Caijun Yang

Current Situation, Determinants, and Solutions to Drug Shortages in Shaanxi Province, China: A Qualitative Study

Objective Drug shortages were a complex global problem. The aim of this study was to analyze, characterize, and assess the drug shortages, and identify possible solutions in Shaanxi Province, western China. Methods A qualitative methodological approach was conducted during May–June 2015 and December 2015–January 2016. Semi-structured interviews were performed to gather information from representatives of hospital pharmacists, wholesalers, pharmaceutical producers, and local health authorities. Results Thirty participants took part in the study. Eight traditional Chinese medicines and 87 types of biologicals and chemicals were reported to be in short supply. Most were essential medicines. Five main determinants of drug shortages were detected: too low prices, too low market demands, Good Manufacturing Practice (GMP) issues, materials issues, and approval issues for imported drugs. Five different solutions were proposed by the participants: 1) let the market decide the drug price; 2) establish an information platform; 3) establish a reserve system; 4) enhance the communication among the three parties in the supply chain; and 5) improve hospital inventory management. Conclusions Western China was currently experiencing a serious drug shortage. Numerous reasons for the shortage were identified. Most drug shortages in China were currently because of “too low prices.” To solve this problem, all of the stakeholders, especially the government, needed to participate in managing the drug shortages.

Non-prescription use of antibiotics among children in urban China: a cross-sectional survey of knowledge, attitudes, and practices

ABSTRACT Background: Non-prescription use of antibiotics in children is an important public health problem. We aimed to investigate primary caregivers’ knowledge, attitudes, and practices of antibiotics use among children in urban China. Methods: Knowledge, attitudes, and practices regarding antibiotics use in children were assessed through a cross-sectional questionnaire survey of 4200 caregivers of children under-7 years from three cities in China. Data were analyzed using descriptive statistics and multivariate analysis. Results: Caregivers’ knowledge gaps and undesirables attitudes regarding appropriate use of antibiotics were identified. 48.2% of respondents reported non-prescription use of antibiotics for children in the past 6 months. The most common sources of antibiotics used without a prescription are community pharmacies and leftovers. Storing antibiotics at home and caregivers’ supportive attitude were positively and significantly associated with non-prescription use of antibiotics in children, while significant inverse associations were found for caregiver’s knowledge of prescription-only regulation on antibiotics sales at community pharmacies. Conclusions: There was a high proportion of primary caregivers self-medicate antibiotics for children in urban China, despite their insufficient knowledge about antibiotic use. Public health initiatives are needed such as public education campaigns and stricter government regulation of antibiotic use and availability in community pharmacies.

Impact of the zero-markup drug policy on hospitalisation expenditure in western rural China: an interrupted time series analysis

To assess the long‐term effects of the introduction of Chinas zero‐markup drug policy on hospitalisation expenditure and hospitalisation expenditures after reimbursement.

Disparities in out-of-pocket inpatient expenditures in rural Shaanxi Province, western China from 2011 to 2014: a time series analysis

To investigate the long‐term trend of disparity of monthly average out‐of‐pocket inpatient expenditures (OOP) between areas with different developing levels since the new healthcare reform.

Prices, availability and affordability of insulin products: a cross-sectional survey in Shaanxi Province, western China

To evaluate price, availability and affordability of insulin products in Shaanxi Province, western China.

The current status and effects of emergency drug shortages in China: Perceptions of emergency department physicians

Objectives The shortage of emergency drugs in China is severe. This study aimed to characterize emergency drug shortages in China and to measure their effects. Methods An online questionnaire based on a literature review was sent to emergency department physicians in Chinese secondary and tertiary hospitals from November 2016 to February 2017. The survey asked physicians questions about their experiences with emergency drug shortages. Results In total, 236 physicians from 29 provinces participated in the survey. According to their responses, 90.7% of the respondents experienced drug shortages during the last year. More than half of the physicians (65.7%) reported that drug shortages occurred at least once a month. Hospitals in the eastern and western regions of China had more emergency drugs in shortage than hospitals in central China, especially those with many inpatient beds (≥800). In addition, the shortage situation was more serious in secondary hospitals than in tertiary hospitals. More respondents agreed that original medicines, injections, essential medicines, medicines without alternative agents and cheap medicines were more susceptible to shortages than generics, oral medicines, nonessential medicines, medicines with alternative agents and expensive medicines, respectively. Most respondents thought that drug shortages always, often or sometimes affected patients [delayed therapy (62.6%), longer rescue and recovery times (58.9%) and higher costs (58.7%)] and physicians [inconvenience (81.0%), higher pressure (76.5%) and harm to patient-doctor relationships (72%)] and compromised hospital reputations (55.1%). Conclusions The shortage of emergency drugs in China is serious, especially in secondary hospitals located in eastern and western China. Emergency drug shortages have significant effects on patients and physicians.

Knowledge, Attitudes and Practices Regarding Diabetes in the General Population: A Cross-Sectional Study from Pakistan

Background: Low knowledge about diabetes risk factors coupled with high disease prevalence is common in low-resource countries. This study evaluated diabetes-related knowledge, attitudes, and practices in the general population in Punjab (Pakistan). Methods: A cross-sectional study was conducted in five districts in Punjab from January to March 2017. Data were collected from 2019 adults aged 18–90 years through face-to-face interviews using a semi-structured questionnaire. The total knowledge score ranged from 0–9; a score ≥6 was considered adequate diabetes awareness. Descriptive statistics, chi-square tests, and linear and binary logistic regression were used for the analyses. Results: Respondents’ mean age was 32.92 ± 11.4 years. In total, 85.9% of respondents had heard of diabetes, and 30.1% knew about the glucose tolerance test. We found 2.3% of respondents scored zero for diabetes knowledge, 11.3% scored 9, and 47.4% scored ≥6 (adequate awareness). Being female (β = 0.37, 95% confidence interval [CI]: 0.16, 0.05; p = 0.001), socioeconomic status (β = 0.24, 95% CI: 0.12, 0.36; p < 0.001), being diabetic (β = 0.82, 95% CI: 0.53, 1.10; p < 0.001), and higher education (β = 0.25, 95% CI: 0.17, 0.33; p < 0.001) were significantly associated with knowledge score. Respondents with high socioeconomic status showed significantly higher positive attitudes compared with those with low socioeconomic status (adjusted odds ratio 1.57, 95% CI: 1.12, 2.24). Only 8.7% (30/343) of those diagnosed with diabetes had never undergone blood glucose screening since diagnosis. Conclusions: Knowledge of diabetes risk factors, management, and care is low in Pakistan’s general population. Targeted public education programs should be instigated at a national level to increase understanding of diabetes prevention and treatment.

Direct and indirect cost of diabetes care among patients with type 2 diabetes in private clinics: a multicenter study in Punjab, Pakistan

ABSTRACT Background: Diabetes mellitus (DM) has a very high prevalence and poses a huge financial encumbrance on patients. This study aimed to evaluate the cost of diabetes care among patients with type 2 diabetes in private clinics of southern Punjab, Pakistan. Research design and methods: This was a descriptive, cross-sectional, prevalence-based, cost-of-illness (COI) study conducted in six private clinics of southern Punjab from July to September 2016, using a pretested questionnaire. Study participants were recruited using a random selection method. Continuous variables, including direct and indirect costs, were summarized using descriptive statistics. Inferential statistics were also used to analyze the correlation between the variables and cost. Results: The mean annual direct cost per patient with diabetes was estimated to be 332 USD. Medications accounted for the largest share (60.4%) of this cost. Age, locality, high socioeconomic status, and prolonged disease duration were significantly associated with the direct costs of illness (p < 0.05). Moreover, 19% of total earnings among very low-income patients were spent on diabetes care. Conclusions: A substantial proportion of patients’ income is spent on diabetes care in Punjab. Our findings support the substantial individual and societal burden caused by diabetes.

Antibiotic Self-Medication among Non-Medical University Students in Punjab, Pakistan: A Cross-Sectional Survey

Background: Antibiotic resistance is a global threat. Scarce knowledge about safe and appropriate antibiotic use is coupled with frequent self-administration, e.g., in China. This repeated self-medication poses potential risk in terms of antibiotic resistance. Low-resource countries are facing an elevated burden of antibiotic self-medication as compared to developed ones. Thus, this study focused on evaluating the pervasiveness of antibiotic self-medication in 3 universities of Southern Punjab, Pakistan. Methods: We conducted a descriptive cross-sectional survey in three government sector universities of Southern Punjab, Pakistan. The study was carried out with self-administered paper-based questionnaires. Data was analyzed using SPSS version 18.0 (IBM, Chicago, IL, USA). Results: Seven hundred twenty-seven students out of 750 (response rate 97%) with a mean age ± SD of 23.0 ± 3.4 years agreed to participate in the study. The proportion of females was slightly greater (52%) compared with males (48%), and almost one-third of the respondents (36%) were in their 2nd year of university. Out of the total, 58.3% practiced self-medication in the preceding six months, and 326 (45%) confirmed the use of antibiotics. Metronidazole was the most frequently self-medicated antibiotic (48%). Out of the total, 72% demonstrated awareness regarding the side effects of antibiotics. Diarrhea was the well-known adverse effect (38%). Forty-three percent affirmed having antibiotic resistance knowledge, and 30% knew that the irregular use of antibiotics would lead to increased antibiotic resistance. Conclusion: Despite having ample awareness of the adverse antibiotic reactions, self-medication among the university students was high and antibiotic resistance was a fairly unknown term.