title: The effect of essential medicines programme on rational use of medicines in China.
abstract: OBJECTIVE
  Irrational use of medicines is a serious problem in China and has been the primary target of China's national essential medicines programme (NEMP). The aim of this study was to evaluate the effect of the NEMP on rational use of medicines in China.
  
  
  METHODS
  A nationwide sample of 3 76 700 prescriptions written by primary care providers from 2007 to 2011 was obtained following a multistage sampling process. Six prescribing indicators were measured: average number of drugs prescribed per prescription, average expenditure per prescription, percentage of prescriptions with antibiotics, with injections, with two or more antibiotics and with corticosteroids. The pre-post with control study design and the difference-in-difference (DID) methodology were employed to evaluate the effect of NEMP.
  
  
  RESULTS
  Prescriptions from primary care institutions with the NEMP implementation were better than those without NEMP implementation. Adjusting for the institution's sizes, ownership, economic geographic regions and the year of NEMP implementation, the DID estimator was statistically significant in all prescribing indicators except for the percentage of prescriptions with injection. The number of drugs per prescription decreased by 0.2 per prescription [95% confidence interval (CI): -0.3, -0.1] after the NEMP was implemented; the percentages of prescriptions with antibiotics, with corticosteroids and with two or more antibiotics decreased by 7% (95% CI: -10, -4), 1% (95% CI: -2, 0) and 2% (95% CI: -3, 0), respectively; and the average expenditure per prescription decreased by eight Renminbi Yuan (95% CI: -14, -2). The effect of NEMP on reducing irrational prescribing was greater in public institutions than in private institutions (P < 0.05).
  
  
  CONCLUSIONS
  China's NEMP is effective in promoting rational use of medicines, and the effect is greater in public institutions than in private institutions. However, the irrational use is still high, pointing to the need for further reforms to tackle the underlying causes, such as clinical guidelines and patient education.
authors.affiliation: School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Gong
authors.affiliation: School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
authors.forename: Chen
authors.initials: C
authors.lastname: Yang
authors.affiliation: School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China, hnyinxiaoxv@126.com.
authors.forename: Xiaoxv
authors.initials: X
authors.lastname: Yin
authors.affiliation: Department of Science and Research Management, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China and.
authors.forename: Minmin
authors.initials: M
authors.lastname: Zhu
authors.affiliation: School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
authors.forename: Huajie
authors.initials: H
authors.lastname: Yang
authors.affiliation: School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
authors.forename: Yunxia
authors.initials: Y
authors.lastname: Wang
authors.affiliation: School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
authors.forename: Yongbin
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Primary Healthcare, Ministry of Health of the People's Republic of China, Beijing, People's Republic of China.
authors.forename: Liqun
authors.initials: L
authors.lastname: Liu
authors.affiliation: School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
authors.forename: Xiaoxin
authors.initials: X
authors.lastname: Dong
authors.affiliation: School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
authors.forename: Shiyi
authors.initials: S
authors.lastname: Cao
authors.affiliation: School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China, hnyinxiaoxv@126.com.
authors.forename: Zuxun
authors.initials: Z
authors.lastname: Lu
mesh_terms: D002681:China; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D018954:Drugs, Essential / Q000627:therapeutic use*; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011320:Primary Health Care
chemical_list: D018954:Drugs, Essential
keywords: China; essential medicines programme; prescribing; primary care; rational use of medicines