The Status Quo of Internet Medical Services in China: A Nationwide Hospital Survey.

Background: Internet medical services (IMS) have been rapidly promoted across China, especially since the outbreak of COVID-19. However, a nationwide study is still lacking. Objective: To unveil the whole picture of IMS across tertiary and secondary hospitals in China, and to evaluate potential influence of the hospital general characteristics, medical staff reserve, and patient visiting capacity on IMS provision. Methods: An online cross-sectional survey was conducted, and 1,995 tertiary and 2,824 secondary hospitals completed questionnaires from 31 administrative regions in China during July 1 and October 31, 2021. Those hospitals are defined having abilities of providing IMS if at least one following service are available: (1) online appointment of diagnoses and treatments; (2) online disease consultation; (3) electronic prescription; and (4) drug delivery. The logistic regression models are used to detect the possible roles on developing IMS. Results: A majority (68.9%) of tertiary hospitals and 53.0% secondary hospitals have provided IMS (p < 0.01). Tertiary hospital also had much higher proportions than secondary hospitals in online appointment of diagnoses and treatments (62.6% vs. 46.1%), online disease consultation (47.3% vs. 16.9%), electronic prescription (33.2% vs. 9.6%), and drug delivery (27.8% vs. 4.6%). In multivariate model, IMS hospitals may be associated significantly with having more licensed doctors (≥161 vs. <161: odds ratio [OR], 1.30; 1.13-1.50; p < 0.01), having more frequency of registration appointments (≥3,356 vs. <3,356: OR, 1.77; 1.54-2.03; p < 0.01), having higher frequency of patient follow-ups (≥1,160 vs. <1,160: OR, 1.36; 1.15-1.61; p < 0.01), having laboratory test appointments (Yes vs. No: OR, 1.25; 1.06-1.48; p = 0.01), and having treatment appointments (Yes vs. No: OR, 1.27; 1.11-1.46; p < 0.01) in the past 3 months. Conclusions: The coverage of IMS is appreciable in China, but the IMS market is still greatly extended and improved. The provision of IMS depends primarily on the scales of the hospitals, including medical staff reserve and patient visiting capacity.

Pharmaceutical expenditure and total health-care expenditure in OECD countries and China: bidirectional Granger causality on the basis of health level.

Background: Previous studies have ignored the bidirectional causality and the heterogeneity of health level. This study explored the bidirectional causality between pharmaceutical expenditure (PE) and total health-care expenditure (Total HCE) considering the health level for effective health investment and national health improvement.Methods: Based on the panel data on PE and Total HCE in 32 OECD countries and China, the Granger causality test was applied. Countries were divided into low- and high-health-level (LH and HH) groups according to their life expectancies.Results: A 1% increase in the growth rate of per capita PE boosted a 0.11% increase in that of per capita Total HCE of the following year in HH group, whereas no such causality existed in LH group. A 1% increase in the growth rate of per capita Total HCE boosted a 0.46% increase in that of the per capita PE of the following year in LH group, whereas no such causality existed in HH group.Conclusion: High-health-level countries should continue to increase the health investment by promoting rational PE growth such as expanding insurance coverage for innovative medicine for health improvement. Low-health-level countries should take optimizing policy to increase health investment in pharmaceutical for medicine accessibility and national health.

Effects of restrictive-prescribing stewardship on antibiotic consumption in primary care in China: an interrupted time series analysis, 2012-2017.

BACKGROUND: The overuse of antibiotics has been a major public health problem worldwide, especially in low- and middle- income countries (LMIC). However, there are few policies specific to antibiotic stewardship in primary care and their effectiveness are still unclear. A restrictive-prescribing stewardship targeting antibiotic use in primary care has been implemented since December 2014 in Hubei Province, China. This study aimed to evaluate the effects of the restrictive-prescribing stewardship on antibiotic consumption in primary care so as to provide evidence-based suggestions for prudent use of antibiotics. METHODS: Monthly antibiotic consumption data were extracted from Hubei Medical Procurement Administrative Agency (HMPA) system from Sept 1, 2012, to Aug 31, 2017. Quality Indictors of European Surveillance of Antimicrobial Consumption (ESAC QIs) combined with Anatomical Therapeutic Chemical (ATC) classification codes and DDD per 1000 inhabitants per day (DID) methodology were applied to measure antibiotic consumption. An interrupted time series analysis was performed to evaluate the effects of restrictive-prescribing stewardship on antibiotic consumption. RESULTS: Over the entire study period, a significant reduction (32.58% decrease) was observed in total antibiotic consumption, which declined immediately after intervention (coefficient = - 2.4518, P = 0.005) and showed a downward trend (coefficient = - 0.1193, P = 0.017). Specifically, the use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins showed declined trends after intervention (coefficient = - 0.0553, P = 0.035; coefficient = - 0.0294, P = 0.037; coefficient = - 0.0182, P = 0.003, respectively). An immediate decline was also found in the contribution of ß-lactamase-sensitive penicillins to total antibiotic use (coefficient = - 2.9126, P = 0.001). However, an immediate increase in the contribution of third and fourth-generation cephalosporins (coefficient = 5.0352, P = 0.005) and an ascending trend in the contribution of fluoroquinolones (coefficient = 0.0406, P = 0.037) were observed after intervention. The stewardship led to an immediate increase in the ratio between broad- and narrow-spectrum antibiotic use (coefficient = 1.8747, P = 0.001) though they both had a significant downward trend (coefficient = - 0.0423, P = 0.017; coefficient = - 0.0223, P = 0.006, respectively). An immediate decline (coefficient = - 1.9292, P = 0.002) and a downward trend (coefficient = - 0.0815, P = 0.018) were also found in the oral antibiotic use after intervention, but no significant changes were observed in the parenteral antibiotic use. CONCLUSIONS: Restrictive-prescribing stewardship in primary care was effective in reducing total antibiotic consumption, especially the use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins. However, the intervention effects were limited regarding the use of combinations of penicillins with ß-lactamase inhibitors, the third and fourth-generation cephalosporins, fluoroquinolones and parenteral antibiotics. Stronger administrative regulations focusing on specific targeted antibiotics, especially the use of broad-spectrum antibiotics and parenteral antibiotics, are in urgent need in the future.

Estimating Factors Related to Fluoroquinolone Resistance Based on One Health Perspective: Static and Dynamic Panel Data Analyses From Europe.

Objectives: Antimicrobial resistance (AMR) has become a One Health problem in which fluoroquinolone resistance has caused great concern. The aim of this study is to estimate factors related to fluoroquinolone resistance involving the professionals and antimicrobial consumption (AMC) in human and animal fields. Methods: A country-level panel data set in Europe from 2005 to 2016 was constructed. The dependent variables were measured by Escherichia coli ( E. coli ) and Pseudomonasaeruginosa ( P. aeruginosa ) resistance rates to fluoroquinolones. Both the static and dynamic panel data models were employed to estimate the above factors associated with the resistance rates. Results: The 10% increase in the number of medical staff and veterinary professionals per 100,000 population were significantly correlated with the 32.44% decrease of P. aeruginosa and 0.57% decrease of E. coli resistance rates to fluoroquinolones (Coef. = -3.244, -0.057; p = 0.000, 0.030, respectively). The 10% increase in the human AMC was correlated with 10.06% and 8.04% increase of P. aeruginosa resistance rates to fluoroquinolones in static and dynamic models (Coef. = 1.006, 0.804; p = 0.006, 0.001, respectively). The 10% increase in veterinary AMC was related to a 1.65% decrease of P. aeruginosa resistance rates to fluoroquinolones (Coef. = -0.165, p = 0.019). Conclusions: The increases in medical and veterinary professionals are respectively associated with the decrease of P. aeruginosa and E. coli resistance rates to fluoroquinolones. The increase in human AMC is also associated with increase of P. aeruginosa resistance rates, while the increase in veterinary AMC was found to be associated with a decrease in resistance rate for P. aeruginosa.

Antibiotic Sales in Primary Care in Hubei Province, China: An Analysis of 2012-2017 Procurement Records.

The over-use of antibiotics has been identified as a major global challenge, where there is insufficient knowledge about the use of antibiotics in primary healthcare settings, especially at a population level. This study aims to investigate the trends and patterns of antibiotic sales in primary care in Hubei, China over a six-year period from 2012 to 2017. Antibiotic sales were expressed with Defined Daily Doses per 1000 inhabitants per day (DIDs) and compared with European countries using the 12 quality indicators proposed by the scientific advisory board of the European Surveillance of Antimicrobial Consumption (ESAC) project. Antibiotic sales increased from 12.8 DID in 2012 to 15.3 DID in 2013, and then declined afterwards. The most commonly used antibiotics, J01C (beta-lactam antimicrobials, penicillins), accounted for 40.5% of total antibiotic sales. Parenteral administration of antibiotics accounted for over 50% of total antibiotic sales. Total antibiotic sales were almost on a par with the 31 European countries monitored by the ESAC project, but cephalosporin sales were higher than at least three quarters of the compared countries, resulting in a significant higher proportion of third-generation cephalosporin consumption (13.8-19.43%). The relative consumption of Fluoroquinolone (9.26-9.89%) was also higher than at least half of the compared countries. There is a lack of robust evidence to show that antibiotic consumption in primary care is lower in Hubei compared with other countries. The preference of clinicians in China to use broad-spectrum and parenteral antibiotics deserves further study and policy attention.

Effects of laboratory capabilities on combating antimicrobial resistance, 2013-2016: A static model panel data analysis.

OBJECTIVES: Antimicrobial resistance (AMR) has become a serious global public health problem. The World Health Organization (WHO) and European Union (EU) have taken actions to combat this issue, in which laboratory capability construction is a crucial part. This study aimed to explore the relationship between laboratory capabilities and antimicrobial resistance from a macro perspective. METHODS: The study used annual national level penal data from the EU Laboratory Capability Monitoring System and Antimicrobial Resistance Surveillance Europe 2013-2016. A conventional static panel data analysis was constructed to establish the relationship between the antimicrobial resistance rates and laboratory capabilities. RESULTS: Laboratory capability on antimicrobial drug resistance characterisation and monitoring (LC8) showed a positive effect on Escherichia coli (E. coli) combined resistance rate (Y5), E. coli resistant rate of aminoglycosides (Y4), and Klebsiella pneumoniae resistant rate of carbapenems (Y8) (OR=0.929, 0.957, and 0.861; P=0.035, 0.007, and 0.026, respectively). However, following the diagnostic testing guidelines (LC2) caused higher resistance rates of Klebsiella pneumoniae to fluoroquinolones (Y6), third-generation cephalosporins (Y7), and aminoglycosides (Y9) (OR=1.076, 1.093, and1.065; P=0.011, 0.032, and 0.002, respectively). CONCLUSIONS: Antimicrobial drug resistance characterisation and monitoring by laboratories has contributed to minimising antimicrobial resistance, while the mechanism of laboratory capabilities to pose an ineffective or negative impact on AMR remains to be further studied.