Prescribing Patterns in Outpatient Clinics of Township Hospitals in China: A Comparative Study before and after the 2009 Health System Reform
Abstract
:1. Introduction
2. Methods
2.1. Data Source and Sampling Method
2.2. Data Analysis
- Percentage of prescriptions requiring antibiotics (PPA)
- Percentage of prescriptions requiring adrenal corticosteroids (PPC)
- Percentage of prescriptions requiring injections (PPI)
- Average number of medicines per prescription (ANMPP)
- Percentage of prescriptions requiring combined use of antibiotics and adrenal corticosteroids (PPA&C)
- Percentage of medicines prescribed from the EML (PEM)
- Average expenditure per prescription (EPP)
3. Results
3.1. Characteristics of Prescription Recipients and Township Hospitals
3.2. Changing Patterns of Prescriptions
3.3. Regional Differences in Changing Prescribing Patterns
3.4. Antibiotic Prescriptions
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Characteristics | Jiangsu | Heilongjiang | Qinghai | |||
---|---|---|---|---|---|---|
2008 | 2013 | 2008 | 2013 | 2008 | 2013 | |
Population (million) | 76.77 | 79.39 | 38.25 | 38.35 | 5.54 | 5.78 |
Rural population (million) | 35.09 | 28.49 | 17.06 | 16.34 | 3.27 | 2.98 |
Population density (people/km2) | 342 | 277.68 | 36.07 | 34.55 | 4.53 | 4.13 |
GDP (billion) | 3098.2 | 5975.3 | 831.4 | 1445.5 | 101.9 | 212.2 |
Health expenditure as a percentage of GDP (%) | 3.16 | 3.74 | 5.62 | 6.73 | 5.87 | 7.73 |
Number of township hospitals | 1396 | 1064 | 919 | 996 | 404 | 405 |
Annual outpatient visits to township hospitals (million) | 67.1 | 77.9 | 9.25 | 9.51 | 2.40 | 2.58 |
Number of physicians per thousand population in rural areas | 0.69 | 1.28 | 0.89 | 1.18 | 0.86 | 1.26 |
Characteristics | Heilongjiang | Jiangsu | Qinghai | |||
---|---|---|---|---|---|---|
2008 | 2013 | 2008 | 2013 | 2008 | 2013 | |
Proportion of practicing physician to the general medical staff (%) | 25.62 | 32.54 | 34.07 | 39.42 | 25.22 | 25.37 |
Average number of beds | 10.5 | 14.3 | 49.7 | 51 | 10.3 | 12.7 |
Proportion of government subsidies to total hospital revenue (%) | 45.37 | 52.58 | 40.25 | 46.05 | 54.89 | 65.56 |
Proportion of medical income to total hospital revenue (%) | 5.02 | 5.37 | 3.45 | 3.79 | 3.23 | 3.02 |
Prescribing Indicator | 2008 | 2013 | Difference (95% CI) | χ2/h | p |
---|---|---|---|---|---|
PPA (%) | 58.1 | 38.4 | −19.7 (−23, −16) | 113.53 | 0.000 |
PPC (%) | 12.7 | 3.7 | −9.1 (−11, −7.1) | 102.39 | 0.000 |
PPI (%) | 54.1 | 24.5 | −29.6 (−33, −26) | 266.97 | 0.000 |
ANMPP | 3.41 | 1.76 | −1.65 (−1.16, −2.14) | 580.36 | 0.000 |
PPA&C (%) | 17.4 | 6.1 | −11.3 (−14.6, −8.1) | 223.43 | 0.000 |
PEM (%) | 49.6 | 85.0 | 35.4 (32, 39) | 416.55 | 0.000 |
EPP | 65.18 | 30.97 | −34.21 (−6.05, −62.37) | 137.63 | 0.000 |
Prescription Indicator | Jiangsu | Heilongjiang | Qinghai | ||||||
---|---|---|---|---|---|---|---|---|---|
2008 | 2013 | Trend | 2008 | 2013 | Trend | 2008 | 2013 | Trend | |
PPA (%) | 59.2 | 36.7 | ↓ * | 54.3 | 45.5 | ↓ * | 68.5 | 34.6 | ↓ * |
PPC (%) | 18.5 | 6.2 | ↓ * | 8.3 | 2.3 | ↓ * | 5.5 | 1.8 | ↓ * |
PPI (%) | 43.2 | 24.2 | ↓ * | 66.9 | 30.6 | ↓ * | 55.5 | 20.0 | ↓ * |
ANMPP | 3.22 | 1.75 | ↓ * | 3.11 | 1.22 | ↓ * | 4.86 | 2.20 | ↓ * |
PPA&C (%) | 15.3 | 3.7 | ↓ * | 10.5 | 2.0 | ↓ * | 2.6 | 1.0 | ↓ * |
PEM (%) | 63.5 | 90.2 | ↑ * | 34.1 | 80.0 | ↑ * | 45.5 | 83.0 | ↑ * |
EPP | 65.62 | 41.56 | ↓ * | 64.11 | 26.78 | ↓ * | 35.21 | 21.64 | ↓ * |
Province | Prescriptions Requiring Antibiotics | Prescriptions Containing only One Antibiotic | Prescriptions Containing Two or More Antibiotics | ||||||
---|---|---|---|---|---|---|---|---|---|
2008 (n (%)) | 2013 (n (%)) | Difference in Percentage (95% CI) | 2008 (n (%)) | 2013 (n (%)) | Difference in Percentage (95% CI) | 2008 (n (%)) | 2013 (n (%)) | Difference in Percentage (95% CI) | |
Jiangsu | 394 (58.2) | 220 (36.7) * | −21.5 (−28, −18) | 286 (43.3) | 192 (32.1) * | −11.2 (−17, −6) | 98 (14.8) | 28 (4.3) * | −10.5 (−13, −7) |
Heilongjiang | 293 (54.3) | 182 (45.5) * | −8.8 (−15, −2) | 199 (36.9) | 165 (41.3) | 4.4 (−2, 11) | 94 (17.4) | 17 (4.3) * | −13.1 (−17, −9) |
Qinghai | 137 (68.5) | 173 (34.6) * | −33.9 (−42, −26) | 99 (49.5) | 158 (31.6) * | −17.9 (−26, −10) | 38 (19.0) | 15 (2.8) * | −16.2 (−22, −10) |
Total | 814 (58.1) | 675 (38.4) * | −19.7 (−17, −10) | 584 (41.7) | 515 (34.4) * | −7.3 (−11, −4) | 230 (16.4) | 60 (3.8) * | −12.6 (−15, −10) |
χ2 | 12.162 | 12.289 | 10.949 | 11.522 | 2.54 | 2.067 | |||
p | 0.002 | 0.002 | 0.004 | 0.003 | 0.281 | 0.356 |
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Ding, D.; Pan, Q.; Shan, L.; Liu, C.; Gao, L.; Hao, Y.; Song, J.; Ning, N.; Cui, Y.; Li, Y.; et al. Prescribing Patterns in Outpatient Clinics of Township Hospitals in China: A Comparative Study before and after the 2009 Health System Reform. Int. J. Environ. Res. Public Health 2016, 13, 679. https://doi.org/10.3390/ijerph13070679
Ding D, Pan Q, Shan L, Liu C, Gao L, Hao Y, Song J, Ning N, Cui Y, Li Y, et al. Prescribing Patterns in Outpatient Clinics of Township Hospitals in China: A Comparative Study before and after the 2009 Health System Reform. International Journal of Environmental Research and Public Health. 2016; 13(7):679. https://doi.org/10.3390/ijerph13070679
Chicago/Turabian StyleDing, Ding, Qingxia Pan, Linghan Shan, Chaojie Liu, Lijun Gao, Yanhua Hao, Jian Song, Ning Ning, Yu Cui, Ye Li, and et al. 2016. "Prescribing Patterns in Outpatient Clinics of Township Hospitals in China: A Comparative Study before and after the 2009 Health System Reform" International Journal of Environmental Research and Public Health 13, no. 7: 679. https://doi.org/10.3390/ijerph13070679