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Objective: To assess the impact of the National Essential Medicines Scheme (NEMS) with respect to urban-rural inequalities regarding drug prescriptions in primary care facilities. Methods: A stratified two-stage random sampling strategy was used to sample 23,040 prescriptions from 192 primary care facilities from 2009 to 2010. Difference-in-Difference (DID) analyses were performed to test the association between NEMS and urban-rural gaps in prescription patterns. Between-Group Variance and Theil Index were calculated to measure urban-rural absolute and relative disparities in drug prescriptions. Results: The use of the Essential Medicines List (EML) achieved a compliance rate of up to 90 % in both urban and rural facilities. An overall reduction of average prescription cost improved economic access to drugs for patients in both areas. However, we observed an increased urban-rural disparity in average expenditure per prescription. The rate of antibiotics and glucocorticoids prescription remained high, despite a reduced disparity between urban and rural facilities. The average incidence of antibiotic prescription increased slightly in urban facilities (62 to 63 %) and reduced in rural facilities (67 % to 66 %). The urban-rural disparity in the use of parenteral administration (injections and infusions) increased, albeit at a high level in both areas (44 %-52 %). Conclusion: NEMS interventions are effective in reducing the overall average prescription costs. Despite the increased use of the EML, indicator performances with respect to rational drug prescribing and use remain poor and exceed the WHO/INRUD recommended cutoff values and worldwide benchmarks. There is an increased gap between urban and rural areas in the use of parenteral administration and expenditure per prescription.

Background: This study aims to examine the prevalence and predictors associated with self-medication, and related consequences in Wuhan, China. Methods: Two-hundred-sixty residents were interviewed from randomly selected four districts of Wuhan, China. A modified version of Anderson’s health behavioral model was used in the survey to collect information of self-medication behavior. Multivariable logistic regression analyses were used to measure correlates of the prevalence of self-medication. Results: Nearly half of the respondents would select self-medication, and 39.1% would see a doctor if they felt sick. The most common self-medicated illnesses were cold and cough, cardiovascular disease and gastrointestinal disease. The main reasons for self-medication were that the illness was not severe (enough) to see the doctor (45%); the patient did not think that the trouble of seeing a doctor was worth the effort (23%); the patient had no time to see the doctor (12%), and the patient did not want to pay high medical costs (15%). Logistic regression results suggested that respondents tended to select self-medication if the illness was minor or short-term (less than seven days). Conclusions: Our findings suggest that more strict regulation on over-the-counter medicines may be required to reduce health risks related to self-medication. Targeted health education on the risks of self-medication should be considered.

Highlights • After decades of investment in public health emergency response system in terms of infrastructure, equipment, inter-organizational communication and other areas, China has claimed that a sound public health emergency response system was established. Despite this, lack of qualified front-line staff that equipped with sufficient knowledge and emergency response skills has crippled the efficient action of emergency response. Although this problem is grave, there is paucity of studies in China exploring this issue. • This study identified the weakest skill areas perceived by participants among key skills highly demanded during public health emergency response. • Totally fourteen key emergency response skills and techniques were highlighted by responders. The five top weakest skill deficiency areas to be addressed were as follows: field epidemiological investigation skills, personal protective skills, nuclear and radioactive emergency handling skills, psychological intervention skills and risk assessment skills. • Major obstacles hindering the efficient promotion and mastery of those key skills among front-line emergency responders were as follows: insufficient funding of technical application, lack of operability, disqualified training and drills, delays in skill updating. • Determinants associated with the self-rated overall skill proficiency of public health emergency responders were explored: the multivariate logistic regression revealed personal protective skills as the most important factor contributing to self-rated overall skill proficiency of public health emergency responders (OR = 2.171), then field epidemiological investigation skills (OR = 1.510). Followed by emergency preparedness plan skills, coping with emergency drills, crisis communication skills, besides, field sampling skills and the professional title., Background To identify the weakest skill areas perceived by participants among key skills highly demanded during emergencies and to explore factors influencing the self-rated overall skill proficiency of public health emergency responders. Methods The participants were selected by a multistage, stratified cluster sampling method in Heilongjiang CDC to complete questionnaires that assessed their perceptions of health emergency response skills and techniques. A final sample of 1,740 staff members was obtained and analyzed. Results The 5 top skill deficiency areas perceived by participants were field epidemiologic investigation, personal protection, effective nuclear and radioactive response as well as psychological interventio (for these two areas gain the equal score), and risk assessment. The logistic regression revealed personal protective skills as the most important factor contributing to the self-rated overall skill proficiency of public health emergency responders, followed by field epidemiologic investigation skills. Conclusions More attention should be given to emergency response skill training and education programs. Major obstacles hindering the promotion of key skills and techniques among front-line emergency responders should be addressed urgently. Continuous efforts should be made to remove the financial, technical, and resource obstacles to improve public health emergency response capacity.

This study identifies potential organizational barriers associated with the implementation of the Chinese National Essential Medicines Policy (NEMP) in rural primary health care institutions. We used a multistage sampling strategy to select 90 township hospitals from six provinces, two from each of eastern, middle, and western China. Data relating to eight core NEMP indicators and institutional characteristics were collected from January to September 2011, using a questionnaire. Prescription-associated indicators were calculated from 9000 outpatient prescriptions selected at random. We categorized the eight NEMP indicators using an exploratory factor analysis, and performed linear regressions to determine the association between the factor scores and institution-level characteristics. The results identified three main factors. Overall, low levels of expenditure of medicines (F1) and poor performance in rational use of medicines (F2) were evident. The availability of medicines (F3) varied significantly across both hospitals and regions. Factor scores had no significant relationship with hospital size (in terms of number of beds and health workers); however, they were associated with revenue and structure of the hospital, patient service load, and support for health workers. Regression analyses showed that public finance per health worker was negatively associated with the availability of medicines (p

To assess the impact of the National Essential Medicines Policy (NEMP) on the use of medicines in government-owned primary care institutions in Hubei province of China.Quasi-experimental design and time-trend analysis.A systematic random sampling strategy was employed to select 55,800 prescriptions from 18 primary care organizations who progressively implemented the NEMP from January 2009 to July 2011. We examined the change of patterns of prescriptions. The facilities that implemented the NEMP at a later stage served as control.An immediate increased uptake of essential medicines of all drugs prescribed which ultimately neared 95%. In total, 38,151 prescriptions (68%) involved antibiotics, and we found no evidence of reduction after the NEMP interventions. A high percentage (59-66%) of prescription drugs were administered through parenteral routes and no reduction was found after the NEMP interventions. Although the average number of medicines per prescription remained unchanged (nearly four), the average cost per prescription declined significantly after the NEMP interventions (¥ 44.67 vs ¥ 26.67 CNY, P0.03).The NEMP interventions reduced the average cost per prescription; however, the irrational use of antibiotics and unnecessary parenteral administration remains prevalent. The goals of the NEMP are partially achieved; we therefore recommend a strategic approach involving all stakeholders to comprehensively achieve all aspirations.