The impact of pharmacist practice of medication therapy management in ambulatory care: an experience from a comprehensive Chinese hospital.

BACKGROUD: With the reform of medical system in China, Beijing municipal hospitals explored a new pharmaceutical care model and set up medication therapy management services (MTMs) in ambulatory care since 2019. We were one of the first hospitals to set up this service in China. At the present, there were relatively few reports about the effect of MTMs in China. In this study, we summarized the implementation of MTMs in our hospital, explore the feasibility of pharmacist-led MTMs in ambulatory care and the impact of MTMs on patients' medical costs. METHODS: A retrospective study was conducted in a university-affiliated, tertiary comprehensive hospital in Beijing, China. The patients who received at least one MTMs and with complete medical records and pharmaceutical documents from May 2019 to February 2020 were included. Pharmacists provided pharmaceutical care for patients according to the MTMs standards issued by the American Pharmacists Association, identified the numbers and classification of the patients' perceived medication-related demands, identified medication-related problems (MRPs), and developed the medication-related action plans (MAPs). All MRPs found by pharmacists, pharmaceutical interventions, and resolving recommendations were documented, and calculate the cost of treatment drugs that patients can reduce. RESULTS: A total of 112 patients received MTMs in ambulatory care, among them 81 cases with the completed record were included in this study. 67.9% of patients had five or more diseases, 83% of them co-took over 5 drugs. While performing MTMs, 128 patients' perceived medication-related demands were recorded in all, monitoring and judgment of adverse drug reaction (ADR) (17.19%) was the most common demand. 181 MRPs were found, with an average of 2.55 MPRs per patient. Nonadherence (38%), excessive drug treatment (20%), and adverse drug events (17.12%) were the top three MRPs. Pharmaceutical care (29.77%), adjustment of drug treatment plan (29.10%) and referral to the clinical department (23.41%) were the top three MAPs. Whereby the MTMs provided by pharmacists, the cost-saving of each patient was about $ 43.2 monthly. CONCLUSION: By participating in the MTMs of outpatients, the pharmacists could identify more MRPs and develop personalized MAPs timely for patients, thereby promoting rational drug use and reducing medical expenses.

Alpha emitter radium-223 in patients with metastatic castration-resistant prostate cancer: A cost-utility analysis.

Objective: To assess the cost effectiveness of radium-223 dichloride for patients with metastatic castration-resistant prostate cancer (mCRPC) in China. Materials and methods: A Markov model was developed to estimate the long-term health and economic outcomes of radium-223 plus best standard care (BSC) treatment and BSC only for bone mCRPC patients over a lifetime horizon. The patients and interventions were modeled according to the ALSYMPCA trial. Costs were collected from a Chinese health system perspective. Utility values were derived from the published literature. The base-case model results were quality-adjusted life year (QALY), total cost, and incremental cost-utility ratio (ICUR). Uncertainty analyses were performed to assess the robustness of our conclusions. Results: Compared with the BSC arm, radium-223 achieved an excess 0.344 QALYs with an incremental cost of $29,459, resulting in an ICUR of $85,647 per QALY. The probability of Ra-223 being cost effective for the patients with bone mCRPC was sharply low (<0.5%) at a willingness-to-pay threshold of $38,136/QALY. Uncertainty analyses revealed that the model is robust to all the input parameters. Conclusion: Radium-223 is unlikely to be cost effective in patients with bone mCRPC at the current WTP threshold, from a Chinese health system perspective. In affluent areas with a high per-capita GDP, radium-223 therapy may be cost effective.

Good Performance of the Chinese Version of Mini Social Cognition and Emotional Assessment in the Early Diagnosis of Behavioral Variant Frontotemporal Dementia.

Social cognition impairment has been recognized as an early and characteristic change in behavioral variant frontotemporal dementia (bvFTD). The Mini Social Cognition and Emotional Assessment (mini-SEA) is a clinical tool to rapidly evaluate social cognition. In this study, we explored the diagnostic value of social cognition by assessing the Chinese version of the mini-SEA and other standard neuropsychological tests in 22 patients with mild bvFTD, 26 patients with mild Alzheimer's disease (AD), including mild cognitive impairment (MCI) and mild dementia, and 30 control subjects. The discriminatory powers of these tests were evaluated and compared using the receiver operating characteristic curve (ROC). The mini-SEA scores of the bvFTD patients were significantly lower than those of the controls (Z = -6.850, adjusted P < 0.001) and AD patients (Z = -3.737, adjusted P = 0.001). ROC analysis showed that the mini-SEA had a high discriminatory power for differentiating bvFTD from the controls, with an area under the curve (AUC) value of 0.989 (95% CI = 0.905-1.000, P < 0.001). The AUC value of the mini-SEA for differentiating bvFTD from AD was 0.899 (95% CI = 0.777-0.967, P < 0.001), higher than that of the Auditory Verbal Learning Test Delayed Recall (AUC = 0.793), Boston Naming Test (AUC = 0.685) or Frontal Assessment Battery (AUC = 0.691). The Chinese version of mini-SEA is a good clinical tool for the early diagnosis of bvFTD, and has a high sensitivity and specificity to discriminate bvFTD from AD.

Does real estate bubble affect corporate innovation? Evidence from China.

With the rapid increase of downward pressure on China's economy, the stability of the property market, as an important part of the economic transformation process, also has a far-reaching impact on enterprises' R&D investment. We select the data of Chinese large and medium-sized industrial enterprises from 1998 to 2015 as our research sample and propose a new combination measurement model based on closeness degree to measure the real estate bubble level in China accurately. The structural vector autoregressive (SVAR) theory is utilized to empirically test the dynamic relationship between the real estate bubble, corporate liquidity, and R&D investment. The results indicate that the real estate bubble level in China is increasing, and a certain risk of deviating from the safety interval in the future exists; The rapid expansion of the real estate bubble has a continuing negative impact on corporate R&D investment, that is, its "credit mitigation effect" is much smaller than the "capital relocation effect," and industrial enterprises will fall into the so-called "low-tech lock-in" state. In other words, to a certain extent, the development of this kind of real estate bubble will not be conducive to the transformation and upgradation of enterprises and long-term economic growth.

Spatial-temporal characteristics and influencing factors of atmospheric environmental efficiency in China.

This research constructs a super efficiency slack-based measure (SBM) model based on the Malmquist-Luenberger (ML) index to analyze the atmospheric environmental efficiency (AEE) of 30 provinces in China from 2000 to 2016 and explores the spatial and temporal differences of AEE by using the coefficient of variation method. This paper further analyzes the internal influencing factors of AEE via the ML index decomposition approach and establishes a panel data regression model to explore AEE's influencing factors in China. The results show some regional differences of the AEE level in China, with it the best in the eastern region and followed in order by the western and central region, and these differences exhibit an increasing trend year by year. During the study period, the development trend of AEE in China is similar to that in the eastern and western regions, showing a "W" shape, where in the central region it has a "U" pattern. The conclusion is that technical progress (TC) is the dominant factor affecting AEE, technical efficiency (EC) fails to effectively promote AEE improvement, and TC and EC present varying degrees of influence and different directions of action in the regions. The analysis results show that the influence effect of economic development on AEE presents a "U" pattern of first declining and then rising. The degree of China opening up to the outside world and its carbon dioxide emissions intensity have significant negative effects on AEE, whereas the increase of pollution control input effectively improves AEE.

Does public concern over haze pollution matter? Evidence from Beijing-Tianjin-Hebei region, China.

Chinese residents are becoming more and more concerned about the living environment especially under the situation of environmental degradation caused by the unbalanced and inadequate economic development. The widespread of internet use provide a new way for public to express the dissatisfaction on environmental pollution. Although the public is the main body of society, the public concern over environmental issues are rarely studied. In this paper, the impact of public concern over haze on haze pollution is quantitatively examined by the utilization of econometric model. Specifically, the Baidu search index (BSI) is utilized as indicators for public concern. Using the panel data consisting of 13 cities in Beijing-Tianjin-Hebei region from the period from January 2014 to December 2019, estimation results showed a significant improvement effect of public concern on haze pollution. In general, the public concern can improve the air quality in a short turn. However, this improvement effect varies with different economic development levels. These findings can help policy makers to better understand the role of public in social governance and improve the air quality in China with the inclusion of public participation.

The mathematical treatment for effect of income and urban-rural income gap on indirect carbon emissions from household consumption.

Climate change and income inequality are global problems with a huge impact on the environment, society, and economic development. Many studies have shown a correlation among income, the income gap, and carbon emissions, but the influence mechanism remains unclear of income and the income gap on carbon emissions. Using the input-output method, we introduce residents' consumption tendency to construct a mathematical model to discuss the mechanism of the influence of income and the income gap on indirect carbon emissions from household consumption (ICEH). Data at the national and provincial levels are used to conduct empirical research based on the model. Our model indicates four scenarios in which income and the income gap affect ICEH through residents' consumption tendency. When richer urban residents have a greater consumption tendency, a decrease in the income gap would reduce carbon emissions. The empirical results show that a decrease in the income gap is correlated with an increase in ICEH in China from 2002 to 2012. Therefore, the win-win situation of "increased income and narrowed income gap-reduced carbon emissions" is hard to achieve in China. Policymakers must urgently explore other ways to reduce carbon emissions.