The impacts of national centralized drug procurement policy on drug utilization of medical institutions: an empirical study in a county-level hospital in China.

PURPOSE: Under the background of the regular implementation of the National Centralized Drug Procurement (NCDP) policy, this study aimed to assess the impacts of the NCDP policy on drug utilization of county-level medical institutions, and probe into the influencing factors of the changes in drug utilization. METHOD: A pre-post study was applied using inpatient data from a county-level medical institution in Nanjing. Drug utilization behavior of medical institutions of 88 most commonly used policy-related drugs (by generic name, including bid-winning and bid-non-winning brands) was analyzed, and the substitution of bid-winning brands for brand-name drugs after policy intervention was evaluated. RESULTS: After policy intervention, 43.18% of policy-related drugs realized the substitution of bid-winning brands for bid-non-winning brands (6.82% of complete substitution, 36.36% of partial substitution). Meanwhile, 40.90% of policy-related drugs failed to realize brand substitution. Multiple factors affected brand substitution, including: (1) Policy effect: brand substitution was more obvious after the intervention of the first and third round of NCDP. (2) Drug market competition: the greater the price reduction of bid-non-winning brands, the more the drugs for the same indication, the more likely that medical institutions keep using the same brands as they did before policy intervention. (3) Previous drug utilization of medical institutions: brand substitution was more obvious in drugs with large number of prescriptions and weak preference for brand-name drugs. CONCLUSION: The NCDP policy promoted the substitution of bid-winning brands for bid-non-winning brands. However, the NCDP policy remained to be further implemented in county-level medical institutions. Policy implememtation efforts, drug market competition and drug utilization of medical institutions would affect the implementation of the NCDP policy.

Clustering-Triggered Emission of Nonconjugated Polyacrylonitrile.

Intrinsic emission from nonconjugated polymers has attracted considerable attention owing to its fundamental importance and intensive applications in diverse fields. The emission mechanism, however, is still in debate. Herein, nonconjugated polyacrylonitrile (PAN) molecules are found to be virtually nonluminescent in dilute solutions, while being highly emissive when concentrated or aggregated as nanosuspensions, solid powders, and films, exhibiting distinct aggregation-induced emission (AIE) characteristics. Moreover, triplet emissions of delayed fluorescence and room temperature phosphorescence are detected from the solid powders. Such unique emission of nonconjugated PAN is ascribed to the formation of cyano clusters, which act as the exact chromophores. In these clusters, through space electronic interactions, namely overlap of π and lone pair (n) electrons among cyano groups extend the conjugation and meanwhile rigidify the molecular conformations, thus offering remarkable emission upon irradiation. The AIE phenomenon can also be well rationalized by the formation of cyano clusters together with conformation rigidification. And the triplet emissions shall be originated from the n-π* transition owing to the presence of lone pairs. It is believed that such clustering-triggered emission mechanism is instructive for further development of unorthodox luminogens.