Single-group Interrupted Time Series Research Articles

Implementation of Opioid Safety Efforts: Influence of Academic Detailing on Adverse Outcomes Among Patients in the Veterans Health Administration.

The Veterans Health Administration (VA) implemented academic detailing (AD) to support safer opioid prescribing and overdose prevention initiatives. Patient-level data were extracted monthly from VA's electronic health record to evaluate whether AD implementation was associated with changes in all-cause mortality, opioid poisoning inpatient admissions, and opioid poisoning emergency department (ED) visits in an observational cohort of patients with long-term opioid prescriptions (≥45-day supply of opioids 6 months prior to a given month with ≤15 days between prescriptions). A single-group interrupted time series analysis using segmented logistic regression for mortality and Poisson regression for counts of inpatient admissions and ED visits was used to identify whether the level and slope of these outcomes changed in response to AD implementation. Among 955 376 unique patients (19 431 241 person-months), there were 53 369 deaths (29 025 pre-AD; 24 344 post-AD), 1927 opioid poisoning inpatient admissions (610 pre-AD; 1317 post-AD), and 408 opioid poisoning ED visits (207 pre-AD; 201 post-AD). Immediately after AD implementation, there was a 5.8% reduction in the odds of all-cause mortality (95% confidence interval [CI]: 0.897, 0.990). However, patients had a significantly increased incidence rate of inpatient admissions for opioid poisoning immediately after AD implementation (incidence rate ratio = 1.523; 95% CI: 1.118, 2.077). No significant differences in ED visits for opioid poisoning were observed. AD was associated with decreased all-cause mortality but increased inpatient hospitalization for opioid poisoning among patients prescribed long-term opioids. Mechanisms via which AD's efforts influenced opioid-related outcomes should be explored.

Preservice science teachers’ cognitive structures regarding the cell and its organelles

Learning the cell, one of the basic subjects of science education, by preservice teachers in a comprehensive way is important for making sense of its vital activities and teaching the subject in a meaningful way in the future. The study aimed to determine preservice science teachers' cognitive structures related to the cell and its organelles before and after the Biology course. The study group consists of 32 preservice science teachers. The single-group interrupted time series design was adopted in the study. Data were collected through the word association test. As a result of the data analysis, it was determined that some organelles could not be associated with other organelles, there was no knowledge about the peroxisome organelle before the intervention. It was observed that more comprehensive and interrelated cognitive structures were formed after the intervention and the peroxisome organelle was also added to this structure.

Exploring the Impact of Routine Activity and Financial Strain on Fraud Victimization During the COVID-19 Pandemic in Hong Kong

This study examines the impact of the COVID-19 pandemic on fraud victimization in Hong Kong, providing valuable insights beyond the Western context. Drawing on general strain theory and routine activity theory, this research explores the influence of economic recession at the local and adjacent societal levels, as well as residential duration (refers to relative time spent at residences), on fraud victimization in Hong Kong. Utilizing 10 years (120 months) of monthly police-recorded victimization data, this study employs various methodologies, including ARIMA forecasting, single-group interrupted time series analysis (ITSA), and Poisson regression, to explore the impact of the COVID-19 pandemic on fraud victimization in Hong Kong. The ARIMA framework reveals an unexpected and significant increase in fraud victimization during the COVID-19 period, surpassing the predicted levels. The ITSA results demonstrate that the pandemic had a short-term and long-term effect on fraud victimization in Hong Kong. To further understand the factors contributing to this change, a Poisson regression analysis is conducted. The findings highlight the positive and significant impact of residential duration and the unemployment rate in mainland China on fraud victimization, aligning with the propositions of routine activity theory and general strain theory. Limitations and policy implications at both the local and international levels are discussed.

Effect of COVID-19 on hospital visits and treatments at the Hue University of Medicine and Pharmacy Hospital: An Interrupted Time Series Analysis from 2017 to 2022

Objectives: The research aims to investigate the impacts of COVID-19 on hospital visits and treatments at Hue University of Medicine and Pharmacy Hospital from 2017 to 2022. Methods: A single group interrupted time series (ITS) analysis was employed to assess the effect of COVID-19. The beginning of the intervention was 8 May, 2021 as the first case reporting period, and there were 312 weeks of study, with 224 weeks before and 88 weeks after the intervention. A total number of hospital admissions (visits and treatments) was defined as a dependent variable. It was calculated weekly and described according to the ICD-10 version. A single ITS analysis was calculated to estimate the changes before and after the COVID-19 period. Results: A total of 844.550 hospital visits and treatments were recorded in the hospital, with a mean of 2.707 visits per week. Before the intervention, the mean weekly visits were 2.918, while after the intervention, they decreased to 2.170 per week. Weekly visits and treatments showed a downward trend, with an overall reduction rate of 25,63%. ITS analysis indicated that a total of weekly hospital visits and treatment started at 2758 (β0=2758,44; 95% CI: 2595 – 2921; p<0,001); and a slightly significant increase every week before the intervention point of 1,42 visits (β1= 1,42; 95% CI: 0,10 – 2,76; p= 0,036). In the first week of intervention (week 225), there was a significant decrease in hospital visits and treatment of 1732,72 (β2 =-1732,72; 95% CI: -2170 – -1294); p<0,001); and followed by a significant increase in annual trends of 17,52 ( 95% CI: 10,64 – 21,39; p<0,001). Conclusions: These findings provided scientific evidence of the significant impact of COVID-19 on the disruption of the provision and access to hospital services for the general population.

Impact of national drug price negotiation policy on the accessibility and utilization of PCSK9 inhibitors in China: an interrupted time series analysis

BackgroundPCSK9 inhibitors are a novel class of lipid-lowering drugs that have demonstrated favorable efficacy and safety. Evolocumab and alirocumab have been added to China’s National Reimbursement Drug List through the National Drug Price Negotiation (NDPN) policy. This study aims to evaluate the impact of the NDPN policy on the utilization and accessibility of these two PCSK9 inhibitors.MethodsThe procurement data of evolocumab and alirocumab were collected from 1,519 hospitals between January 2021 and December 2022. We determined the monthly availability, utilization, cost per daily defined dose (DDDc), and affordability of the two medicines. Single-group interrupted time series (ITS) analysis was performed to assess the impact of the NDPN policy on each drug, and multiple-group ITS analysis was performed to compare the differences between them.ResultsThe NDPN policy led to a significant and sudden increase in the availability and utilization of PCSK9 inhibitors, along with a decrease in their DDDc. In the year following the policy implementation, there was an increase in the availability, utilization, and spending, and the DDDc remained stable. The affordability of PCSK9 inhibitors in China have been significantly improved, with a 92.97% reduction in out-of-pocket costs. The availability of both PCSK9 inhibitors was similar, and the DDDc of alirocumab was only $0.23 higher after the intervention. The market share of evolocumab consistently exceeded that of alirocumab. Regional disparities in utilization were observed, with higher utilization in the eastern region and a correlation with per capita disposable income.ConclusionsThe NDPN policy has successfully improved the accessibility and utilization of PCSK9 inhibitors in China. However, regional disparities in utilization indicate the need for further interventions to ensure equitable medicine access.

Using responsive feedback from routine monitoring data to guide course corrections for a family planning intervention in Nigeria.

This paper aims to promote the use of simple interrupted time series (ITS) analyses of routine data as a responsive feedback tool to improve public health programs. Although advanced ITS techniques exist, their use is often not feasible due to limitations in funding or research capacity. We propose an Excel-based analysis that requires minimal resources or statistical expertise, and illustrate it by measuring the effect of a radio campaign to promote a family planning call center in Nigeria on the demand for family planning information. We used a single group interrupted time series design (ITS) as a responsive feedback mechanism to determine whether the radio campaign influenced use of the Honey&Banana call center. ITS is ideal when there is no control group. ITS uses the pre-intervention trend to predict what would have happened if the intervention were absent. After conducting ITS analyses, the results show that the number of calls requesting family planning information increased throughout the campaign period, with a gain of about 500 additional calls per month, and then decreased after the campaign ended. However, the number of calls gained from the campaign was substantially lower than anticipated. While end-of-project impact evaluations are necessary, there should be regular feedback system to provide program implementers with information about the status of the project, such as failures, successes, and areas of improvements. This would allow implementers to make necessary adjustments as needed throughout the intervention period. The finding that the radio campaign was not living up to expectations helped Honey&Banana program implementers to end the campaign prematurely and re-allocate resources to a more promising activity. Our research shows that basic Excel-based ITS analysis of routine data can be a useful tool for receiving regular feedback to guide programming improvements for organizations that have limited resources and/or research capacity.

The impact of the national volume-based procurement policy on the use of policy-related drugs in Nanjing: an interrupted time-series analysis

BackgroundIn September 2019, the “4 + 7” centralized procurement pilot program was expanded nationwide aiming at reducing drug prices by means of volume-based procurement and using accredited generic drugs for branded drug substitutes. Given the current uncertain effect of the policy outside pilot areas, this study was conducted to evaluate the impact of the National Volume-based Procurement policy on the use of policy-related drugs after expansion.MethodA single-group interrupted time series was applied using drug purchase data, covering 25 months from December 2018 to December 2020. Drugs related to the centralized procurement policy were selected as samples, including 25 first-batch policy-related drugs and 56 alternative drugs. Centralized procured drugs can be divided into bid-winning and non-winning products, where non-winning products were sorted into generic and branded drugs, and alternative products were classified according to different degrees of substitution. Purchase volume, expenditures, and daily costs were measured.ResultsAfter the implementation of the policy, a significant increase was associated with the volume of bid-winning drugs (p < 0.001) and the volume of generic and branded drugs decreased immediately. The DDDc of drugs under the same generic name significantly reduced (an instantaneous drop of bid-winning drugs by approximately 25%, 7.62 CNY for generics and 3.07 CNY for branded drugs), saving 48.2 million CNY of drug expenditures. The policy has a significant effect on the drug for the treatment of cardiovascular diseases and exerted little influence on the drug for the treatment of nervous diseases, and the substitution of generics for antitumor-branded drugs was not obvious. In addition, the procurement volume of alternative drugs appeared to be a “carry-over”.ConclusionsThese findings indicated that the policy demonstrated positive effects in terms of price reductions and cost savings and accelerated the substitution of generics against branded drugs. The “patent cliff” for branded drugs has gradually emerged. Besides, a short-term “spillover effect” of the volume of alternative drugs was observed, requiring special attention and vigilance.

The COVID-19 green certificate’s effect on vaccine uptake in French and Italian regions

The COVID-19 green certificates were introduced in many countries in 2021 to encourage vaccine uptake against the COVID-19 virus in order to reduce the spread of severe infection among the population, ensure the safety of cross-border movements, and facilitate the resumption of social life and economic activities. This study uses a single-group interrupted time series approach to examine the effect of the green certificate announcement on the first doses of the COVID-19 vaccine in 20 Italian and 18 French regions during the summer of 2021. The estimation results show that the green certificate announcement mitigated regional disparities in vaccine uptake. It persuaded undecided people to have their first doses of the COVID-19 vaccine, especially in regions lagging in the mass vaccination campaign. It was less effective in those regions where there was already a high level of vaccine protection. The announcement also proved to be an effective political strategy with which to increase the first-dose rates immediately, but not in the long term.

Prevalence and correlates of condom use at last sexual intercourse pre- and post-COVID-19 lockdown among adolescent girls and young women in central and western Kenya.

We investigated condom use at last sexual intercourse among adolescent girls and young women (AGYW) to determine the prevalence and correlates of condom use pre- and post-COVID-19 lockdown. Condom use was compared pre- and post-COVID-19 lockdown using a single group interrupted time series analysis. Multivariable Poisson regression was used to determine the correlates of condom use at last sexual intercourse. We found a statistically significant decrease in prevalence of condom use at last sexual intercourse post-COVID-19 lockdown. Condom use at last sexual intercourse was associated with younger age, current contraceptive use, and higher education. AGYW in concurrent relationships were less likely to use condoms, as were owners of mobile phones. These findings suggest a disconnect between youth knowledge of HIV prevention and their actual condom use, particularly in concurrent sexual partnerships. Future research should explore how dynamic fertility intentions, mobile phone access, concurrent sexual partnerships and empowerment influence condom use among sub-Saharan AGYW.

Using responsive feedback from routine monitoring data to guide course corrections for a family planning intervention in Nigeria

Background: This paper aims to promote the use of interrupted time series analyses of routine data as a responsive feedback tool to improve public health programs on an ongoing basis. This methodology is demonstrated by measuring the effect of a radio campaign to promote a family planning call center in Nigeria on the demand for family planning information and explains how the results were used to adapt the program. Methods: We used a single group interrupted time series design (ITS) as a responsive feedback mechanism to determine whether the radio campaign influenced use of the Honey&amp;Banana call center. ITS is ideal when a control group is not available and assumes that an interruption of the trend in the outcome measure occurs after the intervention starts. ITS uses the pre-intervention trend to predict what would have happened if the intervention were absent. Results: After conducting ITS analyses, the results show that the number of calls requesting family planning information increased throughout the campaign period, with a gain of about 500 additional calls per month, and then decreased after the campaign ended. However, the number of calls gained from the campaign was substantially lower than anticipated. Conclusions: While end-of-project impact evaluations are necessary, there should be regular feedback system to provide program implementers with information about the status of the project, such as failures, successes, and areas of improvements. This would allow implementers to make necessary adjustments as needed throughout the intervention period. The finding that the radio campaign was not living up to expectations helped program implementers to end the campaign prematurely and re-allocate resources to a more promising activity. Our research shows that basic ITS analysis of routine data can be a useful tool for receiving regular feedback to guide programming improvements.

Changes in anticoagulant and antiplatelet drug supply at US hospitals before and during the COVID-19 pandemic (2018-2021).

Antithrombotic agents have a role in coronavirus disease 2019 (COVID-19) treatment, but the pandemic disrupted medication supply. This study examined changes in the volume of oral and parenteral anticoagulant and antiplatelet medications at US hospitals during the pandemic. IQVIA National Sales Perspective (NSP) data was used to determine the monthly volume of anticoagulants and antiplatelets purchased at US hospitals between January 2018 and February 2021. Mean monthly medication volumes, reported as extended units (EUs), and year-over-year changes in medication volume were determined. A single-group interrupted time series analysis was used to evaluate changes in the rate of growth of monthly medication volumes before (January 2019-February 2020) and during (March 2020-February 2021) the COVID-19 pandemic. Overall, there was a 43.4% decline in the total volume of anticoagulants and antiplatelets at US hospitals in March 2020, driven by a decrease in heparin volume. Mean monthly volumes decreased significantly (P < 0.05) for parenteral anticoagulants (-106,691,340 EU [95% CI, -200,033,910 to -13,348,780]), oral anticoagulants (-354,800 EU [95% CI, -612,180 to -97,420]), and parenteral antiplatelets (-391,880 EU [95% CI, -535,420 to -248,330]). During the pandemic, the monthly volume of oral anticoagulants, parenteral anticoagulants, and parenteral antiplatelets grew significantly more than in the prepandemic period. This growth was primarily seen in volumes of apixaban, argatroban, enoxaparin, heparin, eptifibatide, and tirofiban. Apixaban and heparin volumes continued a prepandemic uptrend, while argatroban and eptifibatide volumes reversed trend. Rapid changes in anticoagulant and antiplatelet volume at US hospitals during the COVID-19 pandemic highlight the need for institutional protocols to manage fluctuating medication volume demands.

Economic evaluation of a medical ambulatory care service using a single group interrupted time-series design.

Increasing demand for hospital services can lead to overcrowding and delays in treatment, poorer outcomes and a high cost-burden. The medical ambulatory care service (MACS) provides out of hospital patient care, including diagnostic and therapeutic interventions for patients that require urgent attention, but which can be safely administered in the ambulatory environment. The programme is yet to be rigorously evaluated. The aim of this study is to evaluate the impact of the MACS programme on emergency department(ED) presentations, hospital admissions, length-of-stay and health service costs from a health system perspective. We used a single group interrupted time series methodology with a multiple baseline approach to analyse the impact of the MACS clinic on ED presentations, hospital admissions, length-of-stay and cost outcomes for general practitioners(GP)-referred, ED-referred and ward-referred patients under two counterfactual scenarios: an increasing trend in health utilization based on preperiod predictions or a stabilization of utilization rates. The time trend of hospital utilization differed after attending MACS for all three referral groups. The time trend for the GP-referred group declined significantly by 0.36 ED presentations per 100 patients per 30 days [95% confidence interval (CI): -0.52 to-0.2], while inpatient length of stay declined significantly by 1.56and 3.70 days, respectively, per 100 ED-referred and ward-referred patients per 30 days (95% CI: -2.51 to-0.57 and -5.71 to-1.69,respectively). Under two different counterfactual scenarios, the predicted net savings for MACS across three patient groups were $78,685 (95% CI: $54,807-$102,563) and $547,639 (95% CI: $503,990-$591,287) per 100 patients over 18 months. MACS was found to be cost-effective for GP and ward-referred groups, but the expected impact for ED-referred patients is sensitive to assumptions. Expansion of the service for GP-referred patients is expected to reduce hospitalizations the most and generate the largest net cost savings.

Impact of school closures and reopening on COVID-19 caseload in 6 cities of Pakistan: An Interrupted Time Series Analysis.

Schools were closed all over Pakistan on November 26, 2020 to reduce community transmission of COVID-19 and reopened between January 18 and February 1, 2021. However, these closures were associated with significant economic and social costs, prompting a review of effectiveness of school closures to reduce the spread of COVID-19 infections in a developing country like Pakistan. A single-group interrupted time series analysis (ITSA) was used to measure the impact of school closures, as well as reopening schools, on daily new COVID-19 cases in 6 major cities across Pakistan: Lahore, Karachi, Islamabad, Quetta, Peshawar, and Muzaffarabad. However, any benefits were contingent on continued closure of schools, as cases bounced back once schools reopened. School closures are associated with a clear and statistically significant reduction in COVID-19 cases by 0.07 to 0.63 cases per 100,000 population, while reopening schools is associated with a statistically significant increase. Lahore is an exception to the effect of school closures, but it too saw an increase in COVID-19 cases after schools reopened in early 2021. We show that closing schools was a viable policy option, especially before vaccines became available. However, its social and economic costs must also be considered.

The effect of non-pharmaceutical policy interventions on COVID-19 transmission across three cities in Colombia.

Governments across the globe have implemented different strategies to handle the COVID-19 pandemic. A national mandatory quarantine was the most applied policy tool. While there are studies that tested the effectiveness of a national mandatory quarantine, the question about the effectiveness of additional quarantine policies is not yet answered. In this study we focus on three large cities in Colombia (Bogota, Medellin and Cali) with similar socio-economic conditions but made use of different COVID-19 prevention measures. We examine whether different non-pharmaceutical policy interventions (NPIs) conducted in these three cities are effective against the spread of the COVID-19 pandemic. We inspect the effect of the quarantine policies restricting exit from home by sex, ID number, whereby only Bogota implemented the restriction to leave the home according to sex followed by a restriction according to ID number, and Medellin and Cali implemented a restriction by ID number only. Data for the analysis are obtained from the National Administrative Department of Statistics of Colombia [Departamento Administrativo Nacional de Estadística (DANE)]. The data on pandemic severity is measured by the number of confirmed COVID-19 cases per city. We conduct single-group interrupted time series analysis (ITSA) to examine differences in the extent of the pandemic severity in Bogota, Medellin and Cali. We found that NPIs in all three Colombian cities had a positive effect on slowing the spread of the pandemic.

Expanding local sales restrictions on flavoured tobacco products to include menthol: retail sales changes in two Minnesota cities

BackgroundIn 2018, Minneapolis and St. Paul, Minnesota, expanded existing local sales restrictions on flavoured (non-menthol/mint/wintergreen) tobacco products (‘flavour policies’) to include menthol/mint/wintergreen-flavoured tobacco products (‘menthol policies’). All policies included exemptions...

EFFECTIVENESS OF ELONGATION LONGITUDINAUX AVEC DECOAPTION OSTEOARTICULAIRE IN CORRECTING FORWARD HEAD POSTURE

Background: Forward head posture, is a deviation of spinal vertebrae from their respective places, which causes anterior translation at head and gives a poking chin with associated sign and symptoms. Conventional physical therapy and manual therapy techniques are effective in correction of forward head posture. Objective: To determine the effectiveness of Elongation Longitudinaux Avec Decoaption Ostéo Articulaire (ELDOA) in correcting forward head posture. Methodology: Single group Interrupted time series quasi experimental design was conducted in outpatient Department (OPD) of Islamabad Physiotherapy &amp; Rehabilitation Centre Bahria Town, from August 20 to January 21 consisting of n=44 male and female participants of 30 to 40 years age. All participants received three sessions per week for 4-weeks after selection through convenience sampling technique. The assessments were done at baseline, 1st, 4th and 12th post treatment day. The assessment was done using tragus to wall distance and shoulder to wall distance via measuring tape for forward head posture, cervical range of motions (ROMs) with inclinometer and pain using Numeric Pain Rating Scale (NPRS). Data analysis was done via SPSS-22. Results: A total of n=21 male with the mean age of 35.96±3.22 years and 23 female with a mean age of 36.22±3.20 years were treated. The tragus to wall distance significantly improved (p&lt;0.05) from 16.55±0.4 to 12.69 ±0.3 cm, 17.57±0.4 to 13.76±0.4 in sitting and standing respectively with (p&lt;.05)and shoulder to wall distance improved from 13.65cm to 9.0 cm with (p&lt;.05) at post 12th treatment day. The Pain and Cervical ROMs also showed statistically significant improvement after 12th session (p&lt;.05). Conclusion: Elongation Longitudinaux Avec Decoaption Ostéo Articulaire (ELDOA) exercises were found to be effective in the correction of forward head posture. Keywords: Keywords: ELDOA, Forward Head Posture. Flexibility,Neck pain.

The impact of National Centralised Drug Procurement policy on the use of policy-related original and generic drugs in China.

To evaluate the effects of the first round of National Centralised Drug Procurement pilot (so-called '4+7' policy) on the use of policy-related original and generic drugs. This study used drug purchasing order data from the Centralised Drug Procurement Survey in Shenzhen 2019, covering 24months from January 2018 to December 2019. '4+7' policy-related drugs were selected as study samples, including 25 drugs in the '4+7' procurement list and 69 alternative drugs that have an alternative relationship with '4+7' List drugs in clinical use. '4+7' List drugs were then divided into bid-winning and bid-non-winning products according to the bidding results. Included drugs were sorted into original and generic drugs. Purchase volume, expenditures, and daily costs were selected as outcome variables, and were measured using Defined Daily Doses (DDDs), Chinese Yuan (CNY), and Defined Daily Drug cost (DDDc). A single-group Interrupted Time Series analysis was adopted to quantify policy effect. After policy intervention, the overall policy-related original drugs significantly decreased by 0.39 CNY (95% CI: -0.62 to -0.17, p<0.01) in DDDc, 5949.36 thousand DDDs (95% CI: -8276.67 to -3622.05, p<0.001) in volume, and 31,575.08 thousand CNY (95% CI: -41,812.68 to -21,337.49, p<0.001) in expenditures. The volume proportion of generic drugs increased from 78.6% to 91.0%, and the expenditure proportion of increased from 30.9% to 49.8%. '4+7' policy promoted the substitution use of domestic generics against original branded drugs and played positive effects on drug price cut and medication burden reduction. The proportion of original branded drugs and generics that passed generic consistency evaluation significantly increased after policy intervention, indicating the improvement of the overall quality level of drug use in China.

Favorable impact in hepatitis C-related mortality following free access to direct-acting antivirals in Spain.

Free treatments for HCV infection with direct-acting antivirals became widespread in Spain in April 2015. We aimed to test whether, after this intervention, there was a more favorable change in population mortality from HCV-related than from non-HCV-related causes. Postintervention changes in mortality were assessed using uncontrolled before-after and single-group interrupted time series designs. All residents in Spain during 2001-2018 were included. Various underlying death causes were analyzed: HCV infection; other HCV-related outcomes (HCC, liver cirrhosis, and HIV disease); and non-C hepatitis, other liver diseases, and nonhepatic causes as control outcomes. Changes in mortality after the intervention were first assessed by rate ratios (RRs) between the postintervention and preintervention age-standardized mortality rates. Subsequently, using quasi-Poisson segmented regression models, we estimated the annual percent change (APC) in mortality rate in the postintervention and preintervention periods. All mortality rates were lower during the postintervention period, although RRs were much lower for HCV (0.53; 95% CI, 0.51-0.56) and HIV disease than other causes. After the intervention, there was a great acceleration of the downward mortality trend from HCV, whose APC went from -3.2% (95% CI, -3.6% to -2.8%) to -18.4% (95% CI, -20.6% to -16.3%). There were also significant accelerations in the downward trends in mortality from HCC and HIV disease, while they remained unchanged for cirrhosis and slowed or reversed for other causes. These results suggest that the favorable changes in HCV-related mortality observed for Spain after April 2015 are attributable to scaling up free treatment with direct-acting antivirals and reinforce that HCV eradication is on the horizon.

The impact of \u201c4\u2009+\u20097\u201d volume-based drug procurement on the volume, expenditures, and daily costs of antihypertensive drugs in Shenzhen, China: an interrupted time series analysis

BackgroundIn 2019, Chinese government launched a nationwide volume-based drug procurement aiming at reducing drug prices and saving drug costs through economies of scale, which aroused widespread attention. The first round of the policy pilot was implemented in 4 municipalities and 7 sub-provincial cities, referred to as “4 + 7” policy. In the “4 + 7” policy, 7 antihypertensive drugs were included. This study was conducted to evaluate the impact of “4 + 7” policy on the use of policy-related antihypertensive drugs.MethodThis study applied single-group Interrupted Time Series (ITS) design. We used drug purchasing data from the Centralized Drug Procurement Survey in Shenzhen 2019, covering 24 months from January 2018 to December 2019. Antihypertensive drugs related to “4 + 7” policy were selected as study samples, including 7 drugs in the “4 + 7” List and 17 alternative drugs. Alternative drugs refer to antihypertensive drugs that have an alternative relationship with “4 + 7” List drugs in clinical use and have not yet been covered by the policy. “4 + 7” List drugs were then divided into bid-winning and bid-non-winning products according to the bidding results. Purchase volume, expenditures, and daily costs were selected as outcome variables, and were measured using Defined Daily Doses (DDDs), Chinese Yuan (CNY), and Defined Daily Drug cost (DDDc).ResultsAfter “4 + 7” policy intervention, the procurement volume of bid-winning antihypertensive drugs significantly increased (3.12 million DDD, 95 % CI = 2.14 to 4.10, p < 0.001), while the volume of non-winning drugs decreased (-2.33 million DDD, 95 % CI= -2.83 to -1.82, p < 0.01). The use proportion of bid-winning antihypertensive drugs increased from 12.31 to 87.74 % after policy intervention. The overall costs of the seven “4 + 7” List antihypertensive drugs significantly declined (-5.96 million CNY, 95 % CI= -7.87 to -4.04, p < 0.001) after policy intervention, with an absolute reduction of 36.37 million CNY compared with the pre-“4 + 7” period. The DDDc of bid-winning antihypertensive drugs significantly decreased (-1.30 CNY, 95 % CI= -1.43 to -1.18, p < 0.001), while the DDDc of non-winning (0.28 CNY, 95 % CI = 0.11 to 0.46, p < 0.01) and alternative (0.14 CNY, 95 % CI = 0.03 to 0.25, p < 0.05) antihypertensive drugs increased markedly.ConclusionsThe implementation of “4 + 7” policy promoted the drug use hypertensive patients gradually concentrated on the quality-guaranteed bid-winning drugs, which might be conducive to improve the overall quality level of drug use of Chinese hypertensive patients. Besides, a preliminary positive policy effect of price cut and cost-saving was observed in the antihypertensive drug category. In the future, price monitoring and drug use management regarding policy-related drugs should also be strengthened.

Effectiveness of a minimal virtual motivational interviewing training for first years medical students: differentiating between pre-test and then-test

BackgroundShifting towards patient-centeredness, medical doctors need patient-centered communication skills. Motivational Interviewing (MI) is an evidence-based, collaborative, goal-oriented communication technique to strengthen a person’s own motivation and commitment to change. The purpose of this study is to evaluate the effectiveness of a brief virtual role-play MI-training program on MI-knowledge and skills in first-year undergraduate medical students, making use of both a pre-test and a then-test (retrospective pre-test) to check for response shift in evaluating the educational intervention. MethodsFour 10–15 min MI-game-based training conversations embedded in the Kognito Conversation Platform™ were offered to the students using a single-group Interrupted Time Series design. ResultsParticipants included 339 undergraduate medical students (RR= 83.1%). The one-hour MI virtual training proved effective in two ways: participants gained knowledge and skills, and increased awareness of the existing intrinsic knowledge and skill they already possess to communicate with future patients in a patient-centered way. ConclusionA brief one-hour MI-training simulation can be effective even if offered at an early stage during medical education. Furthermore, response shift varied and was not present in all students. Practice ImplicationThe addition of a then-test to the study design reveals results that otherwise would not have been found.