral suppression, grounded in the multiphase optimization strategy and using a fractional factorial design to identify intervention components with cost-effectiveness sufficiently favorable for scalability. Results were incorporated into a validated HIV computer simulation to simulate longer-term effects of combinations of components on health and costs. We simulated the 32 corresponding long-term trajectories for viral load suppression, health related quality of life (HRQoL), and costs. The components were designed to be culturally and structurally salient. They were: motivational interviewing counseling sessions (MI), pre-adherence skill building (SB), peer mentorship (PM), focused support groups (SG), and patient navigation (short version [NS], long version [NL]. All participants also received health education on HIV treatment. We examined four scenarios: one-time intervention with and without discounting and continuous interventions with and without discounting. In all four scenarios, interventions that comprise or include SB and NL (and including health education) were cost effective (< $100,000/quality-adjusted life year). Further, with consideration of HRQoL impact, maximal intervention became cost-effective enough to be scalable. Thus, a fractional factorial experiment coupled with cost-effectiveness analysis is a promising approach to optimize multi-component interventions for scalability. The present study can guide service planning efforts for HIV care settings and health departments.
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Affiliation(s)
- Jonathan Feelemyer
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Qinlian Zhou
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Charles M Cleland
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Prima Manandhar-Sasaki
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Leo Wilton
- Department of Human Development, College of Community and Public Affairs (CCPA), State University of New York at Binghamton, Binghamton, NY, USA
| | - Amanda Ritchie
- Constance and Martin Silver Center on Data Science and Social Equity, New York University, New York, NY, USA
| | - Linda M Collins
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA
| | - Marya V Gwadz
- New York University Silver School of Social Work, New York, NY, USA
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Zhao H, Sun Y, Yao X, Shen P, Lin H, Zhan S. Association of outpatient fluoroquinolone prescribing with the National Medical Products Administration announcements of label changes in China. Expert Rev Anti Infect Ther 2024:1-9. [PMID: 38881100 DOI: 10.1080/14787210.2024.2368823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND In 2017 and 2021, the National Medical Products Administration (NMPA) announced to revise the drug label of fluoroquinolones. We aimed to evaluate the association of fluoroquinolone prescribing with the NMPA announcements of label changes. RESEARCH DESIGN AND METHODS Monthly prevalence of fluoroquinolone prescriptions for uncomplicated urinary tract infections (uUTI), acute exacerbation of chronic bronchitis (AECB), and acute sinusitis (AS) between 2016 and 2022 was calculated, and interrupted time series analysis was applied to assess the impacts of NMPA label changes on fluoroquinolone use. RESULTS Prevalence of fluoroquinolone prescriptions decreased by 2.39% (95% CI, -4.72% to -0.07%) for uUTI but increased by 3.02% (95% CI, 1.71% to 4.34%) for AS immediately after the 2017 label change. Moreover, after the 2021 label change, fluoroquinolone use decreased shortly in all the three indications. However, a significant increasing trend was observed in fluoroquinolone use for AECB episodes, and fluoroquinolons were used for 61.4% of treated uUTI, 31.6% of treated AECB, and 5.42% of treated AS at the end of 2022, respectively. CONCLUSIONS The label changes issued by the NMPA had no substantial impacts on fluoroquinolone prescribing in the study region in China. Fluoroquinolone prescribing was still highly prevalent for uUTI and AECB and thus requiring further antimicrobial stewardship.
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Affiliation(s)
- Houyu Zhao
- School of Medicine, Chongqing University, Chongqing, Chiana
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yexiang Sun
- Department of Data Center,Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Xi Yao
- Department of Infection Control, Peking University First Hospital, Beijing, China
| | - Peng Shen
- Department of Data Center,Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Hongbo Lin
- Department of Data Center,Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
- Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China
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Megerssa Y, Kune G, Nigatu M. Health-related quality of life and its predictors among hypertensive patients on follow up at public hospitals in Addis Ababa, Ethiopia: application of Tobit regression model. BMC Res Notes 2024; 17:126. [PMID: 38702824 PMCID: PMC11069134 DOI: 10.1186/s13104-024-06787-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/23/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Health-related quality of life and its associated factors among hypertensive patients living in Ethiopia are not well studied. Therefore, this study aims to assess the level of health-related quality of life and its associated factors in hypertensive patients on follow-up in Public Hospitals in Addis Ababa, Ethiopia. METHODS A facility-based cross-sectional study was conducted among 339 hypertensive patients on follow-up at Yekatit 12 &Zewditu Hospitals. Data were collected through face-to-face interviews using Euro Quality of Life Groups 5 Dimensions 5 Levels (EQ-5D-5L) in combination with Euro Quality of Life Groups Visual Analog Scale (EQ-VAS). A multivariable Tobit regression model was employed to assess the association between EQ-5D-5L index, EQ-VAS, and potential predicting factors. RESULTS The median index value and EQ-VAS Scales score was 0.86 (IQR = 0.74, 0.94) and 69 (IQR = 55, 80) respectively. The proportion of participants reporting anxiety/depression and pain/discomfort problems was highest, while the fewest patients reported problems in the self-care dimension. Older, rural residents, low income, higher stages of hypertension, increased use of antihypertensive medications, and patients with an increased hospitalization rate scored lower on health-related quality of life than others. CONCLUSION Health-related quality of life among hypertensive patients attending public health hospitals in Addis Ababa is unacceptably poor. Emphasis should be given to patients with higher stages of hypertension, increased use of antihypertensive medications, and an increased hospitalization rate giving due focus to older, rural residents, and low-income patients to promote their health-related quality of life.
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Affiliation(s)
- Yordanos Megerssa
- Medical and Sales Representative at Beker General Business PLC, Addis Ababa, Ethiopia
| | - Guta Kune
- Department of Epidemiology, College of Public Health, Jimma University, Jimma, Ethiopia.
| | - Mamo Nigatu
- Department of Epidemiology, College of Public Health, Jimma University, Jimma, Ethiopia
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Du K, Wushouer H, Huang T, Zhou Y, Hu L, Yang Y, Deng Y, Zheng B, Guan X, Shi L. The changes of different restriction level adjustments on antibiotic use in China. Int J Antimicrob Agents 2024; 63:107073. [PMID: 38141837 PMCID: PMC10879917 DOI: 10.1016/j.ijantimicag.2023.107073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 12/25/2023]
Abstract
This quasi-experimental study aimed to investigate the changes in antibiotic use tailored by adjusting provincial antibiotic restriction lists in China using interrupted time-series analysis from 2013 to 2019. Antibiotic use was assessed as defined daily dose (DDD) per 1000 patients per day. Trends and level changes were analysed with segmented regression. The study identified 19 antibiotic formulations in four provinces with adjusted restriction levels (intervention group) and 110 formulations in the rest provinces without adjustments (comparison group). Antibiotics restriction level changed between two categories: (1) between 'highly-restricted' and 'restricted' and (2) between 'restricted' and 'non-restricted'. Analysis revealed distinct trend changes for antibiotics moving between 'highly-restricted' and 'restricted' (β = 0.0211, P = 0.003) and 'restricted' to 'highly-restricted' (β = -0.0039, P = 0.128) compared to the comparison group. After a 2-y adjustment period, when moving from 'restricted' to 'highly-restricted', absolute antibiotic utilisation significantly decreased (P < 0.001), with a relative decrease of 100.8% (P < 0.001) compared to the comparison group. Besides, individual antibiotics with higher consumption displayed greater responsiveness to adjustment. These findings underscore the changes in restriction level adjustments on antibiotics, highlighting antibiotic restriction list policies as crucial tools for antimicrobial stewardship.
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Affiliation(s)
- Kexin Du
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Haishaerjiang Wushouer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration (IRCMA), Peking University, Beijing, China
| | - Tao Huang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Yue Zhou
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Lin Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Yaoyao Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Yanping Deng
- Department of Clinical Pharmacology, National Institute on Drug Dependence, Peking University, Beijing, China
| | - Bo Zheng
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration (IRCMA), Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration (IRCMA), Peking University, Beijing, China
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Pataky RE, Bryan S, Sadatsafavi M, Peacock S, Regier DA. Real-World Cost Effectiveness of a Policy of KRAS Testing to Inform Cetuximab or Panitumumab for Third-Line Therapy of Metastatic Colorectal Cancer in British Columbia, Canada. PHARMACOECONOMICS - OPEN 2023; 7:997-1006. [PMID: 37819586 PMCID: PMC10721761 DOI: 10.1007/s41669-023-00444-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Cetuximab and panitumumab, two anti-EGFR therapies, are widely used for third-line therapy of metastatic colorectal cancer (mCRC) with wild-type KRAS, but there remains uncertainty around their cost effectiveness. The objective of this analysis was to conduct a real-world cost-effectiveness analysis of the policy change introducing KRAS testing and third-line anti-EGFR therapy mCRC in British Columbia (BC), Canada. METHODS We conducted secondary analysis of administrative data for a cohort of mCRC patients treated in BC in 2006-2015. Patients potentially eligible for KRAS testing and third-line therapy after the policy change (July 2009) were matched 2:1 to pre-policy patients using genetic matching on propensity score and baseline covariates. Costs and survival time were calculated over an 8-year time horizon, with bootstrapping to characterize uncertainty around endpoints. Cost effectiveness was expressed using incremental cost-effectiveness ratios (ICER) and the probability of cost effectiveness at a range of thresholds. RESULTS The cohort included 1757 mCRC patients (n = 456 pre-policy and n = 1304 post-policy; of those, n = 420 received cetuximab or panitumumab). There was a significant increase in survival and cost following the policy change. Adoption of KRAS testing and anti-EGFR therapy had an ICER of CA$73,759 per life-year gained (LYG) (95% CI 46,133-186,446). In scenario analysis, a reduction in cetuximab and panitumumab cost of at least 50% was required to make the policy change cost effective at a threshold of CA$50,000/LYG. CONCLUSION A policy of third-line anti-EGFR therapy informed by KRAS testing may be considered cost effective at thresholds above CA$70,000/LYG. Reduction in drug costs, through price discounts or potential future biosimilars, would make anti-EGFR therapy considerably more cost effective. By using real-world data for a large cohort with long follow-up we can assess the value of a policy of KRAS testing and anti-EGFR therapy achieved in practice.
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Affiliation(s)
- Reka E Pataky
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer, Vancouver, BC, Canada.
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
- BC Cancer Research Centre, 675 W. 10th Ave, Vancouver, BC, V5Z 1L3, Canada.
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Cai C, Xiong S, Millett C, Xu J, Tian M, Hone T. Health and health system impacts of China's comprehensive primary healthcare reforms: a systematic review. Health Policy Plan 2023; 38:1064-1078. [PMID: 37506039 PMCID: PMC10566320 DOI: 10.1093/heapol/czad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 07/30/2023] Open
Abstract
China's comprehensive primary healthcare (PHC) reforms since 2009 aimed to deliver accessible, efficient, equitable and high-quality healthcare services. However, knowledge on the system-wide effectiveness of these reforms is limited. This systematic review synthesizes evidence on the reforms' health and health system impacts. In 13 August 2022, international databases and three Chinese databases were searched for randomized controlled trials, quasi-experimental studies and controlled before-after studies. Included studies assessed large-scale PHC policies since 2009; had a temporal comparator and a control group and assessed impacts on expenditures, utilization, care quality and health outcomes. Study quality was assessed using Risk of Bias In Non-randomized Studies of Interventions, and results were synthesized narratively. From 49 174 identified records, 42 studies were included-all with quasi-experimental designs, except for one randomized control trial. Nine studies were assessed as at low risk of bias. Only five low- to moderate-quality studies assessed the comprehensive reforms as a whole and found associated increases in health service utilization, whilst the other 37 studies examined single-component policies. The National Essential Medicine Policy (N = 15) and financing reforms (N = 11) were the most studied policies, whilst policies on primary care provision (i.e. family physician policy and the National Essential Public Health Services) were poorly evaluated. The PHC reforms were associated with increased primary care utilization (N = 17) and improved health outcomes in people with non-communicable diseases (N = 8). Evidence on healthcare costs was unclear, and impacts on patients' financial burden and care quality were understudied. Some studies showed disadvantaged regions and groups that accrued greater benefits (N = 8). China's comprehensive PHC reforms have made some progress in achieving their policy objectives including increasing primary care utilization, improving some health outcomes and reducing health inequalities. However, China's health system remains largely hospital-centric and further PHC strengthening is needed to advance universal health coverage.
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Affiliation(s)
- Chang Cai
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Reynolds Building, St Dunstan's Road, London W6 8RP, UK
| | - Shangzhi Xiong
- The George Institute for Global Health, Faulty of Medicine and Health, University of New South Wales, Level 5, 1 King Street Newtown, Sydney 2042, Australia
- Global Health Research Centre, Duke Kunshan University, Academic Building 3038, No. 8 Duke Avenue, Kunshan, Jiangsu 215316, China
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Reynolds Building, St Dunstan's Road, London W6 8RP, UK
- Public Health Research Centre and Comprehensive Health Research Centre, NOVA National School of Public Health, NOVA University Lisbon, Avenida Padre Cruz, Lisbon 1600-560, Portugal
| | - Jin Xu
- China Center for Health Development Studies, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Maoyi Tian
- The George Institute for Global Health, Faulty of Medicine and Health, University of New South Wales, Level 5, 1 King Street Newtown, Sydney 2042, Australia
- School of Public Health, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin 150081, China
| | - Thomas Hone
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Reynolds Building, St Dunstan's Road, London W6 8RP, UK
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Alves S, Rufo JC, Crispim J. Economic evaluation of biological treatments in patients with severe asthma: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2023; 23:733-747. [PMID: 37265078 DOI: 10.1080/14737167.2023.2221435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/31/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Asthma is a highly prevalent disease, one of the chronic diseases with the highest economic costs; thus, it imposes a high economic burden on society, the healthcare system, patients, and third-party payers. Contrary to this study, until now, systematic reviews of economic evaluations (EEs) of treatments for severe asthma have not been exclusively focused on biological treatments, and have included a small number of studies and only model-based EEs. METHODS This study systematically reviews EEs of biological therapies for severe asthma published until December 2022 using PRISMA guidelines. The review analyzes the cost-effectiveness of biologicals in comparison to SOC, or SOC plus OCS. The quality of the EEs is assessed using Consensus on Health Economics Checklist extended (CHEC-extended). RESULTS Thirty-nine studies were eligible: 15 based on a Markov model, and 19 trial-based; eight adopting societal and NHS perspectives, and seven the payer's perspective. The reviewed EEs addressed cost-effectiveness, cost-utility, and incremental costs and outcomes comparison. Their findings were mainly expressed through ICER-incremental cost-effectiveness ratio (24 studies: 13 concluded that biological were cost-effective) and cost comparison analysis (14 studies: 6 concluded that biological were cost-effective), and were sensitive to a wide variety of factors (e.g. medication cost, treatment response, time horizon, utility benefits, mortality, exacerbation rate, discount rate, etc.). CONCLUSIONS There has been some ambiguity concerning the EE of biological therapies due to variation in choice of study design and contradictory results. Nevertheless, it can be concluded that biological treatments improve health outcomes, in many contexts at a high cost.
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Affiliation(s)
- Sara Alves
- Escola de Economia E Gestão, Universidade Do Minho, Braga, Portugal
| | - João Cavaleiro Rufo
- EPIUnit, Unidade de Epidemiologia, Instituto de Saúde Pública, Porto, Portugal
- Serviço E Laboratório de Imunologia Básica E Clínica, Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - José Crispim
- NIPE, Escola de Economia E Gestão, Universidade Do Minho, Braga, Portugal
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Khanal S, Schmidtke KA, Talat U, Turner AM, Vlaev I. Using multi-criteria decision analysis to describe stakeholder preferences for new quality improvement initiatives that could optimise prescribing in England. FRONTIERS IN HEALTH SERVICES 2023; 3:1155523. [PMID: 37409178 PMCID: PMC10318338 DOI: 10.3389/frhs.2023.1155523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/26/2023] [Indexed: 07/07/2023]
Abstract
Background Hospital decision-makers have limited resources to implement quality improvement projects. To decide which interventions to take forward, trade-offs must be considered that inevitably turn on stakeholder preferences. The multi-criteria decision analysis (MCDA) approach could make this decision process more transparent. Method An MCDA was conducted to rank-order four types of interventions that could optimise medication use in England's National Healthcare System (NHS) hospitals, including Computerised Interface, Built Environment, Written Communication, and Face-to-Face Interactions. Initially, a core group of quality improvers (N = 10) was convened to determine criteria that could influence which interventions are taken forward according to the Consolidated Framework for Implementation Research. Next, to determine preference weightings, a preference survey was conducted with a diverse group of quality improvers (N = 356) according to the Potentially All Pairwise Ranking of All Possible Alternatives method. Then, rank orders of four intervention types were calculated according to models with criteria unweighted and weighted according to participant preferences using an additive function. Uncertainty was estimated by probabilistic sensitivity analysis using 1,000 Monte Carlo Simulation iterations. Results The most important criteria influencing what interventions were preferred was whether they addressed "patient needs" (17.6%)' and their financial "cost (11.5%)". The interventions' total scores (unweighted score out of 30 | weighted out of 100%) were: Computerised Interface (25 | 83.8%), Built Environment (24 | 79.6%), Written Communication (22 | 71.6%), and Face-to-Face (22 | 67.8%). The probabilistic sensitivity analysis revealed that the Computerised Interface would be the most preferred intervention over various degrees of uncertainty. Conclusions An MCDA was conducted to rank order intervention types that stand to increase medication optimisation across hospitals in England. The top-ranked intervention type was the Computerised Interface. This finding does not imply Computerised Interface interventions are the most effective interventions but suggests that successfully implementing lower-ranked interventions may require more conversations that acknowledge stakeholder concerns.
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Affiliation(s)
- Saval Khanal
- Behavioural Science Group, Warwick Business School, University of Warwick, Coventry, United Kingdom
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Kelly Ann Schmidtke
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Liberal Arts, University of Health Sciences and Pharmacy, St Louis, MO, United States
| | - Usman Talat
- Alliance Manchester Business School, University of Manchester, Manchester, United Kingdom
| | - Alice M. Turner
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Ivo Vlaev
- Behavioural Science Group, Warwick Business School, University of Warwick, Coventry, United Kingdom
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He J, You E, Zhong Q, Huang F. Trends and seasonal variation of antibiotic consumption by community residents in Hefei, China, 2012-2016. Public Health 2023; 220:27-32. [PMID: 37229945 DOI: 10.1016/j.puhe.2023.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/13/2023] [Accepted: 04/19/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the trends and seasonal variations of antibiotic consumption by community residents in Hefei, China, over a 5-year period. STUDY DESIGN This was an ecological study. METHODS Data on antibiotic consumption by community residents in Hefei between 2012 and 2016 were collected from the Hefei Center for Disease Control and Prevention. Statistical analysis was carried out using Microsoft Excel 2021, SPSS 26.0 and R4.1.3. An interrupted time series (ITS) analysis was modelled to assess the impact of policies on antibiotic consumption trends. RESULTS Amoxicillin and cephalosporins accounted for 63.64% and 30.48%, respectively, of the total defined daily dose per 1000 inhabitant-days (DID) of antibiotics in 2016. The total consumption of antibiotics decreased from 6.92 DID in 2012 to 5.61 DID in 2016 (Ptrend = 0.017). Seasonal analysis showed an average of 34.24% antibiotic consumption in the winter over the 5 years. The equation constructed by the ITS analysis was Y = 5.530 + 0.323X1 - 7.574X2 - 0.323X3 + ε. CONCLUSION Between 2012 and 2016, overall antibiotic consumption by community residents in Hefei decreased significantly. The impact of antibiotic policies, implemented between 2011 and 2013, started to appear in 2014 when the consumption of antibiotics decreased. This study has important policy implications for the use of antibiotics at the community level. Further studies on the trends of antibiotic consumption are required, and strategies should be designed to promote appropriate use of antibiotics.
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Affiliation(s)
- J He
- School of Public Health, Anhui Medical University, Hefei, Anhui, PR China
| | - E You
- Hefei Center for Disease Control and Prevention, Hefei, Anhui, PR China
| | - Q Zhong
- School of Public Health, Anhui Medical University, Hefei, Anhui, PR China.
| | - F Huang
- School of Public Health, Anhui Medical University, Hefei, Anhui, PR China.
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Hoxha I, Godman B, Malaj A, Meyer JC. 11-Year Trend in Antibiotic Consumption in a South-Eastern European Country; the Situation in Albania and the Implications for the Future. Antibiotics (Basel) 2023; 12:882. [PMID: 37237785 PMCID: PMC10215466 DOI: 10.3390/antibiotics12050882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
There are growing concerns with rising antimicrobial resistance (AMR) across countries. These concerns are enhanced by the increasing and inappropriate utilization of 'Watch' antibiotics with their greater resistance potential, AMR is further exacerbated by the increasing use of antibiotics to treat patients with COVID-19 despite little evidence of bacterial infections. Currently, little is known about antibiotic utilization patterns in Albania in recent years, including the pandemic years, the influence of an ageing population, as well as increasing GDP and greater healthcare governance. Consequently, total utilization patterns in the country were tracked from 2011 to 2021 alongside key indicators. Key indicators included total utilization as well as changes in the use of 'Watch' antibiotics. Antibiotic consumption fell from 27.4 DIDs (defined daily doses per 1000 inhabitants per day) in 2011 to 18.8 DIDs in 2019, which was assisted by an ageing population and improved infrastructures. However, there was an appreciable increase in the use of 'Watch' antibiotics during the study period. Their utilization rose from 10% of the total utilization among the top 10 most utilized antibiotics (DID basis) in 2011 to 70% by 2019. Antibiotic utilization subsequently rose after the pandemic to 25.1 DIDs in 2021, reversing previous downward trends. Alongside this, there was increasing use of 'Watch' antibiotics, which accounted for 82% (DID basis) of the top 10 antibiotics in 2021. In conclusion, educational activities and antimicrobial stewardship programs are urgently needed in Albania to reduce inappropriate utilization, including 'Watch' antibiotics, and hence AMR.
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Affiliation(s)
- Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, 1001 Tirana, Albania
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Admir Malaj
- Independent Researcher, 1001 Tirana, Albania
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa
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Lotfi F, Khodabandeh F, Jafari A, Rezaee M, Rahimi H, Shiravani Z, Keshavarz K. Economic burden of cervical cancer and premalignant lesions associated with human papilloma virus: a societal perspective. Expert Rev Pharmacoecon Outcomes Res 2023; 23:439-447. [PMID: 36876411 DOI: 10.1080/14737167.2023.2186400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Cervical cancer is one of the most common cancers in women, the cause of which is mostly human papilloma virus (HPV). The aim of this study was to determine the economic burden of cervical cancer and premalignant lesions associated with HPV infection from a societal perspective. METHODS The study is a partial economic evaluation (cost of illness), which was conducted cross-sectionally in the referral university clinic in Fars province in 2021. The prevalence-based and bottom-up approaches used to calculate the costs, the indirect costs were calculated by human capital approach. RESULTS The mean cost of premalignant lesions associated with HPV infection was USD 2,853 per patient, which 68.57% was direct medical costs. In addition, the mean cost of cervical cancer was USD 39,327 per patient, the largest share of which (57.9%) was related to indirect costs. The mean annual cost of cervical cancer patients in the country was estimated at USD 40,884,609 as well. CONCLUSION Cervical cancer and premalignant lesions associated with HPV infection imposed a significant economic burden on the health system and patients. The results of the present study can help health policymakers with efficient and equitable prioritization and allocation of resources.
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Affiliation(s)
- Farhad Lotfi
- National Center for Health Insurance Research, Tehran, Iran.,Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Khodabandeh
- Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdosaleh Jafari
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Rezaee
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Rahimi
- School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Zahra Shiravani
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khosro Keshavarz
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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12
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Yang J, Cui Z, Liao X, He X, Wang L, Wei D, Wu S, Chang Y. Effects of a feedback intervention on antibiotic prescription control in primary care institutions based on a Health Information System: a cluster randomized cross-over controlled trial. J Glob Antimicrob Resist 2023; 33:51-60. [PMID: 36828121 DOI: 10.1016/j.jgar.2023.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/16/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVES Overuse and misuse of antibiotics are major factors in the development of antibiotic resistance in primary care institutions of rural China. In this study, the effectiveness of a Health Information System-based, automatic, and confidential antibiotic feedback intervention was evaluated. METHODS A randomized, cross-over, cluster-controlled trial was conducted in primary care institutions. All institutions were randomly divided into two groups and given either a three-month intervention followed by a three-month period without any intervention or vice versa. The intervention consisted of three feedback measures: a real-time pop-up warning message of inappropriate antibiotic prescriptions on the prescribing physician's computer screen, a 10-day antibiotic prescription summary, and distribution of educational manuals. The primary outcome was the 10-day inappropriate antibiotic prescription rate. RESULTS There were no significant differences in inappropriate antibiotic prescription rates (69.1% vs. 72.0%) between two groups at baseline (P = 0.072). After three months (cross-over point), inappropriate antibiotic prescription rates decreased significantly faster in group A (12.3%, P < 0.001) compared to group B (4.4%, P < 0.001). At the end point, the inappropriate antibiotic prescription rates decreased in group B (15.1%, P < 0.001) while the rates increased in group A (7.2%, P < 0.001). The characteristics of physicians did not significantly affect the rate of antibiotic or inappropriate antibiotic prescription rates. CONCLUSION A Health Information System-based, real-time pop-up warnings, a 10-day prescription summary, and the distribution of educational manuals, can effectively reduce the rates of antibiotic and inappropriate antibiotic prescriptions.
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Affiliation(s)
- Junli Yang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Zhezhe Cui
- Guangxi Key Laboratory of Major Infectious Disease Prevention and Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Xingjiang Liao
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, China; Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Xun He
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, China; Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, Guizhou Province, China.
| | - Lei Wang
- Primary Health Department of Guizhou Provincial Health Commission, Guiyang, China
| | - Du Wei
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, China; Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Shengyan Wu
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, China; Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Yue Chang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, China; Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, Guizhou Province, China.
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13
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Mourmouris J, Poufinas T. Multi-criteria decision-making methods applied in health-insurance underwriting. Health Syst (Basingstoke) 2023; 12:52-84. [PMID: 36926373 PMCID: PMC10013473 DOI: 10.1080/20476965.2022.2085190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
This study attempts to structure methodologically the health insurance underwriting process by applying Multi-criteria Decision-making (MCDM) analysis in health insurance underwriting. This is done by assigning a score to each health insurance applicant which can be used to determine whether he or she is accepted, rejected or accepted with special terms and conditions (such as exclusions, additional waiting periods and/ or surcharge). The introduction of MCDM approaches in health insurance underwriting enables the quantification of the selection criteria, the increased standardization and automation of the process and its alignment through quantitative indicators with the risk tolerance/ risk appetite of the insurer, and there lie the novelties of this research. The proposed methodology can be readily implemented by insurers with added value in the underwriting, risk management and distribution (sales & marketing) functions, as well as in the profitability of the company or the level of premium paid by the insured.
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Affiliation(s)
- John Mourmouris
- Economics, Democritus University of Thrace, University Campus, Komotini, Greece
| | - Thomas Poufinas
- Economics, Democritus University of Thrace, University Campus, Komotini, Greece
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14
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Rahman T, Gasbarro D, Alam K. Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature. Health Res Policy Syst 2022; 20:83. [PMID: 35906591 PMCID: PMC9336110 DOI: 10.1186/s12961-022-00886-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background Financial risk protection (FRP), defined as households’ access to needed healthcare services without experiencing undue financial hardship, is a critical health systems target, particularly in low- and middle-income countries (LMICs). Given the remarkable growth in FRP literature in recent times, we conducted a scoping review of the literature on FRP from out-of-pocket (OOP) health spending in LMICs. The objective was to review current knowledge, identify evidence gaps and propose future research directions. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to conduct this scoping review. We systematically searched PubMed, Scopus, ProQuest and Web of Science in July 2021 for literature published since 1 January 2015. We included empirical studies that used nationally representative data from household surveys to measure the incidence of at least one of the following indicators: catastrophic health expenditure (CHE), impoverishment, adoption of strategies to cope with OOP expenses, and forgone care for financial reasons. Our review covered 155 studies and analysed the geographical focus, data sources, methods and analytical rigour of the studies. We also examined the level of FRP by disease categories (all diseases, chronic illnesses, communicable diseases) and the effect of health insurance on FRP. Results The extant literature primarily focused on India and China as research settings. Notably, no FRP study was available on chronic illness in any low-income country (LIC) or on communicable diseases in an upper-middle-income country (UMIC). Only one study comprehensively measured FRP by examining all four indicators. Most studies assessed (lack of) FRP as CHE incidence alone (37.4%) or as CHE and impoverishment incidence (39.4%). However, the LMIC literature did not incorporate the recent methodological advances to measure CHE and impoverishment that address the limitations of conventional methods. There were also gaps in utilizing available panel data to determine the length of the lack of FRP (e.g. duration of poverty caused by OOP expenses). The current estimates of FRP varied substantially among the LMICs, with some of the poorest countries in the world experiencing similar or even lower rates of CHE and impoverishment compared with the UMICs. Also, health insurance in LMICs did not consistently offer a higher degree of FRP. Conclusion The literature to date is unable to provide a reliable representation of the actual level of protection enjoyed by the LMIC population because of the lack of comprehensive measurement of FRP indicators coupled with the use of dated methodologies. Future research in LMICs should address the shortcomings identified in this review. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00886-3.
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Affiliation(s)
- Taslima Rahman
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia. .,Institute of Health Economics, University of Dhaka, Dhaka, 1000, Bangladesh.
| | - Dominic Gasbarro
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
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Debie A, Khatri RB, Assefa Y. Contributions and challenges of healthcare financing towards universal health coverage in Ethiopia: a narrative evidence synthesis. BMC Health Serv Res 2022; 22:866. [PMID: 35790986 PMCID: PMC9254595 DOI: 10.1186/s12913-022-08151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
High burden of healthcare expenditure precludes the poor from access to quality healthcare services. In Ethiopia, a significant proportion of the population has faced financial catastrophe associated with the costs of healthcare services. The Ethiopian Government aims to achieve universal health coverage (UHC) by 2030; however, the Ethiopian health system is struggling with low healthcare funding and high out-of-pocket (OOP) expenditure despite the implementation of several reforms in health care financing (HCF). This review aims to map the contributions, successes and challenges of HCF initiatives in Ethiopia.
Methods
We searched literature in three databases: PubMed, Scopus, and Web of science. Search terms were identified in broader three themes: health care financing, UHC and Ethiopia. We synthesised the findings using the health care financing framework: revenue generation, risk pooling and strategic purchasing.
Results
A total of 52 articles were included in the final review. Generating an additional income for health facilities, promoting cost-sharing, risk-sharing/ social solidarity for the non-predicted illness, providing special assistance mechanisms for those who cannot afford to pay, and purchasing healthcare services were the successes of Ethiopia’s health financing. Ethiopia's HCF initiatives have significant contributions to healthcare infrastructures, medical supplies, diagnostic capacity, drugs, financial-risk protection, and healthcare services. However, poor access to equitable quality healthcare services was associated with low healthcare funding and high OOP payments.
Conclusion
Ethiopia's health financing initiatives have various successes and contributions to revenue generation, risk pooling, and purchasing healthcare services towards UHC. Standardisation of benefit packages, ensuring beneficiaries equal access to care and introducing an accreditation system to maintain quality of care help to manage service disparities. A unified health insurance system that providing the same benefit packages for all, is the most efficient way to attain equitable access to health care.
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16
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Rana A, Mukherjee T, Adak S. Mobility patterns and COVID growth: Moderating role of country culture. INTERNATIONAL JOURNAL OF INTERCULTURAL RELATIONS : IJIR 2022; 89:124-151. [PMID: 35761827 PMCID: PMC9220803 DOI: 10.1016/j.ijintrel.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 01/10/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has resulted in countries reacting differently to an ongoing crisis situation. Latent to this reaction mechanism is the inherent cultural characteristics of each society resulting in differential responses to epidemic spread. Epidemiological studies have confirmed the positive effect of population mobility on the growth of infection. However, the effect of culture on indigenous mobility patterns during pandemics needs further investigation. This study aims to bridge this gap by exploring the moderating role of country culture on the relationship between population mobility and growth of CoVID-19. Hofstede's cultural factors; power distance, individualism/collectivism, masculinity/femininity, uncertainty avoidance, long-term and short-term orientation are hypothesised to moderate the effect of mobility on the reproduction number (R) of COVID-19. Panel regression model, using mobility data and number of confirmed cases across 95 countries for a period of 170 days has been preferred to test the hypotheses. The results are further substantiated using slope analysis and Johnson-Neyman technique. The findings suggest that as power distance, individualism and long-term orientation scores increase, the impact of mobility on epidemic growth decreases. However, masculinity scores in a society have an opposite moderating impact on epidemic growth rate. These Hofstede factors act as quasi moderators affecting mobility and epidemic growth. Similar conclusions could be not be confirmed for uncertainty avoidance. Cross-cultural impact, as elucidated by this study, forms a crucial element in policy formulation on epidemic control by indigenous Governing bodies.
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Affiliation(s)
- Arunima Rana
- Indian Institute of Foreign Trade (IIFT), New Delhi, India
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17
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Shen L, Wei X, Yin J, Haley DR, Sun Q, Lundborg CS. Interventions to optimize the use of antibiotics in China: A scoping review of evidence from humans, animals, and the environment from a One Health perspective. One Health 2022; 14:100388. [PMID: 35686150 PMCID: PMC9171522 DOI: 10.1016/j.onehlt.2022.100388] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/02/2022] [Accepted: 04/03/2022] [Indexed: 12/28/2022] Open
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18
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Coope C, Schneider A, Zhang T, Kadetz P, Feng R, Lambert H, Wang D, Oliver I, Michie S, Cabral C. Identifying key influences on antibiotic use in China: a systematic scoping review and narrative synthesis. BMJ Open 2022; 12:e056348. [PMID: 35338063 PMCID: PMC8961142 DOI: 10.1136/bmjopen-2021-056348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/15/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The inappropriate use of antibiotics is a key driver of antimicrobial resistance. In China, antibiotic prescribing and consumption exceed recommended levels and are relatively high internationally. Understanding the influences on antibiotic use is essential to informing effective evidence-based interventions. We conducted a scoping review to obtain an overview of empirical research about key behavioural, cultural, economic and social influences on antibiotic use in China. METHODS Searches were conducted in Econlit, Medline, PsycINFO, Social Science citation index and the Cochrane Database of Systematic Reviews for the period 2003 to early 2018. All study types were eligible including observational and intervention, qualitative and quantitative designs based in community and clinical settings. Two authors independently screened studies for inclusion. A data extraction form was developed incorporating details on study design, behaviour related to antibiotic use, influences on behaviour and information on effect (intervention studies only). RESULTS Intervention studies increased markedly from 2014, and largely focused on the impact of national policy and practice directives on antibiotic use in secondary and tertiary healthcare contexts in China. Most studies used pragmatic designs, such as before and after comparisons. Influences on antibiotic use clustered under four themes: antibiotic prescribing; adherence to antibiotics; self-medicating behaviour and over-the-counter sale of antibiotics. Many studies highlighted the use of antibiotics without a prescription for common infections, which was facilitated by availability of left-over medicines and procurement from local pharmacies. CONCLUSIONS Interventions aimed at modifying antibiotic prescribing behaviour show evidence of positive impact, but further research using more robust research designs, such as randomised trials, and incorporating process evaluations is required to better assess outcomes. The effect of national policy at the primary healthcare level needs to be evaluated and further exploration of the influences on antibiotic self-medicating is required to develop interventions that tackle this behaviour.
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Affiliation(s)
- Caroline Coope
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Annegret Schneider
- Population Health Sciences, University of Bristol, Bristol, UK
- Centre for Behaviour Change, University College London, London, UK
| | - Tingting Zhang
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Paul Kadetz
- Queen Margaret University, Institute for Global Health and Development, Edinburgh, UK
| | - Rui Feng
- Library, Anhui Medical University, Hefei, Anhui, China
| | - Helen Lambert
- Population Health Sciences, University of Bristol, Bristol, UK
| | - DeBin Wang
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - Isabel Oliver
- Field Service, National Infection Service, Public Health England National Infection Service, Salisbury, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - Christie Cabral
- Population Health Sciences, University of Bristol, Bristol, UK
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Almulhem M, Thayakaran R, Hanif S, Gooden T, Thomas N, Hazlehurst J, Tahrani AA, Hanif W, Nirantharakumar K. Ramadan is not associated with increased infection risk in Pakistani and Bangladeshi populations: Findings from controlled interrupted time series analysis of UK primary care data. PLoS One 2022; 17:e0262530. [PMID: 35025960 PMCID: PMC8757987 DOI: 10.1371/journal.pone.0262530] [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: 03/11/2021] [Accepted: 12/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background The effect of fasting on immunity is unclear. Prolonged fasting is thought to increase the risk of infection due to dehydration. This study describes antibiotic prescribing patterns before, during, and after Ramadan in a primary care setting within the Pakistani and Bangladeshi populations in the UK, most of whom are Muslims, compared to those who do not observe Ramadan. Method Retrospective controlled interrupted time series analysis of electronic health record data from primary care practices. The study consists of two groups: Pakistanis/Bangladeshis and white populations. For each group, we constructed a series of aggregated, daily prescription data from 2007 to 2017 for the 30 days preceding, during, and after Ramadan, respectively. Findings Controlling for the rate in the white population, there was no evidence of increased antibiotic prescription in the Pakistani/Bangladeshi population during Ramadan, as compared to before Ramadan (IRR: 0.994; 95% CI: 0.988–1.001, p = 0.082) or after Ramadan (IRR: 1.006; 95% CI: 0.999–1.013, p = 0.082). Interpretation In this large, population-based study, we did not find any evidence to suggest that fasting was associated with an increased susceptibility to infection.
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Affiliation(s)
- Munerah Almulhem
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Rasiah Thayakaran
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Shahjehan Hanif
- Life and Medical Sciences, University College London, London, United Kingdom
| | - Tiffany Gooden
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Neil Thomas
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jonathan Hazlehurst
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Abd A. Tahrani
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
| | - Wasim Hanif
- Diabetes Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- * E-mail: (KN); (WH)
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- * E-mail: (KN); (WH)
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20
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Yuen SC, Amaefule AQ, Kim HH, Owoo BV, Gorman EF, Mattingly TJ. A Systematic Review of Cost-Effectiveness Analyses for Hepatocellular Carcinoma Treatment. PHARMACOECONOMICS - OPEN 2022; 6:9-19. [PMID: 34427897 PMCID: PMC8807829 DOI: 10.1007/s41669-021-00298-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is associated with significant financial burden for patients and payers. The objective of this study was to review economic models to identify, evaluate, and compare cost-effectiveness estimates for HCC treatments. METHODS A systematic search of the PubMed, Embase, and Cochrane Library databases to identify economic evaluations was performed and studies that modeled treatments for HCC reporting costs and cost effectiveness were included. Risk of bias was assessed qualitatively, considering costing approach, reported study perspective, and funding received. Intervention costs were adjusted to 2021 US dollars for comparison. For studies reporting quality-adjusted life-years (QALYs), we conducted analyses stratified by comparison type to assess cost effectiveness at the time of the analysis. RESULTS A total of 27 studies were included. Non-curative versus non-curative therapy comparisons were used in 20 (74.1%) studies, curative versus curative comparisons were used in 5 (18.5%) studies, and curative versus non-curative comparisons were used in 2 (7.4%) studies. Therapy effectiveness was estimated using a QALY measure in 20 (74.1%) studies, while 7 (25.9%) studies only assessed life-years gained (LYG). A health sector perspective was used in 26 (96.3%) of the evaluations, with only 1 study including costs beyond this perspective. Median intervention cost was $53,954 (range $4550-$4,760,835), with a median incremental cost of $6546 (range - $72,441 to $1,279,764). In cost-utility analyses, 11 (55%) studies found the intervention cost effective using a $100,000/QALY threshold at the time of the study, with an incremental cost-effectiveness ratio (ICER) ranging from - $1,176,091 to $1,152,440 when inflated to 2021 US dollars. CONCLUSION The majority of HCC treatments were found to be cost effective, but with significant variation and with few studies considering indirect costs. Standards for value assessment for HCC treatments may help improve consistency and comparability.
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Affiliation(s)
- Sydney C Yuen
- University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA
| | - Adaeze Q Amaefule
- University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA
| | - Hannah H Kim
- University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA
| | - Breanna-Verissa Owoo
- University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA
| | - Emily F Gorman
- Health Sciences and Human Services Library, University of Maryland, Baltimore, MD, USA
| | - T Joseph Mattingly
- University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA.
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21
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Moye-Holz D, Vogler S. Comparison of Prices and Affordability of Cancer Medicines in 16 Countries in Europe and Latin America. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:67-77. [PMID: 34228312 PMCID: PMC8752537 DOI: 10.1007/s40258-021-00670-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 06/01/2023]
Abstract
BACKGROUND There are concerns that high prices of cancer medicines may limit patient access. Since information on prices for cancer medicines and their impact on affordability is lacking for several countries, particularly for lower income countries, this study surveys prices of originator cancer medicines in Europe and Latin America and assesses their affordability. METHODS For 19 cancer medicines, public procurement and ex-factory prices, as of 2017, were surveyed in five Latin American (LATAM) countries (Brazil, Chile, Colombia, Mexico, and Peru) and 11 European countries (Austria, France, Germany, Greece, Hungary, the Netherlands, Poland, Romania, Spain, Sweden, and the UK). Price data (public procurement prices in LATAM and ex-factory prices in Europe) in US dollar purchasing power parities (PPP) were analyzed per defined daily dose. Affordability was measured by setting medicines prices in relation to national minimum wages. RESULTS The prices of cancer medicines varied considerably between countries. In European countries with higher levels of income, PPP-adjusted prices tended to be lower than in European countries of lower income and LATAM countries. Except for one medicine, all surveyed medicines were considered unaffordable in most countries. In European countries of lower income and LATAM countries, more than 15 days' worth of minimum wages would be required by a worker to purchase one defined daily dose of several of the studied medicines. CONCLUSIONS The high prices and large unaffordability of cancer medicines call for strengthening pricing policies with the aim of ensuring affordable treatment in cancer care.
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Affiliation(s)
- Daniela Moye-Holz
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - S. Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (GÖG/Austrian National Public Health Institute), Stubenring 6, 1010 Vienna, Austria
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22
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Tuvdendorj A, Dechinkhorloo O, Dorjsuren B, Buskens E, Feenstra T. The costs of inappropriate referral pathways in inpatient care for three major noncommunicable diseases in Mongolia: a national registry-based analysis. BMC Health Serv Res 2021; 21:1280. [PMID: 34838017 PMCID: PMC8626993 DOI: 10.1186/s12913-021-07281-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) consistently pose a huge economic burden to health systems and countries in general. The aim of this study was to quantify inpatient costs associated with chronic obstructive pulmonary disease, stroke and ischemic heart disease stratified by type of referral pathway, and to investigate key factors that drive these costs. METHODS A registry-based data analysis was performed using national public hospital inpatient records from 2016 to 2018 for 117,600 unique patients and linking patient-level inpatient health care use with hospital-specific unit cost per bed-day. These were combined to calculate the annual inpatient costs for each of the three disorders per person and per year. Generalized linear modeling was used to assess the association of inpatient costs with age, gender, location, comorbidity, treatment referral pathways and years. RESULTS Across three diagnoses, the majority of patients were female. Most were over 50-60 years old, with more than half being a pensioner, typically with at least one comorbidity. About 25% of patients followed what might be considered inappropriate (unofficial) inpatient referral pathways. Mean annual inpatient costs were int$ 721. These costs rose to int$ 849 for unofficial pathways and dropped to int$677 for official pathways. Further covariates significantly associated with high inpatient costs were location, age, gender, and comorbidity. CONCLUSION Our findings provide background information essential to develop evidence-based and cost-effective interventions aimed at health promotion, prevention and service delivery. Reducing the unofficial use of inpatient care can improve efficient resource allocation in health care and prevent further escalation of inpatient costs in the future.
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Affiliation(s)
- Ariuntuya Tuvdendorj
- Department of Health Policy, School of Public Health, Mongolian National University of Medical Sciences, Zorig street, Ulaanbaatar, 14210, Mongolia.
- Department of Epidemiology, Groningen University, University Medical Center Groningen, Groningen, the Netherlands.
| | | | - Bayarsaikhan Dorjsuren
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Erik Buskens
- Department of Epidemiology, Groningen University, University Medical Center Groningen, Groningen, the Netherlands
| | - Talitha Feenstra
- Department of Epidemiology, Groningen University, University Medical Center Groningen, Groningen, the Netherlands
- Groningen University, Groningen Research Institute of Pharmacy, Groningen, the Netherlands
- Centre for Nutrition, Prevention and Health Services, Institute for Public Health and the Environment, Bilthoven, the Netherlands
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Geda NR, Feng CX, Henry CJ, Lepnurm R, Janzen B, Whiting SJ. Inequalities in adherence to the continuum of maternal and child health service utilization in Ethiopia: multilevel analysis. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:45. [PMID: 34717779 PMCID: PMC8557495 DOI: 10.1186/s41043-021-00271-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/18/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND Despite progress made to improve access to child health services, mothers' consistent utilization of these services has been constrained by several factors. This study is aimed at assessing the inequalities in key child health service utilization and assess the role of antenatal care (ANC) on subsequent service use. METHOD The analysis of the present study was based on the Ethiopian Demographic and Health Surveys, a nationally representative sample of 10,641 children. A health service utilization score was constructed from the affirmative responses of six key child health interventions associated with the most recent birth: ANC service, delivery of the last child at health facilities, postnatal care services, vitamin A intake, iron supplementation and intake of deworming pills by the index child. A mixed effect Poisson regression model was used to examine the predictors of health service utilization and three separate mixed effect logistic regression models for assessing the role of ANC for continued use of delivery and postnatal care services. RESULTS The results of mixed effect Poisson regression indicate that the expected mean score of health service utilization was lower among non-first birth order children, older and high parity women, those living in polygamous families and women living in households with no access to radio. The score was higher for respondents with better education, women who had previous experience of terminated pregnancy, residing in more affluent households, and women with experiences of mild to high intimate partner violence. Further analysis of the three key health services (ANC, delivery, and postnatal care), using three models of mixed effect logistic regression, indicates consistent positive impacts of ANC on the continuum of utilizing delivery and postnatal care services. ANC had the strongest effects on both institutional delivery and postnatal care service utilization. CONCLUSION The findings implicated that maternal and child health services appear as continuum actions/behavior where utilization of one affects the likelihood of the next service types. The study indicated that promoting proper ANC services is very beneficial in increasing the likelihood of mothers utilizing subsequent services such as delivery and postnatal care services.
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Affiliation(s)
- Nigatu Regassa Geda
- Center for Population Studies, College of Development Studies, Addis Ababa University, Sidist Kilo Campus, PO Box 1176, Addis Ababa, Ethiopia
| | - Cindy Xin Feng
- School of Public Health, Health Science E-Wing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Carol J. Henry
- College of Pharmacy and Nutrition, Health Sciences A-Wing, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada
| | - Rein Lepnurm
- School of Public Health, Health Science E-Wing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Bonnie Janzen
- Department of Community Health and Epidemiology, Collège of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Susan J. Whiting
- College of Pharmacy and Nutrition, Health Sciences A-Wing, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada
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Xie L, Du Y, Wang X, Zhang X, Liu C, Liu J, Peng X, Guo X. Effects of Regulation on Carbapenem Prescription in a Large Teaching Hospital in China: An Interrupted Time Series Analysis, 2016-2018. Infect Drug Resist 2021; 14:3099-3108. [PMID: 34408453 PMCID: PMC8364849 DOI: 10.2147/idr.s322938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/14/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose Carbapenem resistance due to the overuse of carbapenems has become a public health problem worldwide, particularly in low- and middle-income countries (LMICs). However, there are few policies guiding carbapenem prescription, and their effectiveness is still unclear. A regulation targeting carbapenem prescription was implemented in March 2017 in China. This study aimed to assess the effects of the regulation for providing evidence on the prudent use of carbapenems. Patients and Methods This was an interventional, retrospective study started in January 2017. The intervention covered establishing performance appraisal indicators, special authorisation, strict prescribing restrictions, and dedicated supervision, particularly in the intensive care unit (ICU). Data on adult inpatients who received at least one carbapenems were extracted from January 2016 to December 2018. Segmented regression analysis was performed to evaluate the effect of the regulation. Results A total of 2005 inpatients received carbapenems. Segmented regression models showed an immediate decline in the intensity of antibiotic consumption (IAC) of carbapenems (coefficient = −9.65, p < 0.001), particularly imipenem (coefficient = −6.82, p = 0.002), and the antibiotic consumption of carbapenems (coefficient = −133.60, p = 0.003) in the ICU. And there is a decreasing trend in the IAC of meropenem (coefficient = −0.03, p = 0.008) in all departments. Furthermore, the IAC of carbapenems and imipenem (coefficient = −0.36, p = 0.035; coefficient = −0.49, p = 0.025, respectively), and the average length of stay (ALoS) (coefficient = −0.73, p < 0.001) showed downward trends in the ICU. Conclusion The intervention effectively reduced the IAC of carbapenems and imipenem, carbapenem consumption and the ALoS in the ICU, and the IAC of meropenem in all departments. The effects of the intervention were significant in the ICU, which indicated an urgent need for stronger regulations focusing on critical departments in the future.
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Affiliation(s)
- Lewei Xie
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yaling Du
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xuemei Wang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Junjie Liu
- School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, People's Republic of China
| | - Xi Peng
- First Affiliated Hospital, School of Medicine, Shihezi University, Xinjiang, Shihezi, People's Republic of China
| | - Xinhong Guo
- First Affiliated Hospital, School of Medicine, Shihezi University, Xinjiang, Shihezi, People's Republic of China
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Liu C. Antibiotic stewardship challenges in an evolving health-care market in China. THE LANCET INFECTIOUS DISEASES 2021; 21:753-754. [DOI: 10.1016/s1473-3099(20)30685-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 01/16/2023]
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Lu EY, Chen HH, Zhao H, Ozawa S. Health and economic impact of the pneumococcal conjugate vaccine in hindering antimicrobial resistance in China. Proc Natl Acad Sci U S A 2021; 118:e2004933118. [PMID: 33758096 PMCID: PMC8020802 DOI: 10.1073/pnas.2004933118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Antimicrobial resistance (AMR) poses a serious threat to global public health. However, vaccinations have been largely undervalued as a method to hinder AMR progression. This study examined the AMR impact of increasing pneumococcal conjugate vaccine (PCV) coverage in China. China has one of the world's highest rates of antibiotic use and low PCV coverage. We developed an agent-based DREAMR (Dynamic Representation of the Economics of AMR) model to examine the health and economic benefits of slowing AMR against commonly used antibiotics. We simulated PCV coverage, pneumococcal infections, antibiotic use, and AMR accumulation. Four antibiotics to treat pneumococcal diseases (penicillin, amoxicillin, third-generation cephalosporins, and meropenem) were modeled with antibiotic utilization, pharmacokinetics, and pharmacodynamics factored into predicting AMR accumulation. Three PCV coverage scenarios were simulated over 5 y: 1) status quo with no change in coverage, 2) scaled coverage increase to 99% in 5 y, and 3) accelerated coverage increase to 85% over 2 y followed by 3 y to reach 99% coverage. Compared to the status quo, we found that AMR against penicillin, amoxicillin, and third-generation cephalosporins was significantly reduced by 6.6%, 10.9%, and 9.8% in the scaled scenario and by 10.5%, 17.0%, and 15.4% in the accelerated scenario. Cumulative costs due to AMR, including direct and indirect costs to patients and caretakers, were reduced by $371 million in the scaled and $586 million in the accelerated scenarios compared to the status quo. AMR-reducing benefits of vaccines are essential to quantify in order to drive appropriate investment.
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Affiliation(s)
- Ember Yiwei Lu
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Hui-Han Chen
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Hongqing Zhao
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599;
- Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
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Gokmen Y, Baskici C, Ercil Y. The impact of national culture on the increase of COVID-19: A cross-country analysis of European countries. INTERNATIONAL JOURNAL OF INTERCULTURAL RELATIONS : IJIR 2021; 81:1-8. [PMID: 33518841 PMCID: PMC7833793 DOI: 10.1016/j.ijintrel.2020.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/16/2020] [Accepted: 12/24/2020] [Indexed: 05/21/2023]
Abstract
In recent years, countries have been fighting with increasing momentum against outbreaks. This struggle requires the effective implementation of several measures that are required in medical science. However, the cultural characteristics of each society prevent these measures from being applied in the same way globally. One area in which social scientists have not applied much effort is observing the impact of countries' cultural characteristics in the fight against outbreaks. Therefore, this study aims to determine whether cultural differences among countries have an impact on their fight against outbreaks. This study uses the COVID-19 pandemic's total cases and selected European countries' cultural dimension scores as data. Due to the differences in the measurement units of cultural and outbreak variables, a stepwise multiple logarithmic regression analysis is preferred to select the proper regression model. The results have shown that power distance has a significant and negative effect on the increase rate of the total COVID-19 cases per million (IRTCCPM). In addition, the results have demonstrated that both individualism and indulgence have significant and positive effects on IRTCCPM, at the 95 % confidence level. However, the hypotheses concerning the impacts of masculinity, uncertainty avoidance, and long-term orientation on the IRTCCPM are rejected at the α = 0.05 level. In light of the findings of this study, it can be asserted that countries act in harmony with their cultural characteristics in the formal or informal practices of their fight against outbreaks. The contributions of the study can be discussed in academic and practical fields.
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Affiliation(s)
- Yunus Gokmen
- The Department of Industry and System Engineering, National Defence University, Turkish Military Academy, Ankara, Turkey
| | - Cigdem Baskici
- Başkent University, Department of Healthcare Management, Center for Strategy and Technology, Ankara, Turkey
| | - Yavuz Ercil
- Başkent University, Center for Strategy and Technology, Ankara, Turkey
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28
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Liu W, Hassan Gillani A, Xu S, Chen C, Chang J, Yang C, Ji W, Jiang M, Zhao M, Fang Y. Antibiotics (Macrolides and Lincosamides) Consumption Trends and Patterns in China's Healthcare Institutes. Based on a 3 Year Procurement Records, 2015-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010113. [PMID: 33375251 PMCID: PMC7794919 DOI: 10.3390/ijerph18010113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 02/08/2023]
Abstract
In this study, we investigated the trends and patterns of antibiotic consumption (macrolides and lincosamides) in China’s healthcare institutions from 2015 to 2017. The China Drug Supply Information Platform (CDSIP) was officially launched in 2015. We collected records from this national centralized bidding procurement system between 2015 and 2017. The use of J01F antibiotics (macrolides or lincosamides) was calculated in a defined daily dose per 1000 inhabitants per day (DID).Purchase data from 70,366 national medical facilities included in the CDSIP were collected. The procurement data of 66,007 medical facilities have not changed over 3 years. There is a slight decline in the consumption of J01F antibiotics, which decreased from 3.03 DID in 2015 to 2.91 DID in 2017. Azithromycin (20.6%) was the most commonly used antibiotic in 2017 among all classes, followed by clindamycin (17.9%) and erythromycin (13.7%). Parenteral antibiotics accounted for 32.0% of total antibiotic consumption and 59.6% of total antibiotics expenditure in 2017. The overall consumption of most antibiotics decreased slightly over the 3-yearstudy period. This may be owing to China’s health-related policies in the past few years. A gap still exists in antibiotic use between regions and dosage forms. Further studies are needed to optimize antibiotic prescribing and reduce antibiotic resistance.
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Affiliation(s)
- Wenchen Liu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (W.L.); (A.H.G.); (S.X.); (C.C.); (C.Y.); (W.J.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an 710049, China
| | - Ali Hassan Gillani
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (W.L.); (A.H.G.); (S.X.); (C.C.); (C.Y.); (W.J.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an 710049, China
| | - Sen Xu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (W.L.); (A.H.G.); (S.X.); (C.C.); (C.Y.); (W.J.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an 710049, China
| | - Chen Chen
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (W.L.); (A.H.G.); (S.X.); (C.C.); (C.Y.); (W.J.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an 710049, China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (W.L.); (A.H.G.); (S.X.); (C.C.); (C.Y.); (W.J.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an 710049, China
- Correspondence: (J.C.); (Y.F.); Tel.: +86-29-82655132 (J.C. & Y.F.); Fax: +86-29-82655424 (Y.F.)
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (W.L.); (A.H.G.); (S.X.); (C.C.); (C.Y.); (W.J.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an 710049, China
| | - Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (W.L.); (A.H.G.); (S.X.); (C.C.); (C.Y.); (W.J.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an 710049, China
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (W.L.); (A.H.G.); (S.X.); (C.C.); (C.Y.); (W.J.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an 710049, China
| | - Mingyue Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (W.L.); (A.H.G.); (S.X.); (C.C.); (C.Y.); (W.J.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an 710049, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (W.L.); (A.H.G.); (S.X.); (C.C.); (C.Y.); (W.J.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an 710049, China
- Correspondence: (J.C.); (Y.F.); Tel.: +86-29-82655132 (J.C. & Y.F.); Fax: +86-29-82655424 (Y.F.)
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Perceived Value of Electronic Medical Records in Community Health Services: A National Cross-Sectional Survey of Primary Care Workers in Mainland China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228510. [PMID: 33212868 PMCID: PMC7698410 DOI: 10.3390/ijerph17228510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/06/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022]
Abstract
Objective: To evaluate the degree to which electronic medical records (EMRs) were used in primary care and the value of EMRs as perceived by primary care workers in China. Methods: A cross-sectional survey was conducted on 2719 physicians (n = 2213) and nurses (n = 506) selected from 462 community health centres across all regions of mainland China except for Tibet. Regional differences in the responses regarding the functionality of existing EMR systems and the perceived value of EMRs were examined using Chi-square tests and ordinal regression analyses. Results: Less than 59% of the community health centres had adopted EMRs. More than 89% of the respondents believed that it was necessary to adopt EMRs in primary care. Of the existing EMR systems, 50% had access to telehealth support for laboratory, imaging or patient consultation services. Only 38.4% captured data that met all task needs and 35.4% supported referral arrangements. “Management of chronic conditions” was voted (66%) as the top preferred feature of EMRs. Higher levels of recognition of the value of EMRs were found in the relatively more developed eastern region compared with their counterparts in other regions. Conclusions: Rapid EMR adoption in primary care is evident in mainland China. The low level of functionality in data acquisition and referral arrangements runs counter to the requirements for “management of chronic conditions”, the most preferred feature of EMRs in primary care. Regional disparities in the realised value of EMRs in primary care deserve policy attention.
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Wang D, Liu C, Zhang X, Liu C. Identifying Antibiotic Prescribing Patterns Through Multi-Level Latent Profile Analyses: A Cross-Sectional Survey of Primary Care Physicians. Front Pharmacol 2020; 11:591709. [PMID: 33343361 PMCID: PMC7748108 DOI: 10.3389/fphar.2020.591709] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Overuse of antibiotics significantly fuels the development of Antimicrobial resistance, which threating the global population health. Great variations existed in antibiotic prescribing practices among physicians, indicating improvement potential for rational use of antibiotics. This study aims to identify antibiotic prescribing patterns of primary care physicians and potential determinants. Methods: A cross-sectional survey was conducted on 551 physicians from 67 primary care facilities in Hubei selected through random cluster sampling, tapping into their knowledge, attitudes and prescribing practices toward antibiotics. Prescriptions (n = 501,072) made by the participants from 1 January to March 31, 2018 were extracted from the medical records system. Seven indicators were calculated for each prescriber: average number of medicines per prescription, average number of antibiotics per prescription, percentage of prescriptions containing antibiotics, percentage of antibiotic prescriptions containing broad-spectrum antibiotics, percentage of antibiotic prescriptions containing parenteral administered antibiotics, percentage of antibiotic prescriptions containing restricted antibiotics, and percentage of antibiotic prescriptions containing antibiotics included in the WHO “Watch and Reserve” list. Two-level latent profile analyses were performed to identify the antibiotic prescribing patterns of physicians based on those indicators. Multi-nominal logistic regression models were established to identify determinants with the antibiotic prescribing patterns. Results: On average, each primary care physician issued 909 (ranging from 100 to 11,941 with a median of 474) prescriptions over the study period. The mean percentage of prescriptions containing antibiotics issued by the physicians reached 52.19% (SD = 17.20%). Of those antibiotic prescriptions, an average of 82.29% (SD = 15.83%) contained broad-spectrum antibiotics; 71.92% (SD = 21.42%) contained parenteral administered antibiotics; 23.52% (SD = 19.12%) contained antibiotics restricted by the regional government; and 67.74% (SD = 20.98%) contained antibiotics listed in the WHO “Watch and Reserve” list. About 28.49% of the prescribers were identified as low antibiotic users, compared with 51.18% medium users and 20.33% high users. Higher use of antibiotics was associated with insufficient knowledge, indifference to changes, complacency with satisfied patients, low household income and rural location of the prescribers. Conclusion: Great variation in antibiotic prescribing patterns exists among primary care physicians in Hubei of China. High use of antibiotics is not only associated with knowledge shortfalls but also low socioeconomic status of prescribers.
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Affiliation(s)
- Dan Wang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
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Wang X, Tang Y, Liu C, Liu J, Cui Y, Zhang X. Effects of restrictive-prescribing stewardship on antibiotic consumption in primary care in China: an interrupted time series analysis, 2012-2017. Antimicrob Resist Infect Control 2020; 9:159. [PMID: 32977855 PMCID: PMC7519519 DOI: 10.1186/s13756-020-00821-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/21/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The overuse of antibiotics has been a major public health problem worldwide, especially in low- and middle- income countries (LMIC). However, there are few policies specific to antibiotic stewardship in primary care and their effectiveness are still unclear. A restrictive-prescribing stewardship targeting antibiotic use in primary care has been implemented since December 2014 in Hubei Province, China. This study aimed to evaluate the effects of the restrictive-prescribing stewardship on antibiotic consumption in primary care so as to provide evidence-based suggestions for prudent use of antibiotics. METHODS Monthly antibiotic consumption data were extracted from Hubei Medical Procurement Administrative Agency (HMPA) system from Sept 1, 2012, to Aug 31, 2017. Quality Indictors of European Surveillance of Antimicrobial Consumption (ESAC QIs) combined with Anatomical Therapeutic Chemical (ATC) classification codes and DDD per 1000 inhabitants per day (DID) methodology were applied to measure antibiotic consumption. An interrupted time series analysis was performed to evaluate the effects of restrictive-prescribing stewardship on antibiotic consumption. RESULTS Over the entire study period, a significant reduction (32.58% decrease) was observed in total antibiotic consumption, which declined immediately after intervention (coefficient = - 2.4518, P = 0.005) and showed a downward trend (coefficient = - 0.1193, P = 0.017). Specifically, the use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins showed declined trends after intervention (coefficient = - 0.0553, P = 0.035; coefficient = - 0.0294, P = 0.037; coefficient = - 0.0182, P = 0.003, respectively). An immediate decline was also found in the contribution of β-lactamase-sensitive penicillins to total antibiotic use (coefficient = - 2.9126, P = 0.001). However, an immediate increase in the contribution of third and fourth-generation cephalosporins (coefficient = 5.0352, P = 0.005) and an ascending trend in the contribution of fluoroquinolones (coefficient = 0.0406, P = 0.037) were observed after intervention. The stewardship led to an immediate increase in the ratio between broad- and narrow-spectrum antibiotic use (coefficient = 1.8747, P = 0.001) though they both had a significant downward trend (coefficient = - 0.0423, P = 0.017; coefficient = - 0.0223, P = 0.006, respectively). An immediate decline (coefficient = - 1.9292, P = 0.002) and a downward trend (coefficient = - 0.0815, P = 0.018) were also found in the oral antibiotic use after intervention, but no significant changes were observed in the parenteral antibiotic use. CONCLUSIONS Restrictive-prescribing stewardship in primary care was effective in reducing total antibiotic consumption, especially the use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins. However, the intervention effects were limited regarding the use of combinations of penicillins with ß-lactamase inhibitors, the third and fourth-generation cephalosporins, fluoroquinolones and parenteral antibiotics. Stronger administrative regulations focusing on specific targeted antibiotics, especially the use of broad-spectrum antibiotics and parenteral antibiotics, are in urgent need in the future.
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Affiliation(s)
- Xuemei Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Yuqing Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Junjie Liu
- School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, China
| | - Youwen Cui
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
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Kwiatkowska R, Shen X, Lu M, Cheng J, Hickman M, Lambert H, Wang D, Oliver I. Patients without records and records without patients: review of patient records in primary care and implications for surveillance of antibiotic prescribing in rural China. BMC Health Serv Res 2020; 20:564. [PMID: 32571303 PMCID: PMC7310238 DOI: 10.1186/s12913-020-05308-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 05/07/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We need to monitor patterns of antibiotic prescribing in order to develop and evaluate antibiotic stewardship interventions in rural China. As part of a multidisciplinary study of antibiotic use in Anhui Province we assessed the validity of electronic records (e-records) as a source of surveillance data. METHODS One township healthcare centre and one village clinic were selected in each of three different counties. Patients with symptoms of Upper Respiratory Tract Infection (URTI), exacerbation of Chronic Obstructive Pulmonary Disease (COPD) or Urinary Tract Infection (UTI) were recruited consecutively. Researchers observed and documented clinic consultations and interviewed each of the study participants. E-records were compared to clinic observations and patient interviews. RESULTS A total of 1030 patients were observed in clinic. Antibiotics were prescribed in 917 (89%) of consultations. E-records were created only for individuals with health insurance, with considerable between-site variation in completeness (0 to 98.7% of clinic consultations) and in the timing of documentation (within-consultation up to weeks afterwards). E-record accuracy was better in relation to antibiotics (82.8% of e-records accurately recorded what was prescribed in clinic) than for diagnosis and symptoms (45.0 and 1.1% accuracy). Only 31 participants (3.0%) presented with UTI symptoms. CONCLUSIONS We have confirmed very high rates of outpatient antibiotic prescribing in rural Anhui province. E-records could provide useful information to inform stewardship interventions, however they may be inaccurate and/or biased. Public Health authorities should focus on improving technical infrastructure and record-keeping culture in outpatient settings. Further research is needed into community treatment of UTIs.
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Affiliation(s)
- Rachel Kwiatkowska
- NIHR Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol Medical School, Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
- Field Service, National Infection Service, Public Health England, 3rd floor, 2 Rivergate, Bristol, BS1 6EH, UK.
| | - Xingrong Shen
- School of Health Service Management, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Manman Lu
- School of Health Service Management, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Jing Cheng
- School of Health Service Management, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Matthew Hickman
- NIHR Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol Medical School, Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Helen Lambert
- Population Health Sciences, Bristol Medical School, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Debin Wang
- School of Health Service Management, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Isabel Oliver
- NIHR Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol Medical School, Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Field Service, National Infection Service, Public Health England, 3rd floor, 2 Rivergate, Bristol, BS1 6EH, UK
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Goldstone D, Bantjes J, Nel D, Stanbridge J, Lewis I. Alcohol use predicts emergency psychiatric unit admission for non-fatal suicidal behaviour in the Western Cape (South Africa): a case-control study. Int J Psychiatry Clin Pract 2020; 24:163-172. [PMID: 31928103 DOI: 10.1080/13651501.2019.1711419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective: We aimed to describe patterns of substance use among patients admitted to an emergency psychiatric unit for non-fatal suicidal behaviour (NFSB) or another psychiatric reason and establish whether there were significant differences in patterns of substance use between the two groups.Methods: We employed a case-control design (N = 50) and collected data about participants' substance use in Cape Town, South Africa. Data were analysed using Chi-square and Mann-Whitney tests, factor analysis, and logistic regressions.Results: Prevalence of lifetime Alcohol Use Disorder (AUD) was 60% in the NFSB group and 28% in the control group. 12% of the NFSB group and 20% of the control group had a lifetime Tobacco Use Disorder. Prevalence of lifetime illicit Substance Use Disorder was 44% in the NFSB group and 60% in the control group. Hospital admission for NFSB was associated with: any past 24-hour alcohol use; quantity of past 24-hour alcohol use; quantity of past-month alcohol use; lifetime AUD; past 12-month AUD; and current AUD; and was not associated with the use of any other substances (p<.05). Past 12-month AUD was the best predictor of hospital admission for NFSB, controlling for, respectively, any past 24-hour alcohol use (aOR = 13.33, p = .023) and quantity of past 24-hour alcohol use (aOR = 9.01, p = .022)Conclusions: Patients admitted to emergency psychiatric units for NFSB have increased needs for the treatment of AUDs compared to patients admitted for another psychiatric emergency. Findings support calls for interventions to prevent NFSB among psychiatric patients with a history of AUD.Key pointsRates of substance use among patients admitted to emergency psychiatric units in South Africa were high compared to the general population.Hazardous alcohol use was uniquely associated with hospital admission for non-fatal suicidal behaviour compared to another psychiatric emergency.Tobacco use and illicit substance use were not associated with hospital admission for non-fatal suicidal behaviour compared to another psychiatric emergency.The association between hazardous alcohol use and hospital admission for non-fatal suicidal behaviour did not appear to be affected by demographic variables.Patients admitted to hospital for non-fatal suicidal behaviour have increased needs for the treatment of alcohol use disorders compared to other psychiatric patients.
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Affiliation(s)
- Daniel Goldstone
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Jason Bantjes
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Daan Nel
- Department of Statistics and Actuarial Science, Stellenbosch University, Stellenbosch, South Africa
| | - Jessica Stanbridge
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Ian Lewis
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Song Y, Han Z, Song K, Zhen T. Antibiotic Consumption Trends in China: Evidence From Six-Year Surveillance Sales Records in Shandong Province. Front Pharmacol 2020; 11:491. [PMID: 32362828 PMCID: PMC7181956 DOI: 10.3389/fphar.2020.00491] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background The overuse of antibiotics is a serious public health problem in China, causing a high rate of antimicrobial resistance. This study identified the trends of antibiotic consumption in China to provide evidence for further intervention. Method The six-year surveillance data on antibiotic sales from 2012 to 2017, which served as a proxy for consumption, were collected from 39 public health care facilities in Shandong province, including three tertiary hospitals, six secondary hospitals, and 30 primary health centers. Based on the Anatomical Therapeutic Chemical (ATC)/DDD methodology, antibiotic consumption was formulated in defined daily doses (DDD) per 1,000 inhabitants per day (DID). Results The total antibiotic consumption among all health care settings increased from 16.07 DID in 2012 to a peak of 17.44 DID in 2015 and then decreased to 11.35 DID in 2017 with a 34.90% reduction. J01C (beta-lactam antimicrobials, penicillin), the most frequently used antibiotic class, accounted for 36.32% of the total DID. Consumption of carbapenems increased from 0.029 DID in 2012 to 0.08 DID in 2017. Parenteral antibiotics accounted for nearly 40% of the total consumption. Compared with the 2012 figures, the 2017 consumption showed a small increase in hospital sector that was compensated by the decrease in community care. Conclusion A substantial reduction in total antibiotic consumption was observed in China from 2012 to 2017. However, the extensive consumption of broad-spectrum antimicrobials, high proportion of parenteral antibiotic use, and increased use of last-resort antibiotics attracted public health concerns.
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Affiliation(s)
- Yan Song
- Shandong Institute of Medicine and Health Information, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China.,School of Health Care Management, Shandong University, Jinan, China
| | - Zhiyan Han
- Shandong Institute of Medicine and Health Information, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Kuimeng Song
- Shandong Institute of Medicine and Health Information, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Tianmin Zhen
- Shandong Institute of Medicine and Health Information, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
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Du Y, Li J, Wang X, Peng X, Wang X, He W, Li Y, Wang X, Yang Q, Zhang X. Impact of a Multifaceted Pharmacist-Led Intervention on Antimicrobial Stewardship in a Gastroenterology Ward: A Segmented Regression Analysis. Front Pharmacol 2020; 11:442. [PMID: 32351389 PMCID: PMC7174747 DOI: 10.3389/fphar.2020.00442] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 03/20/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Irrational use of antimicrobial agents for gastrointestinal diseases deserves attention, but corresponding antimicrobial stewardship programs (ASPs) are generally not a priority for managers. We conducted this study to evaluate the effectiveness of multifaceted pharmacist-led (MPL) interventions in the gastroenterology ward (GW) to provide evidence for the efficacy of ASPs in a non-priority department. METHODS This was an interventional, retrospective study implemented in China. The MPL intervention lasting 1.5 years involved daily ward rounds with physicians, regular review of medical orders, monthly indicator feedback, frequent physician training, and necessary patient education. Data on all hospitalized adults receiving antibiotics was extracted from the hospital information system over a 36-month period from January 2016 to December 2018. Segmented regression analysis of interrupted time series was performed to evaluate the effect of the MPL interventions (started in July 2017) on antibiotic use and length of hospital stay, which was calculated monthly as analytical units. RESULTS A total of 1763 patients receiving antibiotics were enrolled. Segmented regression models showed descending trends from the baseline in the intensity of antibiotic consumption (coefficient = -0.88, p = 0.01), including a significant decline in the level of change of the proportion of patients receiving combined antibiotics (coefficient = -9.91, p = 0.03) and average length of hospital stay (coefficient = -1.79, p = 0.00), after MPL interventions. The MPL interventions led to a temporary increase in the proportion of patients receiving antibiotics (coefficient = 4.95, p = 0.038), but this was part of a declining secular trend (coefficient = -0.45, p = 0.05). CONCLUSION The MPL interventions led a statistically significant decline in the number of patients receiving antibiotics, the antibiotic consumption, and the average hospital stay post-intervention compared to the pre-intervention phase of the study. Health policymakers should actively practice MPL interventions by clinical pharmacists in ASPs in those departments that are not included in priority management.
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Affiliation(s)
- Yaling Du
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Jing Li
- First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Xinchun Wang
- First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Xi Peng
- First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Xiaoyi Wang
- First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Wenying He
- First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Yan Li
- First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Xuemei Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiuxia Yang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Wang X, Li F, Wang X, Zhang X, Liu C, Wang D, Wang H, Chen Y. Effects of different mark-up drug policies on drug-related expenditures in tertiary public hospitals: an interrupted time series study in Shanghai, China, 2015-2018. Biosci Trends 2020; 14:16-22. [PMID: 32092747 DOI: 10.5582/bst.2019.01350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Irrational use of drugs remains a major challenge especially in developing countries, which contributed to a heavy pharmaceutical expenditure burden. Price regulation has been taken to curb the growth of pharmaceutical expenditures in many countries. This study aimed to investigate the impact of different mark-up drug policies on drug-related expenditures in tertiary public hospitals in Shanghai, China. Data were drawn from the audited financial statement in 24 tertiary public hospitals in Shanghai from January 2015 to December 2018. Drug-related revenue data and per capita cost data pre- and post-intervention were included. Interrupted time series design was applied to assess the actual effects of Fixed Percent Mark-up Drug (FPM) policy and Zero Mark-up Drug (ZMD) policy respectively. Results showed that ZMD policy achieved better intervention effects on declining drug-related expenditures than FPM policy. Apart from a declining trend in drug proportion (coefficient = -0.0017, p = 0.031), no other significant changes were found during FPM implementation. However, ZMD policy was associated with a level decline in per capita outpatient drug cost (coefficient = -12.21, p = 0.025) and a trend decline in per capita inpatient drug cost (coefficient = -25.12, p < 0.001), as well as a level decrease (coefficient = -0.0256, p = 0.001) and a downward tendency (coefficient = -0.0018, p < 0.001) in drug proportion. ZMD policy was effective in regulating drug-related expenditures, while FPM policy was difficult to achieve expected results due to the existence of profit space. Further regulation should be strengthened in the future, especially on drug revenue and per capita drug cost.
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Affiliation(s)
- Xianji Wang
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China
| | - Fen Li
- Shanghai Health Development Research Center, Shanghai, China
| | - Xuemei Wang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dan Wang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Haiyin Wang
- Shanghai Health Development Research Center, Shanghai, China
| | - Yingyao Chen
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China
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Almulhem M, Susarla R, Alabdulaali L, Khunti K, Karamat MA, Rasiah T, Tahrani AA, Hanif W, Nirantharakumar K. The effect of Ramadan fasting on cardiovascular events and risk factors in patients with type 2 diabetes: A systematic review. Diabetes Res Clin Pract 2020; 159:107918. [PMID: 31711857 DOI: 10.1016/j.diabres.2019.107918] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 10/02/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022]
Abstract
Ramadan is the fasting month in Islam. Muslims around the world observe Ramadan every year, including people with diabetes. Data on the association of fasting in people with diabetes are sparse. The purpose of this study is to assess the association of fasting on cardiovascular risk factors and events in people with diabetes. A comprehensive search was conducted in the following database: Embase, Medline, Cochrane library and CINAHL. The following key terms were used: Ramadan, Ramazan, Ramadhan, Muslim, Islam and fasting. Studies were eligible if they included people with Type 2 diabetes who fasted during Ramadan and reporting results on cardiovascular risk factors or events. Overall 22 studies met inclusion criteria for the review; five studies reported cardiovascular outcomes and 17 reported changes in risk factors. There is insufficient evidence to link Ramadan fasting with increased or reduced incidence of cardiovascular events in people with diabetes, though there were some indication stroke risk may be increased. Findings were inconsistent in term of risk factors as some favoured Ramadan and others did not..
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Affiliation(s)
- Munerah Almulhem
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Radhika Susarla
- Institute of Translational Medicine, University of Birmingham, UK
| | - Luluh Alabdulaali
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | | | | | - Thayakaran Rasiah
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Abd A Tahrani
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, UK.
| | - Wasim Hanif
- Diabetes Department, University Hospitals Birmingham NHS Foundation Trust, UK.
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Antibiotic Sales in Primary Care in Hubei Province, China: An Analysis of 2012-2017 Procurement Records. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183376. [PMID: 31547325 PMCID: PMC6765864 DOI: 10.3390/ijerph16183376] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/01/2019] [Accepted: 09/07/2019] [Indexed: 12/12/2022]
Abstract
The over-use of antibiotics has been identified as a major global challenge, where there is insufficient knowledge about the use of antibiotics in primary healthcare settings, especially at a population level. This study aims to investigate the trends and patterns of antibiotic sales in primary care in Hubei, China over a six-year period from 2012 to 2017. Antibiotic sales were expressed with Defined Daily Doses per 1000 inhabitants per day (DIDs) and compared with European countries using the 12 quality indicators proposed by the scientific advisory board of the European Surveillance of Antimicrobial Consumption (ESAC) project. Antibiotic sales increased from 12.8 DID in 2012 to 15.3 DID in 2013, and then declined afterwards. The most commonly used antibiotics, J01C (beta-lactam antimicrobials, penicillins), accounted for 40.5% of total antibiotic sales. Parenteral administration of antibiotics accounted for over 50% of total antibiotic sales. Total antibiotic sales were almost on a par with the 31 European countries monitored by the ESAC project, but cephalosporin sales were higher than at least three quarters of the compared countries, resulting in a significant higher proportion of third-generation cephalosporin consumption (13.8–19.43%). The relative consumption of Fluoroquinolone (9.26–9.89%) was also higher than at least half of the compared countries. There is a lack of robust evidence to show that antibiotic consumption in primary care is lower in Hubei compared with other countries. The preference of clinicians in China to use broad-spectrum and parenteral antibiotics deserves further study and policy attention.
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Rogers Van Katwyk S, Grimshaw JM, Nkangu M, Nagi R, Mendelson M, Taljaard M, Hoffman SJ. Government policy interventions to reduce human antimicrobial use: A systematic review and evidence map. PLoS Med 2019; 16:e1002819. [PMID: 31185011 PMCID: PMC6559631 DOI: 10.1371/journal.pmed.1002819] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 05/03/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Growing political attention to antimicrobial resistance (AMR) offers a rare opportunity for achieving meaningful action. Many governments have developed national AMR action plans, but most have not yet implemented policy interventions to reduce antimicrobial overuse. A systematic evidence map can support governments in making evidence-informed decisions about implementing programs to reduce AMR, by identifying, describing, and assessing the full range of evaluated government policy options to reduce antimicrobial use in humans. METHODS AND FINDINGS Seven databases were searched from inception to January 28, 2019, (MEDLINE, CINAHL, EMBASE, PAIS Index, Cochrane Central Register of Controlled Trials, Web of Science, and PubMed). We identified studies that (1) clearly described a government policy intervention aimed at reducing human antimicrobial use, and (2) applied a quantitative design to measure the impact. We found 69 unique evaluations of government policy interventions carried out across 4 of the 6 WHO regions. These evaluations included randomized controlled trials (n = 4), non-randomized controlled trials (n = 3), controlled before-and-after designs (n = 7), interrupted time series designs (n = 25), uncontrolled before-and-after designs (n = 18), descriptive designs (n = 10), and cohort designs (n = 2). From these we identified 17 unique policy options for governments to reduce the human use of antimicrobials. Many studies evaluated public awareness campaigns (n = 17) and antimicrobial guidelines (n = 13); however, others offered different policy options such as professional regulation, restricted reimbursement, pay for performance, and prescription requirements. Identifying these policies can inform the development of future policies and evaluations in different contexts and health systems. Limitations of our study include the possible omission of unpublished initiatives, and that policies not evaluated with respect to antimicrobial use have not been captured in this review. CONCLUSIONS To our knowledge this is the first study to provide policy makers with synthesized evidence on specific government policy interventions addressing AMR. In the future, governments should ensure that AMR policy interventions are evaluated using rigorous study designs and that study results are published. PROTOCOL REGISTRATION PROSPERO CRD42017067514.
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Affiliation(s)
- Susan Rogers Van Katwyk
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Ontario, Canada
| | - Jeremy M. Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Miriam Nkangu
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Ranjana Nagi
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Ontario, Canada
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Steven J. Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, and McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
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Leggat SG, Liu C, Wu Q. Sino-Australian University Partnership in Health Management Education. Front Public Health 2018; 6:251. [PMID: 30246005 PMCID: PMC6137234 DOI: 10.3389/fpubh.2018.00251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/15/2018] [Indexed: 02/03/2023] Open
Abstract
This paper outlines a successful partnership program between La Trobe University in Melbourne Australia, and Harbin Medical University in Harbin, China. These two universities have been collaborating for more than 15 years to provide a comprehensive Master of Health Administration program that adapts the Australian curriculum to meet the rapidly increasing need for qualified health services managers throughout China. This paper describes the mechanisms by which the joint programs were developed and how the two universities work together in partnership to continually improve the program components and outcomes, taking into account the significant differences in context and cultures. Since 2001, La Trobe University has enrolled about 1000 Chinese health services managers, with 721 completing a Master's degree, who are now having increasing influence on the reforms of the Chinese health care system. The partnership has enriched Australian knowledge of Chinese culture and values, as well as the Chinese health system and health policies, as evidenced by the large volume of joint publications. The profession of health management has been substantially strengthened in China, and working together, Chinese and Australian academics have had demonstrated impact on enhancing the reforms of the Chinese public health system. Further studies, with sufficient funds for data collection, are needed to evaluate the long-term impacts of transnational programs on academic and health system development in China.
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Affiliation(s)
- Sandra G. Leggat
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Chaojie Liu
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
- *Correspondence: Chaojie Liu
| | - Qunhong Wu
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
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