Hospital Drug Research Articles

PP071 Topic: AS09–Global Health/Resource Limited Setting/Health Inequalities/Impact of Global Warming/Other: EXPLORING THE PROBLEM OF SUBSTANDARD AND FALSIFIED DRUGS IN HOSPITAL SETTINGS WORLDWIDE

PP071 Topic: AS09–Global Health/Resource Limited Setting/Health Inequalities/Impact of Global Warming/Other: EXPLORING THE PROBLEM OF SUBSTANDARD AND FALSIFIED DRUGS IN HOSPITAL SETTINGS WORLDWIDE

Assessment of knowledge and perception of prescribers towards rational medicine use in the Ashanti Region of Ghana.

Prescribers must possess extensive knowledge and maintain a positive attitude towards the rational use of medicines to achieve desirable treatment outcomes and effectively prevent treatment failures, increased costs, drug toxicities, and interactions. The objective of this study was to evaluate prescribers' understanding and perception concerning the rational use of medicines in public hospitals. Additionally, the study aimed to identify the factors that influence rational prescribing practices. A structured data instrument was developed to collect demographic data and evaluate participants' knowledge and perception of rational medicine use, in line with the study objectives. Chi-squared statistics and Fisher's exact test were utilized to identify factors associated with good knowledge and perception among participants. Logistic regression was then employed to assess the strength of the associations, with odd ratios reported at a significant level of 0.05. Out of 192 participants, 85.4% held a positive view of rational medicine use, stressing patient safety and recognizing risks like antimicrobial resistance and polypharmacy. Perception was influenced by factors such as prescriber profession, access to references, and drug bulletin updates. Additionally, 65.6% demonstrated good knowledge of rational medicine use, which was notably influenced by factors like using standard prescribing guidelines, having a functional Drug and Therapeutics Committee, prescriber profession, and the frequency of drug bulletin updates. The study emphasizes the critical need to address knowledge gaps among healthcare professionals, especially nurses and other prescribers, to ensure the safe and effective use of medications. It highlights the positive influence of utilizing preferred prescribing references and the existence of functional Drug and Therapeutics Committees in hospitals on knowledge levels. However, the unexpected findings regarding the limited impact of frequent updates of drug bulletins require further investigation.

Valuation of prescription patterns of <i>Helicobacter pylori</i> drugs in outpatient department, Meru Teaching and Referral Hospital

BACKGROUND Helicobacter pylori infects up to half of the world’s population. Infection with Helicobacter pylori is a major contributing factor for gastric ulcers, gastric carcinoma, and extra gastric disease. The main aim of this study was to observe the prescription patterns of Helicobacter pylori drugs at Meru Teaching and Referral Hospital, Meru. This infection is mostly treated by a triple-drug regimen for successful eradication. The available regimens are a combination of proton pump inhibitors, antibiotics, bismuth sulfate, and histamine blockers. METHODOLOGY A cross-sectional retrospective review of the patient files for Helicobacter pylori was done at Meru Teaching and Referral Hospital (MeTRH). Systematic random sampling was used to select 262 medical records for review. Data was collected using the pre-tested abstraction forms and was coded and analyzed for descriptive statistics. RESULTS Out of the 262 medical records that were reviewed, 147 (56.4%) were males prescribed the Helicobacter pylori drug regimen. Among all the young adults (age: 12-39 years) were more likely to get Helicobacter pylori infection. The medication regimens that were highly preferred at MeTRH were 14-day and 7-day clarithromycin triple-based therapy. The 14-day triple therapy accounted for 74.5% of all patient files. The most administered drug class for Helicobacter pylori were proton pump inhibitors at 45.3% followed by antibiotics at 38.8% and the least prescribed drugs were the H2 blockers with 15.9%. CONCLUSION Regarding the most prescribed drug, the proton pump inhibitors while the most preferred regimen was the 14-day clarithromycin triple-based therapy. This data will certainly be important for the pharmaceutical management chain to manage the stock of analyzed drugs and also can spread awareness regards the appropriate handling of drugs which can improve adherence and reduce the rate of treatment failure and the emergence of antibiotic drug resistance.

The evolving treatment landscape of multiple myeloma in Portugal: A nation‐wide retrospective cohort study of real‐world clinical practice

AbstractObjectivesTo characterize variations in real‐world treatment patterns in multiple myeloma (MM) in Portugal over a 5‐year period.MethodsA retrospective cohort multicenter study using secondary data of national hospital drug consumption database from 11 Portuguese public hospitals between 2017 and 2022.ResultsNumber of MM‐treated patients increased 53% over 5 years (from 825 to 1266 patients). Constant slight predominance of male patients (55%), 82% over 60 years old (median age, 70 years), and half of newly diagnosed patients were transplant‐eligible. The highest growth rate was in second‐line treatments, with a sixfold increase in patients in fourth‐line or beyond. First‐line treatment pattern remained stable both in transplant‐eligible (bortezomib, cyclophosphamide and dexamethasone (VCd_, bortezomib, thalidomide and dexamethasone (VTd), and bortezomib, lenalidomide and dexamethasone (VRd)) and noneligible patients (bortezomib, melphalan and prednisolone (VMP), VCd, and lenalidomide, dexamethasone (Rd)). Maintenance therapy increased from 5% to 16%, shifting from thalidomide to lenalidomide. Second and third lines were dominated by daratumumab‐based regimens after 5 years. No standard of care in fourth‐line treatment. Treatment duration increased in transplant‐eligible due to maintenance therapy and in noneligible due to fourth‐line treatments. Patients moved from first‐ to second‐line more rapidly over time.ConclusionsThere was an increase in MM patients reaching advanced treatment lines and significant changes in the treatment patterns, driven by access to more effective frontline treatments and longer duration of treatment.

Spectrum of heart failure in 16 sub-saharan countries: drugs strategies and 8-year trends (the february study 2016-2023)

Abstract Background Heart failure (HF) is a growing public health concern in Sub-Saharan Africa (SSA). The hospital prevalence studies estimate that in SSA, HF is responsible for 9.4% to 42.5% of all medical admission. However, little is known about the management of HF in hospitalization in SSA. Purpose To describe in hospital drugs strategies and 8-year trends in Africa. Methods We conducted a transversal and longitudinal study in cardiology departments of 37 hospitals(public and private) in 16 SSA countries. The February study is an ongoing observatory included all inpatients in February from each year since 2016. Collected data included socio-demographic and clinical characteristics, causes of admission, clinical, biological, complementary examinations, medicines, length of stay were collected by the investigating physicians. HF severity was defined according to proportion of Left Ventricular Ejection Fraction(LVEF):reduced(LVEF<40%), mildly reduced(LVEF[41-49%] or preserved(LVEF>50%). All analyses were performed with random effect on countries through scripts developed in the R software(4.0.3(2020-10-10)). Results Overall, 2351 patients(57±17.5 years; 54% men) were admitted for HF in the February study. HF representing 44.6% of all patients admitted. Proportions of patients included for HF varied across countries from 28% Democratic Republic of the Congo to 75% in Guinea. At admission, 56% of patients had reduced LVEF; 12.5% had mildly reduced and 31.5% had preserved LVEF. Proportions of drug classes varied significantly according to LVEF: diuretics were significantly less prescribed in patients with preserved LVEF(65%) compared to patients with mildly reduced(77%) or reduced(73%) LVEF (P>0.01). The same result was observed for betablockers(BB)(30%VS46% and 46%) and angiotensin-converting enzyme inhibitors(ACEI)(50%vs77% and 71%)(p<0.01). Mineralocorticoid receptor antagonists were significantly more prescribed in patients with preserved LVEF(p<0.01). The proportion of treated with BB increased significantly over the years(p<0.05) from 17% in 2016 to 62% in 2023. Proportions of drugs strategies differed significantly across countries adjusted for LVEF. Drugs strategies differed significantly according to LVEF(p<0.01). The more reduced the LVEF, the more the drugs strategy increased. In patients with preserved LVEF, the proportion of monotherapy was 20%; this decreased to 9% in patients with reduced LVEF. Combinations of three drugs increased from 35% in patients with preserved LVEF to 46% in patients with reduced LVEF. Overall, drugs strategies differed across years(p<0.05): three-drug strategies increased from 35% in 2016 to 51% in 2023 and two-drug strategies decreased from 38% in 2016 to 23% in 2023. Conclusion Up-titrated strategies were prescribed according to severity of HF and access to BB increased across years according to international guidelines. However, novel drugs classes remain unavailable in SSA.

Assessment of miligram(Mg) content of some notable analgesics used by residents of Maiduguri Metropolis: evidence from high performance liquid chromatographic technique

Diclofenac sodium and paracetamol are Over the counter (OTC) medications used as analgesic and antipyretic agents to relieve pains, fever and headaches. The aim of this work was determine the mg content of paracetamol and diclofenac sodium in selected samples across the Maiduguri metropolis using High Performance liquid chromatography (HPLC) method. For paracetamol samples an intersil ODS-3V column (150 mm × 4.6 mm; 5 μm pore size) was used at the temperature of 35oC the mobile phase was methanol: water (20:80) using isocratic elution at the flow rate of 2 mL/min, injection volume of 10 μL and a diode array detector. For diclofenac sodium samples, the chromatographic conditions were the same except the mobile phase which was methanol: water (63:37), flow rate of 0.8 mL min, injection volume of 20 μL and column temperature was set at 30 oC. A total of 45 samples were analysed; which comprised of paracetamol tablet, paracetamol syrup and diclofenac sodium tablet which were randomly selected from three different sources; hospital pharmacy, community pharmacy and drug patent stores. The percentage mg content for paracetamol tablets ranged from 48 to 83 % while that of the paracetamol syrups ranged from 72 to 120 % and finally diclofenac sodium tablets ranged from 73 to 174 %. Adopting the United State Pharmacopoeia (USP) as reference for assessment tool, it was observed that all the paracetamol tablet samples failed, 4 out of 15 paracetamol syrup samples failed, and 11 out of 15 diclofenac sodium tablet samples failed. There was statistical significance (p< 0.05) between class of drug and percentage mg content but there was no significance (p< 0.05) between source of drug and percentage constituent. HPLC technique was used successfully for quantitative determination of paracetamol and diclofenac sodium dosage forms.

Effect of Social Skill Training on Social Function in Patients with Schizophrenia

Objective: To explore the effect of Social Skills Training (SST) on the social function of inpatients with schizophrenia. Methods: A total of 40 patients with schizophrenia (20 in the intervention group and 20 in the control group) were selected from a psychiatric hospital in Shanghai for 10 times (once a week) of social skills training. The control group was treated with routine hospitalization (drug therapy and routine hospitalization nursing) for 10 weeks. Social Disability Screening Schedule before and after intervention for patients enrolled in the intervention group (Social Disability Screening Schedule, SDSS and Scale of Social Function in Psychosis Inpatients, SSPI). Conclusion: The results of social skills training on SDSS and SSPI were different between the two groups, and there was no statistical value (P > 0.05). Observation of patients in this group, when undergoing social skills training, SSPI score was significantly better than the control group (P < 0.01) and SDSS score was significantly lower than the control group (P < 0.01), the differences were statistically significant. Social skills training and social work group intervention can improve psychiatric symptoms and further enhance social function in hospitalized patients with schizophrenia.

Analysis of hospitalization expenditures and influencing factors for inpatients with chronic bronchitis based on SHA2011 in a central Province of China.

This study compared the hospitalization expenses of patients with chronic bronchitis in a central province (Province A) in China to estimate the direct medical cost of the family. Our data included hospitalization records of 30,341 patients with chronic bronchitis from five urban general hospitals in Province A. Using descriptive statistics and regression analysis, we explored the relevant factors affecting hospitalization expenses. Our study results have indicated that from 2016 to 2020, the medical expenditure of patients with chronic bronchitis increased annually, with an average annual growth rate of 22.65%. Among all kinds of expenses, the hospitalization expenses, drug cost, bed cost, test cost and other cost of UEMI (Urban Employee Medical Insurance) are higher than that of other types of medical insurance. The check-up fees of CMI (Commercial Insurance) are lower than that of other types of insurance. Between 2016 and 2019, the average medical expenses per patient with chronic bronchitis increased by 44%, which is the highest average medical expenses among patients aged 60-70. And the highest average medical expenditure emerged when the number of service days is between 5 and 10 days. The increase in expenditure could be attributed to the rapid development of medical technology and the increasing medical demand of the people. Overall, the results of our study implied a significant increase in medical expenses for patients with chronic bronchitis from 2015 to 2020, indicating that chronic bronchitis could bring heavy economic pressures to patients, their families and society.

Association of orthogeriatric co-management with prescription frequencies of anti-osteoporotic drugs in patients with fragility fractures: An observational study with health insurance data

BackgroundGeriatricians are increasingly involved in the treatment of fragility fractures. In Germany, hospitals that meet specific standards for orthogeriatric co-management (OGCM) are additionally certified as 'geriatric trauma centers.' One responsibility of OGCM is the appropriate management of osteoporosis through medication. We aimed to analyse the association between prescription frequencies of anti-osteoporotic drugs in hospitals with certified OGCM, those with non-certified OGCM, and those with no OGCM at all. MethodsClaims data from nearly 200,000 patients aged 80 and older with an incident index fracture of the humerus, forearm, hip, pelvis, or spine, were obtained from a German health insurance. Hospitals were categorized into three groups: no OGCM, with OGCM, and with certified OGCM. The outcomes were new prescriptions for specific anti-osteoporotic drugs and vitamin D within 180 days after the index fracture. Crude incidences and adjusted incidence rate ratios (IRR) were calculated. ResultsPrescription rates of specific anti-osteoporotic drugs and vitamin D increased from hospitals with no OGCM to hospitals with OGCM and were highest in hospitals with certified OGCM. This pattern was observed across all fracture types, age groups, and both men and women, except for forearm fractures. For example, in hip fractures, the IRR for prescriptions of specific anti-osteoporotic drugs in hospitals with certified OGCM compared to those with no OGCM was 2.17 (95% CI: 1.90–2.48). ConclusionOGCM, especially when coupled with certification as a 'Geriatric Trauma Center,' is associated with higher prescription rates of specific anti-osteoporotic drugs and vitamin D after fragility fractures in Germany.

"Before medically advised" departure from hospital and subsequent drug overdose: a population-based cohort study.

A substantial number of hospital admissions end in patient-initiated departure before medical treatment is complete. Whether "before medically advised" (BMA) discharge increases the risk of subsequent drug overdose remains uncertain. We performed a retrospective cohort study using administrative health data from a 20% random sample of residents of British Columbia, Canada. We focused on nonelective, nonobstetric hospital stays occurring between 2015 and 2019. We used survival analysis to compare the rate of fatal or nonfatal illicit drug overdose in the first 30 days after BMA discharge versus the rate after physician-advised discharge. Overall, 6440 of 189 808 (3.4%) hospital stays ended in BMA discharge. Among 820 overdoses occurring in the first 30 days after any hospital discharge, 755 (92%) involved patients with a history of substance use disorder. Unadjusted overdose rates were 10-fold higher after BMA discharge than after physician-advised discharge, and BMA discharge was associated with subsequent overdose even after adjustment for potential confounders (crude incidence, 2.8% v. 0.3%; adjusted hazard ratio [HR] 1.58; 95% confidence interval [CI] 1.31-1.89). Before medically advised discharge was associated with increases in subsequent emergency department visits (adjusted HR 1.92; 95% CI 1.83-2.02) and unplanned hospital readmissions (adjusted HR 2.07; 95% CI 1.96-2.19), but there was no significant association with the uncommon outcomes of fatal overdose and all-cause mortality. Before medically advised departure is associated with an increased risk of drug overdose in the first 30 days after discharge. Improved treatment of substance use disorder, expanded access to overdose prevention services, and new means of postdeparture outreach should be explored to reduce this risk.

Combining cohorts of prospectively collected and linked data to improve health after release from prison

BackgroundWhile people who experience incarceration have remarkably poor health profiles, undertaking research to inform evidence-based responses is complicated by difficulties of recruiting people in prison; high rates of socioeconomic marginalisation, study attrition; and legislative and financial barriers to linked data research. There are many advantages to pooling data from multiple studies involving people who experience incarceration, including greater statistical power and geographic and participant heterogeneity. However, there are also challenges that need to be addressed. MethodsWe combined four prospective cohort studies of adults released from prisons in four Australian states. Pre-release interviews, and validated screening assessments, were linked to primary care, medicine dispensing, hospital, alcohol and other drug treatment services, ambulatory mental health, ambulance, corrective services, and death records. Data were harmonised by team members reviewing variable definitions and categories within subject domains. ResultsThe combined cohort consists of 4,232 adults, including 1,544 Indigenous people and 905 women, with a median age of 31 years. Data linkage will enable a median of 9.3 years of prospective follow-up after release from incarceration. Differences in data structures, coding systems between and within datasets, changes over time, and grouping of records belonging to the same event were also addressed. ConclusionThis combined multi-site cohort study is an example of a complex, policy-oriented data linkage project. It was developed to underpin evidence-based, culturally appropriate interventions, health policy and service development for people who were incarcerated. This presentation will discuss the processes and pitfalls experienced while building a multi-sectoral, multi-jurisdictional data linkage project.

Analyzing the Impact of Drug Name Similarity on Dispensing Errors: An Examination Using a Drug Name Similarity Index.

Dispensing errors pose a significant health risk, with drug name similarity being a potential contributory factor. To determine the impact of drug name similarity on dispensing errors within clinical settings, we analyzed 563 dispensing errors at an acute hospital in Japan from April 2015 to June 2018. Drug name similarity between two drugs was classified into Name-Similar and Name-Dissimilar groups using the m2-vwhtfrag index, the value of the drug name similarity. Drug efficacy similarity was categorized into Efficacy-Same, Efficacy-Close, and Efficacy-Far. The drug name similarity and drug efficacy similarity of all possible pair combinations were obtained and similarly classified. The proportion of the number of pairs with dispensing errors per the total number of drug pairs in the hospital's drug formulary in each category was calculated. The highest proportion of the number of pairs with dispensing errors was 36% for the Efficacy-Same and Name-Similar group, and the lowest proportion was 0.022% for the Efficacy-Far and Name-Dissimilar group. The proportion of the number of pairs with dispensing errors was significantly higher in the Name-Similar category than in the Name-Dissimilar category for all drug efficacy categories. Our results indicate that drug name similarity increases the risk of dispensing errors, and that m2-vwhtfrag is a useful indicator to assess dispensing errors in clinical practice. Such drug name and efficacy similarity evaluations can help identify factors causing dispensing errors, and predict the risk of dispensing errors for newly adopted drugs, considering the relationship with the whole drug formulary in the hospital dispensary.

ADVANCE: a biomedical informatics approach to investigate acute kidney injury in infants.

Acute kidney injury (AKI) occurs in up to half of infants admitted to the neonatal intensive care unit (NICU) and is associated with increased risks of death and more days of mechanical ventilation, hospitalization, and vasopressor drug support. Our objective was to build a granular relational database to study the impact that AKI has on infants admitted to Level-IV NICUs. A relational database was created by linking data from the Children's Hospitals Neonatal Database with AKI-focused data from electronic health records from 9 centers. The current cohort consists of 24,870 infants with a median (IQR) gestational age of birth of 37 weeks (32 weeks, 39 weeks), and a median birth weight of 2.720 kg (1.750 kg, 3.310 kg). There was a male predominance with 14,214 (57%) males. In all, 2434 (9.8%) of the mothers were of Hispanic ethnicity. The maternal race breakdown of the cohort was as follows: 741 (3.0%) Asian, 5911 (24%) Black, and 14,945 (60%) White. Overall mortality was 5.8%. The ADVANCE relational database is an innovative research tool to rigorously study the epidemiology of AKI in a large national cohort of infants admitted to Level-IV NICUs involved in the Children's Hospital Neonatal Consortium. We used a biomedical informatics approach to build a relational database to study acute kidney injury in infants. We highlight our methodology linking Children's Hospital Neonatal Consortium and electronic health record data from nine neonatal intensive care units. The ADVANCE relational database is a granular and innovative research tool to study risk factors and in-hospital outcomes of acute kidney injury and mortality in a vulnerable patient population.

Assessment of pattern of adverse drug reactions with chemo-therapeutic drugs in a tertiary care hospital of Government Medical College Anantnag: a prospective observational study

Assessment of pattern of adverse drug reactions with chemo-therapeutic drugs in a tertiary care hospital of Government Medical College Anantnag: a prospective observational study

Retrospective analysis of adverse drug reaction enquiries to a hospital drug information service: lessons to be learned to increase in-hospital drug safety.

Adverse drug reactions (ADRs) are a major drug safety concern and a frequent topic of enquiries to hospital drug information services. Our goal was to analyse these enquiries regarding background, complexity, nature of ADR, and involved drug classes to improve in-hospital drug safety. Retrospectively, ADR enquiries to a German university hospital pharmacy drug information 2018-2022 were analysed regarding enquirer (profession, medical specialty) and enquiry details (drugs, suspected ADR/enquiry prior to drug initiation, ADR system organ class, probable cause identified, and enquiry complexity). Of 543 enquiries, 516 (95%) were asked by physicians, 493 (91%) patient-specific, 390 (71%) on suspected ADRs, and 153 (28%) prior to drug initiation. Enquiries originated frequently from internal medicine (74/13.6%), paediatrics (71/13.1%), neurology (70/12.9%), and haemato-oncology (62/11.4%). Most frequent ADRs were haematologic (94/17%) and hepatic (72/13%). The median number of drugs per enquiry was three (range 0-37), 209 (38%) enquiries referred to one specific drug, 165 (30%) concerned ≥11 drugs. A probable cause for suspected ADRs was identified in 75 (36%) enquiries concerning one drug and 155 (94%) with ≥11 drugs. Most frequent drugs were antineoplastic (54/25.8%), nervous-system-drugs (42/20.1%), and anti-infective (40/19.1%). Most enquiries (342/63%) were complex (multiple/specialist resources). Enquiries were usually asked by physicians referring to suspected ADRs in specific clinical situations. A probable cause was identified in many cases pointing to a direct positive impact on patient care. Enquiries prior to drug initiation should be encouraged to increase drug safety. Information on main ADR effects and drug classes helps with targeted counselling.

The Rationale and Design of the KOSovan Acute Coronary Syndrome (KOS-ACS) Registry.

The KOSovan Acute Coronary Syndrome (KOS-ACS) Registry is established as a prospective, continuous, nationwide, web-based registry that is operated online. The KOS-ACS registry is designed with the following objectives: (1) to obtain data on the demographic, clinical, and laboratory characteristics of ACS patients treated in Kosovo; (2) to create a national database with information on health care in ACS patients treated in Kosovo; (3) to identify the national features of associations between ACS characteristics and clinical outcomes, including mortality, complications, the length of hospital stay, and the quality of clinical care; and (4) to propose a practical guide for improving the quality and efficiency of ACS treatment in Kosovo. The Kosovo Society of Cardiology and University of Prishtina will be responsible for the development of the KOS-ACS registry and centralized data analysis at the national level. The KOS-ACS Registry will enroll all patients admitted, at any of the registered clinical centers, with the diagnosis of ACS and who will be clinically managed at any of the Kosovo hospitals. Data on patient demographics, clinical characteristics, previous and hospital drug treatment, and reperfusion therapy will be collected. The type of ACS (unstable angina, NSTEMI, or STEMI) will also be clearly defined. The time from first medical contact to balloon inflation (FMC-to-balloon) and door-to-ballon time will be registered. In-hospital death and complications will be registered. Data on the post-hospital primary outcome (MACE: cardiac death, all-cause mortality, hospitalization, stroke, need for coronary revascularization) of patients, at 30 days and 1 year, will be included in the registry.

A Survey of the Prevalence of Infections Present among Inpatients in a Tertiary Care Hospital in 2023

Objective: To explore the current infection rate among inpatients in a tertiary hospital in 2023, to understand the infection situation in the hospital, and to provide a reliable basis for carrying out further hospital infection prevention and control and other work. Methods: Inpatients of a tertiary hospital on a certain date in 2023 were selected, and the survey data were extracted with the Apricot Grove real-time monitoring system using a combination of questionnaires and medical record data. Results: The infection rate was 12.63%, of which the hospital infection rate was 2.25% and the community infection rate was 10.38%. Lower respiratory tract infections accounted for 77.28% of the community infections, and lower respiratory tract infections accounted for 73.44% of the cases of hospital infections, with a total of 44 strains of pathogens isolated from hospital infections, and a total of 218 strains of pathogens isolated from community infections. The total application rate of antimicrobial drugs was 31.67%, the proportion of prophylactic drugs in the whole hospital was 9.66%, the proportion of therapeutic drugs was 90.33%, and the rate of bacterial culture delivery was 39.18%. Conclusion: The infection rate survey truly reflects the dynamics of infection in this hospital, makes clearer the key departments and key links of hospital infection prevention and control, further provides the basis for targeted infection control, and improves the knowledge and execution of hospital infection prevention and control by medical staff.

The impact of Chinese volume-based procurement on pharmaceutical market concentration.

Optimizing the pharmaceutical industrial structure is the key mission of China's healthcare reform. From the industrial structure perspective, this study empirically evaluated the impact of China's national volume-based procurement (NVBP) policy on market concentration in the hospital-end drug market. This study used drug procurement data of China's public medical institutions which obtained from the national database. A quasi-natural experiment was designed involving eleven pairs of matched treatment-control region combinations, with NVBP policy as the intervention measure. The market was defined by drug name (molecular boundary) and city/province (geographical boundary). Market changes were measured from three dimensions: the number of enterprises and products, market share, and Herfindahl-Hirschman index (HHI). Dual comparison approach and difference-in-difference (DID) method with fixed effect model were applied to quantify policy impacts. The number of enterprises and products decreased by 18 and 83 in pilot regions after NVBP policy, far more than the decreases in control regions (6 and 21). The accumulative market share of 15 bid-winning enterprises increased by 53.67% in volume and 18.79% in value, among which the increment of enterprises with low baseline market share was more prominent (66.64% and 36.40%). Among three enterprise types, the market share of generic consistency evaluation (GCE) certificated generics significantly increased, GCE uncertificated generics significantly decreased, and originators slightly decreased. DID models indicated significantly positive impact of NVBP policy on market concentration, with HHI-volume and HHI-value increasing by 49.33% (β = 0.401, p < 0.01) and 21.05% (β = 0.191, p < 0.01). The implementation of NVBP promoted the intensive drug circulation and supply of Chinese public hospitals, intensifying the exit of GCE uncertificated generics from the hospital-end market. NVBP combined with GCE standards significantly improved market concentration, which brought a positive signal of pharmaceutical industrial structure optimization in China. In the future context of normalized and institutionalized NVBP, the balance should be further sought between low drug prices and reliable hospital drug supply, sustainable industry development.

The practice and evaluation of antifungal stewardship programs at a tertiary first-class hospital in China

BackgroundThe sharp increase in fungal infections, insufficient diagnostic and treatment capabilities for fungal infections, poor prognosis of patients with fungal infections as well as the increasing drug resistance of fungi are serious clinical problems. It is necessary to explore the implementation and evaluation methods of antifungal stewardship (AFS) to promote the standardized use of antifungal drugs.MethodsThe AFS programme was implemented at a tertiary first-class hospital in China using a plan-do-check-act (PDCA) quality management tool. A baseline investigation was carried out to determine the utilization of antifungal drugs in pilot hospitals, analyse the existing problems and causes, and propose corresponding solutions. The AFS programme was proposed and implemented beginning in 2021, and included various aspects, such as team building, establishment of regulations, information construction, prescription review and professional training. The management effectiveness was recorded from multiple perspectives, such as the consumption of antifungal drugs, the microbial inspection rate of clinical specimens, and the proportion of rational prescriptions. The PDCA management concept was used for continuous improvement to achieve closed-loop management.ResultsIn the first year after the implementation of the AFS programme, the consumption cost, use intensity and utilization rate of antifungal drugs decreased significantly (P < 0.01). The proportion of rational antifungal drug prescriptions markedly increased, with the proportion of prescriptions with indications increasing from 86.4% in 2019 to 97.0% in 2022, and the proportion of prescriptions with appropriate usage and dosage increased from 51.9 to 87.1%. In addition, after the implementation of the AFS programme, physicians’ awareness of the need to complete microbial examinations improved, and the number of fungal cultures and serological examinations increased substantially. Statistics from drug susceptibility tests revealed a decrease in the resistance rate of Candida to fluconazole.ConclusionThis study indicated that the combination of AFS and the PDCA cycle could effectively reduce antifungal consumption and promote the rational use of antifungal drugs, providing a reference for other health care systems to reduce the overuse of antifungal drugs and delay the progression of fungal resistance.

Surveillance for the Use of Anti-MRSA Drugs in Pediatric Hospitals

Surveillance for the Use of Anti-MRSA Drugs in Pediatric Hospitals