Modeling Seasonal and Spatiotemporal Variation: The Example of Respiratory Prescribing

Impact of the zero-mark-up drug policy on drug-related expenditures and use in public hospitals, 2016-2018: an interrupted time series study in Shaanxi

OBJECTIVE

The aim of this study was to measure the impact of zero-mark-up drug policy (ZMDP) on drug-related expenditures and use in urban hospitals.

DESIGN

This was a retrospective observational study of trends in drug expenses and use in the context of the ZMDP using an interrupted time series analysis.

SETTING

Twelve hospitals (three tertiary hospitals and nine secondary hospitals) in Xi'an, which is the capital of Shaanxi Province in Western China.

DATA AND PARTICIPANTS

The prescription information for all outpatients and inpatients in the study hospitals from January 2016 to April 2018 was used in this study.

INTERVENTIONS

The Chinese government announced the policy intervention measure of the ZMDP, which was implemented in all public hospitals as of 1 April 2017.

PRIMARY MEASURES

Monthly drug expenditures, monthly medical expenditures, the percentage of drug expenditures among total medical expenditures, the average outpatient drug expenditure per visit, the percentage of prescriptions that include an injection and the percentage of prescriptions that include an antibiotic.

RESULTS

Monthly total medical expenses increased in both tertiary and secondary hospitals after the ZMDP was implemented. In tertiary hospitals, the average outpatient drug expenditures per visit showed a slow decreasing trend before the intervention and an increasing trend after the intervention, with statistically significant changes in both the level (p<0.001) and the trend (p=0.02). Secondary hospitals showed a slow increasing trend both before and after the policy implementation, with no significant change in the trend (p=0.205). The proportion of prescriptions, including injections, was over 20% in secondary hospitals and less than 20% in tertiary hospitals, with no significant changes to this indicator observed after implementation of ZMDP.

CONCLUSIONS

The effect of the ZMDP on drug-related expenditures and use in Chinese public hospitals was not substantially evident. Future pharmaceutical reform measures should give more consideration to physician prescription behaviours.

A spatial-temporal statistical analysis of health seasonality: explaining HFMD infections within a children population along the Vietnamese south central coast

Background

Various neglected tropical diseases show spatially changing seasonality at small areas. This phenomenon has received little scientific attention so far. Our study contributes to advancing the understanding of its drivers. This study focuses on the effects of the seasonality of increasing social contacts on the incidence proportions at multiple district level of the childhood hand-foot-mouth disease in Da Nang city, Viet Nam from 2012 to 2016.

Methods

We decomposed the nonstationary time series of the incidence proportions for the nine spatial-temporal (S-T) strata in the study area, where S indicates the spatial and T the temporal stratum. The long-term trends and the seasonality are presented by the Fourier series. To study the effects of the monthly average ambient temperature and the period of preschooling, we developed a spatial-temporal autoregressive model.

Results

Seasonality of childhood hand-foot-mouth disease incidence proportions shows two peaks in all spatial strata annually: large peaks synchronously in April and small ones asynchronously during the preschooling period. The peaks of the average temperature are asynchronous with the seasonal peaks of the childhood hand-foot-mouth disease incidence proportions in the period between January and May, with the negative values of the regression coefficients for all spatial strata, respectively: \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\beta}_{{\mathrm{T}}_11}^{S_1}=-0.18\pm 0.07;{\beta}_{{\mathrm{T}}_11}^{S_2}=-0.25\pm 0.09;{\beta}_{{\mathrm{T}}_11}^{S_3}=-0.14\pm 0.05 $$\end{document}βT11S1=−0.18±0.07;βT11S2=−0.25±0.09;βT11S3=−0.14±0.05. The increasingly cumulative preschooling period and the seasonal component of the incidence proportions are negatively correlated in the period between August and December, with the negative values of the regression coefficients for all temporal strata, respectively: \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\beta}_{{\mathrm{T}}_32}^{S_1}=-0.40\pm 0.01;{\beta}_{{\mathrm{T}}_32}^{S_2}=-0.29\pm 0.00;{\beta}_{{\mathrm{T}}_32}^{S_3}=-0.25\pm 0.01 $$\end{document}βT32S1=−0.40±0.01;βT32S2=−0.29±0.00;βT32S3=−0.25±0.01.

Conclusions

The study shows that social contact amongst children under five years of age is the important driving factor of the dynamics of the childhood hand-foot-mouth disease outbreaks in the study area. The preschooling season when children’s contact with each other increases stimulates the geographical variation of the seasonality of childhood hand-foot-mouth disease infections at small areas in the study area.