THE IRRATIONAL USE OF DRUGS IN RURAL CHINA: EVIDENCES FROM TWO PROVINCES Qiang SUN, Jia YIN, Genyong ZUO, Qingyue MENG Center for Health Management &

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1 THE IRRATIONAL USE OF DRUGS IN RURAL CHINA: EVIDENCES FROM TWO PROVINCES Qiang SUN, Jia YIN, Genyong ZUO, Qingyue MENG Center for Health Management & Policy, Shandong University Problem statement: the irrational use of drugs in rural China is unclear. Objectives: To evaluate the irrational use of drugs in rural China. Design: A cross-sectional study was designed. Setting: in Shandong and Ningxia provinces in Study population: Total 13,481 rural residents were investigated. 3,000 prescriptions were randomly collected. 49 health care providers were interviewed. Policies: related policies and health promotions on rational drug use are implementing in China. Outcome measures: the behavior and perception of health care providers and rural residents on use of drugs were measured. Results: 75.3% and 66.2% of prescriptions at village clinics have antibiotics in Shandong and Ningxia respectively. Accustomed prescription practices of rural health providers and economic incentives from selling drugs are the main reasons. Over 50% of surveyed populations don t know consequence of irrational use of antibiotics in both provinces. Over 50% of prescriptions have the injections in the township health centers and village clinics. The rural patients believe the injections with better effects than oral drugs. 54.6% and 60% of the rural patients can not comply with medical advice to take drugs. Conclusions: The irrational use of medicines is very severely in rural China in terms of high antibiotic use and injection use. Implementing trainings on and reforming the incentive mechanism for rural health providers are urgent and essential for improving rational use of drugs. Targeted health promotions on rural residents for improving their knowledge and setting up correct beliefs on rational drug use are also important. Funding Sources: supported by Europe Union from

2 Background Overuse, under use, or misuse of drugs has resulted in wastage of scarce resources, poor quality and unnecessary costs of health care. The irrational use of drugs in rural China is unclear Ministry of Health has issued policies and carried out health promotion activities for improving the use of drugs rationally in the hospitals and in the communities.

3 Study Aims To evaluate the basic situation of rational use of drugs in rural China by studying the behavior and perception of health care providers and rural residents.

4 Methods 1 Design: A cross-sectional study was designed to evaluate the use of drugs in rural China Setting: Shandong and Ningxia provinces in In each province, the public hospitals and rural community were the basic study sites

5 Methods 2 3 counties, 9 towns and 54 villages were randomly sampled in each province Total 13,481 rural residents were investigated in two provinces 3,000 prescriptions were randomly collected from county hospitals to village clinics in two provinces 49 health care providers from different levels were interviewed

6 Results 1 The average No. of drugs and drug cost in Shandong Health facilities No. of Pre Aver. No. of Drugs Aver. cost(rmb) County hospital Township health center Village clinic The average No. of drugs and drug cost in Ningxia Health facilities No. of Pre Aver. No. of Drugs Aver. cost(rmb) County hospital Township health center Village clinic

7 Results 2 High Antibiotic use Health facilities County hospital Township health center Village clinic χ 2 P % of prescriptions with Antibiotics in Shandong <0.001 % of prescriptions with Antibiotics in Ningxia Accustomed prescription practices of rural health providers and economic incentives from selling drugs are the main reasons resulted in the high antibiotic utilization

8 High Injection Use Health facilities County hospital Township health center Village clinic χ 2 P Results 3 % of prescriptions with Injections in Shandong <0.001 % of prescriptions with Injections in Ningxia Wrong beliefs: The rural patients actively require using the injections as they believe the effect of injections is better than oral drugs. Economic incentives: The injective drugs usually had higher mark-up

9 Results 4 Poor knowledge: over 50% of surveyed populations don t know consequence of irrational use of antibiotics in both provinces. Poor adherence: 54.6% and 60% of the rural patients can not comply with medical advice to take drugs in Shandong and Ningxia respectively.

10 Summary 1 The irrational use of medicines is very severely in rural China in terms of high antibiotic use and injection use Economic incentives and lack of continuous training to health care providers are main reasons

11 Summary 2 Poor knowledge, wrong beliefs and poor adherence of rural residents on drug use worse the irrational use of medicines

12 Policy implication and conclusion Implementing continuous on-the-job trainings on and reforming the incentive mechanism for rural health providers are urgent and essential for improving rational use of drugs in rural China. Targeted health promotions on rural residents for improving their knowledge and setting up correct beliefs on rational drug use are also important.