title: Application of propensity scores to estimate the association between government subsidy and injection use in primary health care institutions in China.
abstract: BACKGROUND
  The problem posed by therapeutic injection is a clinical practice issue that influences health care quality and patient safety. Although sufficient government subsidy was one of the 12 key interventions to promote rational drug use initiated by WHO (World Health Organization), limited information is available about the association between government subsidy and injection use in primary health care institutions. In 2009, National Essential Medicines System (NEMS) was implemented in China. The subsidy policy plays an important role in maintaining primary health care institutions. This study explores the impact of government subsidies on the injection use in primary health care institutions in China.
  
  
  METHODS
  126 primary health institutions were included in this study. Institutions were divided into two groups (intervention and control groups) according to the median GS (General subsidy per personnel). Propensity score matching (PSM) was used to minimize the observed covariate differences in the characteristics of the primary institutions between the two groups. Kappa score was calculated to determine the consistency between the groups. Paired chi-square test and Relative Risk (RR) were calculated to compare the differences in injection use between the groups.
  
  
  RESULTS
  Among all the investigated prescriptions, the overall percent of people who received an injection prescribed was 36.96% (n = 12600). PSM showed no significant covariate difference among the 34 groups obtained through this analysis. Kappa score (k = -0.082, p = 0.558) indicated an inconsistency between groups and paired chi-square test revealed a significant difference (p < 0.05) in injection use between the two groups. Relative Risk = 0.679 (95%CI [0.485, 0.950]) indicate that high General subsidy per personnel is a protective factor for primary health care institutions to prescribe injections properly. The intervention group obtained a higher possibility of using injection properly.
  
  
  CONCLUSIONS
  The overall effect of government subsidy on the use of injection was positively significant. However, the mechanism by which government subsidy influence injection administration remains unclear, and thus requires further study.
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, HuaZhong University of Science and Technology, Wuhan, HuBei Province, China.
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Tang
authors.forename: Xiaopeng
authors.initials: X
authors.lastname: Zhang
authors.forename: Chunyan
authors.initials: C
authors.lastname: Yang
authors.forename: Lianping
authors.initials: L
authors.lastname: Yang
authors.forename: Hongtao
authors.initials: H
authors.lastname: Wang
authors.forename: Xinping
authors.initials: X
authors.lastname: Zhang
mesh_terms: D002681:China; D016903:Drug Monitoring; D018954:Drugs, Essential; D005380:Financing, Government / Q000706:statistics & numerical data*; D005102:Health Expenditures; D006300:Health Services Misuse / Q000191:economics*; D006801:Humans; D007267:Injections / Q000592:standards / Q000706:statistics & numerical data*; D061214:Patient Safety; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D057216:Propensity Score; D011787:Quality of Health Care; D011795:Surveys and Questionnaires
chemical_list: D018954:Drugs, Essential