Alternatives to U.S. drug policy

The current United States drug policy is not succeeding; it neither significantly reduces the supply nor the demand for illicit drugs. This paper and its accompanying table explores alternatives to the current national policy. None of the options discussed offers a panacea to our problems; each has various flaws and advantages. The analysis uses a harm reduction approach, and examines certain variables in order to assess relative costs and benefits of each option. The debate can be reduced to one fundamental question: which policy proposal is politically feasible and can minimize harm while maximizing benefits? Health and public health professional are urged to become more proactive on behalf of a more effective policy.     

药品经济学基本理论指导药房托管之浅见

作为南京市属医院药房托管试点单位,在两年多药房托管工作的实践中,始终坚持＂反腐、惠民、增效＂的宗旨,针对降低药品费用问题,将药品经济学的基本理论作为指导,从药品市场、药品费用、药品价格、药品需求等方面分析,尤其是在药品的采购、流通、使用的环节上不断探索和实践,在控制药品费用的增长、降低老百姓的药品费用方面取得了较好的成效。随着医院药房托管这项工作的不断深入,从经济学的角度对药品市场、药品费用、药品价格、药品需求等方面,研究药品领域的经济现象和经济活动,还有许多问题需要探讨。     

我国农村药品“两网”建设效果研究

目的:探讨我国农村"两网"建设的效果及存在的问题,提出相关建议。方法:文献综述现场调查。结果:我国"两网"建设取得的效果显著,但仍存在供应保障水平较低,运行机制和保障机制不健全等问题。结论:应建立长效机制,增加资金投入,进一步完善药品供应网建设,强化监督网的管理,统筹多部门工作,加强信息化建设。     

The Evolution of Supply and Demand in Markets for Generic Drugs

Policy Points

• Much concern about generic drug markets has emerged in recent policy debates.
• Important changes in regulations, the structure of purchasing, and the length of the drug supply chain have affected generic drug markets.
• Effective price competition remains the rule in generic markets for large‐selling drugs. Smaller markets and those for injectable products often have less price competition and are more susceptible to supply disruptions.

ContextThe image of generic drugs as a commodity sold in competitive markets is an oversimplification, as evidenced by increasing accounts of price spikes, sustained high price‐cost margins, and market disruptions. The mismatch between the canonical economic model of generic drug markets and reality motivated our empirical project.MethodsTo explore recent changes in those factors impacting the supply and demand for generic drugs, we studied, from a variety of sources, the data on price, competition, supply disruptions and recalls, changes to the supply chain, and buy‐side concentration. We examined quarterly data through 2018 for a cohort of 77 molecules that lost patent protection during the so‐called patent cliff between 2010 and 2013.FindingsOn the supply side, we found that for large‐market oral solids, generic entry and price declines were consistent with past studies showing a significant number of market entrants and substantial reductions in the average price of a molecule. In smaller markets for oral solids and injectable products, we observed fewer entrants, higher rates of exit, smaller price reductions, and, in some cases, considerable price instability. The number of reported shortages increased across all generic market types over time, with the rate of shortage increases especially pronounced in markets for injectable products. The number of product recalls also rose over our study period. Although we did not estimate causal effects, we did find several changes in the market environment for generic drugs that may contribute to these phenomena. The demand side for generics has become more concentrated. Supply chains rely more on producers outside the United States (particularly from China and India). Contracting practices have undergone changes that may inhibit competition in product supply. FDA regulatory scruitiny has increased.ConclusionsCompetition in generic drug markets varies widely by market size and product form. Recent changes in demand‐side market structure imply more downward pressure on prices stemming from buy‐side concentration. The FDA''s greater regulatory oversight puts upward pressure on costs, and the lengthening of the supply chain increases production uncertainty for producers. Demand and supply‐side changes point to further market instabilities across all generic markets due to producers’ changing economic position.     

我国药品安全管制的现状分析及对策研究

在分析了我国药品安全管制现状及存在不足的基础上,提出了探索性建议：一是加强药品安全立法,提高管制执行效率;二是完善药品标准体系,加强复查力度;三是建立药品安全信息系统;四是加强部门间、地区间的机构合作。     

1000例老年患者用药合理性分析

目的了解老年患者的用药情况,评判药物使用的合理性。方法应用回顾性病历调查方法对1000例老年住院患者用药进行了分析,共查阅5600余条医嘱。结果1000名患者住院期间使用药物平均为4~15种,最多可达26种;35·2%患者存在不合理用药现象;有8种常见的不合理用药表现,药物相互作用及药物不良反应随用药品种增多而增加。结论老年住院患者存在不合理用药,应加强临床用药的监测,尽量减少用药品种,避免不合理的联合用药,进一步提高老年住院患者的用药水平。     

浅析我国台湾地区药害救济法及制度借鉴

目的 借鉴我国台湾地区的药害救济制度,探索我国大陆的药害救济制度.方法 详细解析我国台湾地区的药害救济法的立法背景、目的以及药害救济法的具体内容.结果与结论 这种制度对于我国大陆医药制度的改革和发展具有一定的借鉴和参照的价值.     

2012-2018年甘肃省药品集中采购情况分析

目的:评价甘肃省药品集中采购政策实施的效果,总结药品集中采购取得的成绩和不足,为甘肃省进一步完善药品集中采购政策提供参考。方法:从甘肃省药品集中招标采购平台上导出2012-2018年药品采购相关统计数据,使用Ex-cel软件进行描述性统计分析。使用指标主要有均数、百分比、集中度等。结果:2012-2018年甘肃省药品集中采购的药物金额总体上逐年增加、药品价格以中低价格为主、市场集中度较低,各级医院基本药物的采购金额大体上呈增加趋势。结论:甘肃省药品集中采购政策总体上实施效果良好,但还应有针对性地规范完善。     

Impact of paracetamol pack size restrictions on poisoning from paracetamol in England and Wales: an observational study

BACKGROUND: About 500 drug poisoning deaths involving paracetamol (acetaminophen) occur every year in England and Wales. To reduce the number of deaths, regulations were introduced in 1998 to restrict the sale of paracetamol. In this paper, we evaluate the impact of these regulations. METHODS: Mortality data for England and Wales were provided by the Office for National Statistics. Deaths were defined as due to compound paracetamol (paracetamol in combination with another analgesic, a low dose opioid or other ingredients) or paracetamol only, with or without alcohol or other drugs. The Department of Health provided data on all hospital admissions with a primary diagnosis of paracetamol poisoning. RESULTS: Mortality rates for paracetamol only were similar for males and females, and decreased from about 4.5 to 2.8 per million between 1997 and 1999 and again from about 3.1 to 2.2 per million between 2001 and 2002. These falls may be attributable to random variation in the rates. Deaths involving compound paracetamol, which were not subject to the 1998 regulations, remained relatively constant over the study period. There was evidence of a decreasing trend in paracetamol only mortality rates and this followed overall trends for other drug poisoning excluding opioids and drugs of misuse. Hospital admissions due to paracetamol poisoning increased from about 27 000 to 33 000 between 1995/1996 and 1997/1998 and then decreased to 25 000 in 2001/2002. There were almost 50 per cent more admissions for females than males, with the highest admission rates amongst females aged 15-24 years old. CONCLUSIONS: Between 1993 and 2002, mortality rates and hospital admissions due to paracetamol poisoning declined. However, the contribution of the 1998 regulations to this decline is not clear. Paracetamol poisoning continues to be an important public health issue in England and Wales and represents significant workload for the NHS in England.     

某高校医院门诊口服抗高血压药物用药分析

目的评价门诊抗高血压药物的使用情况及趋势,为临床合理用药提供依据。方法采用回顾性分析方法,应用限定日剂量、用药频度和日治疗费用等客观指标,对云南大学校医院门诊2010年2012年抗高血压药物使用情况进行统计分析。结果3年内各类抗高血压药物中用药金额最大的是钙拮抗剂（CCB）,其次为血管紧张素Ⅱ受体阻断药（ARB）,2个品种使用金额占总额的80％以上。血管紧张素转换酶抑制剂（ACEI）用药频度有逐年上升趋势。结论该校医院门诊抗高血压药物使用基本合理,符合目前高血压治疗原则。     

Recreational Drug Use Among Primary Care Patients: Implications of a Positive Self-Report

Should recreational drug use raise clinical concern? We examined the association between weekend-only recreational drug use at baseline (yes vs no) and any increase in recreational drug use frequency or severity over 6 months among primary care patients who screen positive for drug use. In the weekend-only recreational drug use group (52/483 [10.8%]), 54% (28/52) started using drugs on weekdays. Compared with use not limited to weekends, weekend-only use was associated with lower odds of increasing drug use frequency (AOR 0.48, P = 0.03) and lower odds (non-significant) of increasing severity (AOR 0.56, P = 0.07). Although weekend-only recreational drug use appears prognostically less severe, the findings nonetheless suggest that continued episodic monitoring may be clinically wise.     

Parental and Peer Influences on the Risk of Adolescent Drug Use

Using a probability sample of 4,230 adolescents from grades 7–12, we used negative binomial regression to estimate the effects of peer and six family variables on the risk of adolescent drug use. Peer drug use had relatively strong effects of adolescent drug use. Parental drug attitudes, sibling drug use, and adult drug use had significant direct effects net of peer influences. In addition, they had significant indirect effects that were mediated by peer drug use. The influences of parental monitoring, attachment to mother, and attachment to father were statistically significant but relatively small. The findings applied to alcohol, binge drinking, cigarettes, marijuana, and other illicit drugs. Editors' Strategic Implications: The authors interpret their findings as being more consistent with social learning than social control theory. This research, although cross-sectional and limited to adolescents' self-reports, contributes to a growing literature on the direct and indirect influences of parents on their teens' substance use rates. It speaks to the need for school- and community-based prevention efforts to focus on families as well as peers.     

农村药品"监督与供应"网络建设评价体系指标的信度分析

目的:为了检验“农村药品监督与供应网络建设评估体系”的可信度。方法:用该评估体系对江西省42个县的农村药品监督与供应网络建设工作进行了评估,根据评估结果用SPSS统计软件计算其Cronbach’sα系数,检验评价指标体系内部一致性可信度(Internal Consistency Reliability)。结果:该评价指标体系总信度α=0.7537,各评价指标的信度在0.5474～0.7452之间,各评价指标的复合相关系数在0.6270～0.9600之间。结论:评价指标体系内部一致性较好,结果表明该评估体系是一个总信度比较好的评估体系。     

药品零差率政策背景下乡镇卫生院药品利润率及利润分析

目的:研究乡镇卫生院药品利润率和利润状况,为政府决策提供参考依据.方法:采用多阶段分层随机抽样方法抽取乡镇卫生院,调查其机构基本情况和药品进货数据.结果:样本乡镇卫生院2008年平均药品利润率为42.55％,平均药品利润为76 791.06元;化学药品利润占总药品利润的比例最高,为78.20％;药品利润率及利润存在地区、医院等级和药品种类间的差异.结论:政府在药品零差率政策实施后应因地制宜地制定补偿政策.     

Direct-to-consumer advertising of pharmaceuticals: developed countries experiences and Turkey

While several major problems concerning drugs occur in the world, the attempts to direct-to-consumer advertising (DTCA) has gained a considerable impetus lately in both developed and developing countries. DTCA has increasingly become an appealing advertising alternative for the pharmaceutical industry as drug companies have come to wrestle with such problems as the expansion of the drug market; the decline of the medical representatives' work efficiency; drug reimbursement restrictions; and the escalating role of the Internet in the consumer market. Some of the main disadvantages of the DTCA are: increasing drug expenditures, unnecessary drug consumption and adverse effect risks. Even though the influence of pharmaceuticals on health services and the economy hold the same importance in the developed and developing countries, its negative consequences have increased by encompassing developing countries in its grip. Therefore, in this review, using Turkey as an example, the situation of direct-to-consumer advertisements in developing countries is analysed in relation with developed countries.     

药品分类补偿的经验借鉴

本文介绍了西欧6国、东欧7国、泰国、澳大利亚药品分类补偿的情况。国外对OTC药品一般不列入医疗保险的药品报销目录范围，患者要承担一定比例的药费，控制药品费用要从价格-补偿-用量控制三管齐下才能奏效。分类给付药品政策的研究为减少社保基金的负担，满足不同用药的需求水平提出了一种新的思路。     

“以药养医”的根源分析与破除对策

通过对“以药养医”的分析认为:医疗服务价格体系不合理是“以药养医”的根源,“药价虚高”和医疗服务价格低于成本必然导致“以药养医”,而要破解“以药养医”就必须同时切断医生账面收入和灰色收入与卖药之间的关系.在此基础上,提出了放开药品定价和招标垄断、根据成本全面调整医疗服务价格、合理确定医务人员收入与社会平均工资倍数关系等3个方面的具体措施.     

121例二线抗结核药品不良反应分析

目的探讨二线抗结核药品药品不良反应(ADR)发生的特点。方法从某院2017年度ADR报告汇总表中选取二线抗结核药品所致ADR患者的病历,对不同性别、年龄的患者ADR发生情况,ADR类型以及患者各种ADR所涉及的器官系统及其主要临床表现、转归数据信息进行统计分析。结果报告的121例二线抗结核药品ADR患者中,男性占比较高(72例,59. 50%),年龄 60岁者居多(70例,57. 85%)。引发ADR的药品剂型主要是注射剂型(80例,66. 12%),主要药品是莫西沙星(38例,31. 40%)和左氧氟沙星(29例,23. 96%)。ADR累及的器官系统以全身性为主(69/128,53. 91%),其次是中枢及外周神经系统(22/128,17. 19%)。严重的ADR患者9例(7. 44%),痊愈和好转的ADR患者118例(97. 52%)。结论使用二线抗结核药品ADR多发生于老年患者,尤其以喹诺酮类药品的全身性损害和中枢及外周神经系统损害为主。在诊治过程中,应及时对高危人群和主要治疗药品进行ADR监测和主动干预,并作出应对处理。