ObjectiveTo compare the efficacy and compliance of children children with refractory epilepsy receiving ketogenic diet (KD) in outpatient department with children receiving KD treatment in inpatient department. MethodsA retrospective study of 44 children with intractable epilepsy receiving the modified classical ketogenic diets in outpatient department from June 2014 to December 2015, who were followed-up during the third, sixth and twelfth month. Records of epileptic seizures and adverse reactions were used to evaluate the efficacy and retention rate of inpatient department KD treatment in children with refractory epilepsy, and compared with 104 children receiving KD treatment in inpatient department at the same period. ResultsThirty-four of the forty-four children comleted observation after 12-month follow-up, 15 cases had been seizure freedom, 22 cases had more than 50% reduction in seizure frequency, 12 patients had less than 50% reduction in seizure frequency.The total effective rate of the KD therapy in outpatient department was 64.7%, and the retention rate was 71%. 18 of of the 104 children with KD treatment in inpatient department at the same period comleted observation after 12-month follow-up, 3 cases had been seizure freedom, 5 cases had more than 50% reduction in seizure frequency, 13 cases had less than 50% reduction in seizure frequency.The total effective rate of the KD therapy in inpatient department was 27.8%, and the retention rate was 17.3%. ConclusionThe KD therapy in outpatient department is effective to children with intractable epilepsy, and there is a highly efficacy and compliance of children receiving KD in outpatient department comparing with children receiving KD in inpatient department. Therefore, it's optional to children with refractory epilepsy who can't received KD by inpatient department because of insufficient number of beds.
Objective To investigate constitution and costs of inpatients with circulation system diseases in Karamay Central Hospital in 2014 and provide baseline data for further evidence-based pharmacy studies of circulation system single disease. Methods The information of drug use and expenditure of circulation system diseases were collected from the hospital information system (HIS). We analyzed the data of frequency, constituent ratio and cumulative frequency by using Excel 2007 software. Results A total of 2 898 inpatients with circulation system diseases were included. The top three diseases were cerebral infarction, angina and hypertension. The cerebral infarction and coronary heart disease accounted for the largest proportion in the cost. The top one disease of total hospitalization cost, drug expense per capita and inspection cost per capita was cerebral infraction. Conclusion Based on the above results, cerebral infraction and angina were selected as the evidence-based pharmacy study goal of single disease.
ObjectiveTo describe the status of epilepsy inpatients healthcare service in tertiary public hospitals in China by the data collected from the Hospital Quality Monitoring System.MethodsA population-based study was conducted with data of hospitalized patients collected from the Hospital Quality Monitoring System between 2015 and 2017. Diagnoses were identified by International Statistical Classification of Diseases and Related Health Problems 10th Revision codes for epilepsy (G40). The information of demographic characteristics, costs, payment methods, and discharge status were extracted and analyzed annually to make cross-sectional studies.ResultsA total of 329 241 hospitalized epilepsy patients from 585 tertiary public hospitals were identified. The average age of the patients was 31.74 and male patients accounted for 60.00% of the total. The proportion of patients covered by the national basic medical insurance in the three years was 50.15%, and that in the year 2015, 2016, and 2017 was 49.03%, 49.79%, and 51.80%, respectively; the proportion of patients with full self-payment was 30.40%. The average length of hospital stay was 6.65 d, the average cost for each stay was 7 985.53 yuan, the average self-payed cost for each stay was 3 979.62 yuan. In terms of the discharge way of the patients, 88.02% discharged following doctors’ advice, 0.40% were transferred to another hospital with doctors’ advice, and 6.59% discharged against doctors’ advice. The in-hospital mortality in the three years was 0.16%, and that in the year 2015, 2016, and 2017 was 0.19%, 0.16%, and 0.12%, respectively.ConclusionThe study shows that the in-hospital mortality rate of epilepsy inpatients in the tertiary public hospitals in China decreased gradually from 2015 to 2017, the coverage rate of national basic medical insurance increased year by year, and there is still room for further improvement.
ObjectiveBased on the off-label drug use (OLDU) record application of alprostadil injection (Lipo-PGE1) which was the only one rejected in the Guangdong General Hospital in 2013, we retrospectively investigated all the background information of inpatients' OLDU of Lipo-PGE1 in 2012, so as to provide references for intervention of OLDU and effect evaluation. MethodsAccording to OLDU in dose record application of clinical departments, we summarized medical orders about inpatients' use of Lipo-PGE1 during hospitalization in 2012 and analyzed OLDU situation according to drug labels. Then, we summarized situation of drug use in all departments, analyzed OLDU incidence in dose, calculated prescribed daily dose (PDD) and drug use density (DUD) in each department to evaluate the degree of OLDU in dose. Resultsa) A total of 106 576 medical orders involving 8 620 case-times were analyzed. According to the data of cases, medical orders and drug use amount, the OLDU incidences were 34.43%, 25.16% and 41.37%, respectively. Lipo-PGE1 was used in every clinical department in this hospital and OLDU occurred in 69.44% departments (25/36). b) According to the number of medical orders, there were 6 departments with the OLDU incidence in dose > 50% and 5 departments with the OLDU incidence in dose during 50% to 20%. c) The average of PDD of the whole hospital was 12.77 μg. A total of 25 departments' PDDs were off-label, and 10 departments' PDDs were above the average level of the whole hospital. The ICU's PDD was the highest, with 2.35 times more than label dose. d) The PDD in each department was not directly proportional to DUD, which indicated the degree of OLDU in dose was not directly proportional to use intensity. This may be caused by different disease burdens in departments. ConclusionLipo-PGE1 is widely used in the Guangdong General Hospital where OLDU in dose occurs commonly. Since PDD and DUD reflect different contents, the two indicators should be combined to monitor OLDU.
Objective To investigate the inpatients disease constitution of the Tibet autonomous region people’s hospital, to provide baseline date for further rational drug use analysis. Methods The medical records of inpatients from 2014 to 2015 were collected from hospital information system. Diseases were classified based on international Classification of Diseases Coding (ICD-10). We analyzed the general situation, main discharge diagnosis and single diseases. Distribution of inpatients frequency, constituent ratio, cumulative frequency of diseases were calculated by Microsoft office 2007. Results (1) A total of 19 177 patients were discharged in 2014, sex ratio (male : female) was 1.07 : 1, involving all 21 system disease of ICD-10; 20 970 inpatients were discharged in 2015, the sex ratio was 1.05 : 1, covering 20 system diseases of ICD-10. (2) The constituent ratio of 3 diseases were over 10%: exogenous injury or poisoning, digestive disease and diseases concerning pregnancy, childbirth and puerperium. (3) The constituent ratio of 5 diseases were between 5% to 10%: respiratory diseases, circulatory system disease, the factors influencing health status and health care institutions contact-tumor morphology, genitourinary system disease, and tumor. (4) In 2014, the top of 10 single diseases based on constituent ratio were singletons natural birth, lung infection, chemotherapy, type 2 diabetes, gallstones with chronic cholecystitis, bronchial pneumonia, gall bladder stones, neonatal aspiration pneumonia, high altitude pulmonary edema, premature rupture of membranes; in 2015, the top 10 main single diseases included singletons natural birth, lung infection, tumor chemotherapy, type 2 diabetes, gallstones with chronic cholecystitis, bronchial pneumonia, cholelithiasis, neonatal aspiration pneumonia, cancer maintenance chemotherapy, iron deficiency anemia. Conclusion The inpatients disease composition of the Tibet autonomous region people’s hospital has certain regional specificity.
ObjectiveTo retrospectively analyze off-label drug use (OLDU) situation of ambroxol hydrochloride injection (AHI) among inpatients in the Guangdong General Hospital in 2012, so as to provide references for AHI OLDU. MethodsAll medical orders of AHI for inpatients in the Guangdong General Hospital in 2012 were included, and OLDU was judged according to drug labels. We summarized situation of drug use in all departments, analyzed OLDU incidence in administration path and in dose, calculated prescribed daily dose (PDD) and utilization index (DUI) in each department to evaluate the degree of OLDU in dose. Resultsa) A total of inpatients 138 227 patient-days who used AHI were included. OLDU occurred in all departments in this hospital and the total OLDU incidence was 67.06%. b) OLDU in dose occurred in 71.43% of the departments (25/35) with an incidence of 29.53%; the top 4 departments were cardiac surgery intensive care unit department (CICU) (97.74%), cardiac surgery department (97.51%), pediatric cardiac surgery department (72.30%) and pediatric intensive care unit department (PICU) (70.28%) in order. c) The PDDs in CICU department, cardiac surgery department, PICU departments, pediatric cardiac surgery department, oncological surgery ward, neurosurgery ward and intensive care unit (ICU) were higher than the defined daily dose (DDD), of which, the DUI/cDUI in CICU, cardiac surgery department, PICU and pediatric cardiac surgery department were 1 to 3 times higher than normal level. d) No relevant adverse drug reaction/adverse event (ADR/AE) reports were received in this hospital in 2012. ConclusionAHI is widely used in the Guangdong General Hospital, and AHI OLDU is commonly-seen. Further studies should be conducted to analyze the influence factors of AHI OLDU in dose and to evaluate the rationality of its application.
Objective To provide baseline data for further evidence-based evaluation and selection of essential medicine by analyzing the inpatient disease constitution in 8 pilot township health centers located in eastern, central and western China in 2010. Methods The analysis was performed to compare the similarities and differences of both systematic diseases and top 15 single diseases of inpatients in 8 pilot township health centers located in eastern, central and western China in 2010. The Microsoft Excel 2003 and SPSS 13.0 softwares were used for data classification and analysis, and the frequency and composition were used as describing statistical indicators. Results a) The top 5 systematic diseases were respiratory, digestive, circulatory, urinary tract and urogenital systems, as well as the trauma and toxicosis, with accumulative constituent ratio accounting for 71.0%-81.6%; b) The inpatients suffering from top 15 systematic diseases were 10 630, accounting for 61.10%. Each of the respiratory and digestive system contained 6 single diseases including 4 acute and 2 chronic ones, with inpatients accounting for 99.2% and 93.8%, respectively; the circulatory system contained 3 single diseases which were all chronic with inpatient ratio of 84.6%; and c) The chronic diseases were in majority within the top 15 single diseases, which were most commonly seen rather than acute diseases in the pilot township health centers in eastern and central China. The inpatients’ acute diseases were more often seen than chronic diseases in well-off and fundamental township health centers. Conclusion a) The top 5-6 systematic diseases are stable in the pilot township health centers in eastern, central and western China in 2010. The common single inpatient diseases are centralized, which benefits the selection and adjustment of essential medicine for the pilot township health centers in China; b) The capacity building of the western, fundamental and well-off township health centers to diagnose and treat inpatients suffering acute diseases should be promoted; c) The capacity building of the central and general township health centers to diagnose and manage inpatients suffering chronic diseases should be promoted; d) The capacity building of the eastern and well-off township health centers to provide outpatient service should be promoted. The function of the eastern township health centers needs further clarification and improvement; and e) More attention should be paid to diseases prevention, control and treatment for women, children, the elderly and the population with high burden of diseases.
Objective To investigate drug usage and costs of angina inpatients in Karamay Central Hospital in 2014 and to provide evidence and reference for evidence-based pharmacy study of single disease in circulation system. Methods The information of drug use and expenditure of angina inpatients were collected from the hospital information system (HIS). We analyzed the data including frequency, proportion and cumulative proportion by Excel 2007 software. Results We included 351 angina inpatients in Karamay Central Hospital in 2014 whose average age was 69.44±10.65 years old. Fifty-one kinds of drugs were used for angina therapy. The expenditure of drugs was 122.46 yuan per person. The symptomatic treatment drugs included 11 kinds of drugs. The top 3 usage drugs were isosorbide denigrates, aspirin, nitroglycerin. The secondary prevention medicines included 35 kinds of drugs, and were prescribed for 1 953 times; the anti-hypertensive drugs were most prescribed. The Chinese patent medicine were prescribed for 69 times. The compound Danshen dripping pill was the most prescribed drug. In total expenditure, the cost of clopidogrel, atorvastatin, irofiban ranked top three. Rivaroxaban, tirofiban, low molecular weight heparin were the top 3 drugs for per-time expenditure. Conclusion The top 3 used drugs are isosorbide denigrates, aspirin, nitroglycerin for angina inpatients in Karamay Central Hospital in 2014, while the top 3 total expenditure drugs are clopidogrel, atorvastatin and irofiban.
Object To investigate the constitution and expense of inpatient diseases in Jili Community Health Service Center (JCHSC) in Liuyang City of Hunan Province from 2008 to 2010, so as to provide baseline data for further study. Methods The questionnaire was applied and inpatient records in JCHSC between 2008 and 2010 were collected. The diseases were classified and standardized according to the International Classification of Disease, 10th Edition (ICD-10) based on the first diagnosis extracted from discharge records. Such information as general condition, discharge diagnosis and medical expenses etc. were analyzed by using statistic software of Microsoft Excel 2003 and SPSS 13.0. Results a) There were 9 chronic diseases and 6 acute ones among the top 15 single diseases, and both the average hospital stay and per-average hospitalization expense of chronic diseases were higher than those of acute ones (7.8 days vs. 5.6 days; ?2 733 vs. ?1551); b) Per-average expense of drugs as for both acute and chronic diseases accounted for nearly 50% of the total/general expense; c) There were 3 types of treatment models in JCHSC. Model A was only the internal medicine therapy, Model B was internal medicine assisted with surgery, and Model C was surgery assisted with internal medicine therapy; d) In detail, the total per-average expenses in JCHSC between 2008 to 2010 as for each single disease were as follows: coronary heart diseases (CHD, ?2 374 to ?2 680), urinary calculi (?3 268 to ?3 337), chronic bronchitis (?2 452 to ?2 488); e) Per-average hospitalization expenses in internal departments were ?1 719 to ?1 942 for acute diseases and ?2 386 and ?2 523 for chronic ones. Among surgical departments, the per-average hospitalization expenses as for acute diseases and chronic diseases were ?1 438 to ?1 579 and ?3 044 to ?3 607, respectively; and f) The average hospital stay for acute diseases in internal departments were 5.5 to 5.8 days for acute diseases and 6.9 to 7.3 days for chronic ones. By contrast, those in surgical departments were 5.9 to 6.2 days for acute diseases and 8.3 days for chronic ones, respectively. Conclusion a) In JCHSC, a total of 7 inpatient diseases among the top 15 single diseases in 2010 are all chronic with per-average total expense over ?2 000, which is higher than the average level of national CHSC (?2 357.6); b) According to the features of expense constitution models of the inpatient single diseases, the hospitalization expense should be controlled specifically; c) There are 3 kinds of diseases with yearly-increasing per-average total expenses as CHD, hypertension and pulmonary infection during recent 3 years; meanwhile, 4 diseases are with yearly-decreasing per-average total expenses as chronic bronchitis, cholecystolithias or accompanied with cholecystitis, diabetes and inguinal hernia; d) The per-average expenses of chronic diseases in surgical departments are higher than those in internal departments, but those of the acute diseases in surgical departments are lower. Meanwhile, the per-average total expenses as for both chronic and acute diseases in surgical departments present a decline trend year by year. Although the per-average expense on drugs as for both acute and chronic diseases in internal departments show a decline trend, the per-average total expenses indicate an ascending trend; and f) The average hospital stay of chronic diseases is longer than acute ones, while that of the surgical diseases is also longer than internal ones.
Objective To provide basis to improve the ability of primary care services in Chengdu by comparatively analyzing inpatient medical service of primary medical institutions (community health service centers and township health centers). Methods From October to November 2016, the data of inpatient services in primary medical institutions in Chengdu, including 390 primary medical institutions in 22 districts (cities) and counties, were investigated by questionnaire. SPSS 19.0 was used for data collection and analysis, while the univariate logistic regression and multiple logistic regression were used to analyze the influencing factors. Results It was more common for rural primary medical institutions to carry out inpatient medical services than urban (96.18% vs. 53.84%). The coverage rate of insurance in urban areas was higher than rural areas (98.41% vs. 90.87%), while the rate of adopting clinical pathway of single disease was quite low both in urban areas (23.81%) and rural areas (18.25%). Primary medical institutions in urban areas launched more special projects of inpatient services than those in rural areas (14.29%–17.46% vs. 3.57%–7.54%). The total amount of inpatient medical services in 2015 in rural areas was larger than urban areas (529 611 vs. 103 912), the total number of inpatient services in rural was 5.09 times that in urban primary medical institutions, the average inpatient services in 2015 per one rural primary medical institution was 1.27 times that in urban, per 10 000 residents in rural areas consumed 3.01 times more inpatient medical services than those in urban areas in average, the median beds utilization efficiency in rural areas was better than in urban areas (74.47% vs. 22.47%); work intensity of inpatient medical service in rural areas was greater than in urban areas (234.57 vs. 81.74 cases per year per doctor). The number of inpatient services was positively related to population in service (when less than 100 000 residents), inpatient beds, the number of drugs, the number of medical staff. Conclusions For inpatient medical service, there are obvious differences between urban and rural areas in Chengdu. Therefore, above differences should be taken into full consideration in the allocation of resources in primary medical institutions. Thus more targeted management measures should be formulated.