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To assess the procurement of medicines to treat cancer in China.We conducted a descriptive analysis of the national procurement data for 20 anti-cancer medicines in China from 2015 to 2020. We estimated the number of defined daily doses procured per year in three areas of China for essential medicines and medicines for targeted therapies. We adjusted the data by the number of cancer patients in each region for each year.Between 2015 and 2020, the number of defined daily doses per patient decreased from 40.87 to 35.86 (-12.27%) for essential medicines, while the number increased from 0.85 to 12.52 (1381.15%) for target medicines. The procurement of three out of 10 essential medicines decreased, whereas procurement of all 10 targeted medicines increased. In 2020, the eastern area procured the most essential medicines (44.98 doses per patient) and targeted medicines (16.55 doses per patient), but had the smallest relative change in procurement of both essential medicines (-22.76%) and targeted medicines (978.16%). The central area had the largest increase in procurement of both essential medicines (9.64%; from 25.25 to 27.68 doses per patient) and targeted medicines (4587.81%; from 0.23 to 10.64 doses per patient).Procurement of anti-cancer medicines varied across regions. Specific policies are needed at the national level to eliminate inequalities in access to these medicines. Two issues that need attention are the lower access to many essential anti-cancer medicines in some provinces and the increase in use of targeted medicines.Évaluer l'approvisionnement en médicaments pour traiter le cancer en Chine.Nous avons réalisé une analyse descriptive des données d'approvisionnement nationales pour 20 médicaments contre le cancer en Chine, entre 2015 et 2020. Nous avons estimé le nombre de doses quotidiennes définies achetées chaque année dans trois régions du pays, aussi bien de médicaments essentiels comme de médicaments destinés à des thérapies ciblées. Nous avons ajusté ces données en tenant compte du nombre de patients atteints d'un cancer chaque année dans chacune des régions.Entre 2015 et 2020, le nombre de doses quotidiennes définies par patient a décliné, passant de 40,87 à 35,86 (−12,27%) pour les médicaments essentiels, tandis que ce nombre a augmenté de 0,85 à 12,52 (1381,15%) pour les médicaments ciblés. L'acquisition de trois des dix médicaments essentiels a diminué; en revanche, les dix médicaments ciblés ont tous connu une hausse en matière d'approvisionnement. En 2020, c'est la région orientale qui s'est procuré le plus de médicaments essentiels (44,98 doses par patient) et ciblés (16,55 doses par patient), bien qu'elle affiche la plus petite variation relative dans l'achat de médicaments essentiels (−22,76%) et ciblés (978,16%). La région centrale, elle, a enregistré la plus importante augmentation dans l'acquisition de médicaments essentiels (9,64%; de 25,25 à 27,68 doses par patient) et ciblés (4587,81%; de 0,23 à 10,64 doses par patient).L'approvisionnement en médicaments contre le cancer diffère d'une région à l'autre. Des mesures spécifiques sont nécessaires à l'échelle nationale pour mettre un terme aux inégalités dans l'accès à ces traitements. Deux problèmes en particulier doivent être examinés: l'accès plus limité à de nombreux médicaments essentiels contre le cancer dans certaines provinces, ainsi que l'utilisation accrue de médicaments ciblés.Evaluar la adquisición de medicamentos para tratar el cáncer en China.Se realizó un análisis descriptivo de los datos de adquisición nacional de 20 medicamentos contra el cáncer en China de 2015 a 2020. Se calculó la cantidad de dosis diarias definidas adquiridas por año en tres regiones de China para medicamentos esenciales y medicamentos para tratamientos dirigidos. Asimismo, se ajustaron los datos en función de la cantidad de pacientes con cáncer en cada región para cada año.Entre 2015 y 2020, la cantidad de dosis diarias definidas por paciente disminuyó de 40,87 a 35,86 (-12,27 %) para los medicamentos esenciales, mientras que la cantidad aumentó de 0,85 a 12,52 (1381,15 %) para los medicamentos dirigidos. La adquisición de tres de los 10 medicamentos esenciales disminuyó, mientras que la adquisición de los 10 medicamentos dirigidos aumentó. En 2020, la región oriental adquirió la mayor cantidad de medicamentos esenciales (44,98 dosis por paciente) y de medicamentos dirigidos (16,55 dosis por paciente), pero tuvo el menor cambio relativo en la adquisición tanto de medicamentos esenciales (-22,76 %) como de medicamentos dirigidos (978,16 %). La región central es la que más ha aumentado la compra de medicamentos esenciales (9,64 %, de 25,25 a 27,68 dosis por paciente) y de medicamentos dirigidos (4587,81 %, de 0,23 a 10,64 dosis por paciente).La adquisición de medicamentos contra el cáncer varía según las regiones. Se necesitan políticas específicas a nivel nacional para eliminar las desigualdades en el acceso a estos medicamentos. Dos temas que requieren atención son el menor acceso a muchos medicamentos esenciales contra el cáncer en algunas provincias y el aumento del uso de medicamentos dirigidos.تقييم شراء الأدوية لعلاج السرطان في الصين.قمنا بإجراء تحليل وصفي لبيانات المشتريات الوطنية لعدد 20 دواءً مقاومًا للسرطان في الصين خلال الفترة من 2015 إلى 2020. وقد قدرنا عدد الجرعات اليومية المحددة التي يتم شراؤها كل عام في ثلاث مناطق بالصين للأدوية الأساسية، وأدوية العلاجات المستهدفة. قمنا بتعديل البيانات حسب عدد مرضى السرطان في كل منطقة لكل عام.بين عامي 2015 و2020، انخفض عدد الجرعات اليومية المحددة لكل مريض من 40.87 إلى 35.86 (−%12.27) للأدوية الأساسية، بينما ارتفع العدد من 0.85 إلى 12.52 (%1381.15) للأدوية المستهدفة. انخفض شراء ثلاثة من كل 10 أدوية أساسية، في حين زاد شراء جميع الأدوية الـ 10 المستهدفة. في عام 2020، اشترت المنطقة الشرقية الأدوية الأساسية جداً (44.98 جرعة لكل مريض)، والأدوية المستهدفة (16.55 جرعة لكل مريض)، ولكن كان لها أقل تغيير نسبي في شراء كل من الأدوية الأساسية (%22.76)، والأدوية المستهدفة (%978.16). شهدت المنطقة المركزية أكبر زيادة في شراء كل من الأدوية الأساسية (%9.64؛ من 25.25 إلى 27.68 جرعة لكل مريض)، والأدوية المستهدفة (%4587.81؛ من 0.23 إلى 10.64 جرعة لكل مريض).اختلفت مشتريات الأدوية المكافحة للسرطان عبر المناطق. هناك حاجة إلى سياسات محددة على المستوى الوطني للقضاء على حالات عدم المساواة في الحصول على هذه الأدوية. هناك مسألتان تحتاجان إلى الاهتمام، وهما الحصول المتدني على العديد من الأدوية الأساسية المكافحة للسرطان في بعض المقاطعات، والزيادة في استخدام الأدوية المستهدفة.旨在评估中国癌症治疗药物的采购情况。.我们对中国 2015 年至 2020 年 20 种抗癌药物的国家采购数据进行了描述性分析。我们估计了中国三个地区每年采购的基本药物和靶向治疗药物的日规定剂量。我们根据每个地区每年的癌症患者数量对数据进行了调整。.在 2015 年至 2020 年期间，每名患者服用的基本药物的日规定剂量从 40.87 剂下降到 35.86 剂 (-12.27%)，靶向药物从 0.85 剂增加到 12.52 剂 (1381.15%)。十分之三的基本药物的采购量有所下降，然而，所有 10 种靶向药物的采购量均有所增加。2020 年，东部地区对基本药物（每名患者 44.98 剂）和靶向药物（每名患者 16.55 剂）的采购量最多，但对基本药物 (−22.76%) 和靶向药物 (978.16%) 的采购量的相对变化最小。中部地区对基本药物（9.64%；每名患者从 25.25 剂增加到 27.68 剂）和靶向药物（4587.81%；每名患者从 0.23 剂增加到 10.64 剂）的采购量增福最大。.各地区抗癌药物的采购量存在差异。需要在国家层面制定具体政策，以消除在这些药物的获得性方面的差距。需要注意两个问题，在一些省份，许多基本抗癌药物的获得性较低，并且靶向药物的使用量有所增加。.Оценить закупки препаратов для лечения рака в Китае.В период с 2015 по 2020 год был проведен описательный анализ данных о национальных закупках 20 противораковых препаратов в Китае. Было подсчитано количество установленных суточных доз основных лекарственных средств и лекарственных препаратов для таргетной терапии, закупаемых в год в трех районах Китая. Данные были скорректированы по количеству пациентов с онкологическими заболеваниями в каждом регионе за каждый год.В период с 2015 по 2020 год количество установленных суточных доз на одного пациента снизилось с 40,87 до 35,86 (–12,27%) для основных лекарственных средств, в то время как для лекарственных препаратов для таргетной терапии это количество увеличилось с 0,85 до 12,52 (1381,15%). Закупки трех из 10 основных лекарственных средств снизились, при этом закупки всех 10 препаратов для таргетной терапии увеличились. В 2020 году в восточном регионе было закуплено больше всего основных лекарственных средств (44,98 дозы на пациента) и лекарственных препаратов для таргетной терапии (16,55 дозы на пациента), однако относительное изменение закупок как основных лекарственных средств (–22,76%), так и препаратов для таргетной терапии (978,16%) было наименьшим. В центральном регионе наблюдался наибольший рост закупок как основных лекарственных средств (9,64%; с 25,25 до 27,68 дозы на пациента), так и лекарственных препаратов для таргетной терапии (4587,81%; с 0,23 до 10,64 дозы на пациента).Закупки противораковых препаратов различались по регионам. Для устранения неравенства в доступе к этим лекарственным препаратам необходимы конкретные меры на национальном уровне. Две требующие внимания проблемы – это снижение доступности многих основных противораковых препаратов в некоторых провинциях и увеличение использования препаратов для таргетной терапии.

Compound opioid analgesics (COA) are widely used for cancer pain relief, but few studies investigated the use of that. We aimed to report the characteristics and trend of COA consumption in different regions and health facilities in China. The procurement data of two types of COA, compound codeine phosphate (CCP) and oxycodone and acetaminophen (OAA), in all medical institutions of 20 provinces from 2015 to 2018 were used. Data were presented as Defined Daily Dose for Statistical purpose (SDDD) and expenditures per million inhabitants per day. The annual consumption of COA and ratio of two combinations were compared among regions and institutions. We found, during 2015 - 2018, COA consumption increased at an average rate of 7.32% in SDDD and 19.19% in expenditures, while OAA accounted for most of the consumption. Highest COA consumption appeared in Northern China, with 121.72 SDDD and 1689.87 RMB (2015), whereas the lowest COA consumption was only 11.28 SDDD appearing in Southern China. The ratio of OAA and CCP (in SDDD) was highest in Southern China (53.14 in 2018), whereas lowest in West North (0.37 in 2018). In terms of institutions, tertiary had the highest COA consumption, with 16.74 SDDD and 292.73 RMB (2018). The SDDD of OAA was 27.44 times of that of CCP in tertiary, while it was only 0.11 in primary. Overall, COA consumption is on an upward trend and different among regions and health institutions in either amount or types of COA. These findings call for establishment of COA management regulations.

John Alimamy Kabba,1– 3 Peter Bai James,4,5 Zongjie Li,1– 3 Christian Hanson,6,7 Jie Chang,1– 3 Chenai Kitchen,1– 3 Minghuan Jiang,1– 3 Mingyue Zhao,1– 3 Caijun Yang,1– 3 Yu Fang1– 3 1Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, People’s Republic of China; 2Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, People’s Republic of China; 3Shaanxi Center for Health Reform and Development Research, Xi’an, People’s Republic of China; 4Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; 5Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney 2007, Australia; 6Pharmacy Board, Ministry of Health and Sanitation New England, Freetown, Sierra Leone; 7Pharmacy Department, Well Star Atlanta Medical Centre South, East Point, GA, USACorrespondence: Yu FangDepartment of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, #76 Yanta West Road, Xi’an 710061, People’s Republic of ChinaTel +86 29 82655132Email yufang@mail.xjtu.edu.cnPurpose: Rational use of medicines is a necessary constrict towards increasing access for those that desperately need them in society. In this study, we assess medicines prescribing patterns in healthcare facilities implementing free healthcare policy for pregnant women, lactating mothers and children under the age of five in Sierra Leone.Materials and Methods: Using WHO drug use indicators, we evaluated prescription records from the pharmacies of four hospitals; one from each of the four regions in Sierra Leone. To study prescribing indicators, we systematically sampled 1200 prescriptions overall (300/hospital) retrospectively spanning a year, from June 2017 to July 2018. In evaluating patients care indicators, we randomly sampled 120 (30/hospital) patients encounter prospectively. We used MS Excel 2016 and IMB SPSS in data analysis, and p< 0.05 was considered significant for associational analysis.Results: The average drug per prescription was 3.6 (SD=1.3) overall, 3.5 (1.3) for children under five and 3.4 (1.4) for pregnant women/lactating mothers. Eighty-seven percent of prescriptions for under-five children contains antibiotics as opposed to 68.4% of prescriptions for pregnant women/lactating mothers. More injections were prescribed per encounter for pregnant women/lactating mothers 23.2% than for children under five 18.1%. Overall, generic prescribing and prescribing from the National Essential Medicines List were 74.9% and 73.8%, respectively. None of the studied health facilities dispensed all of the prescribed medicines. The most prescribed pharmacological class of drugs were antibiotics, and paracetamol was the most commonly prescribed drug.Conclusion: Following WHO drug use indicators used in this study, drugs were irrationally prescribed within government hospitals providing free healthcare in Sierra Leone. Sustainability of the free healthcare scheme will require efficient medicine supply and management strategies. Therefore, the formulation of stewardship programs and/or an active Drug and Therapeutics Committee may be necessary to optimise drug use in these hospitals.Keywords: prescribing pattern, rational drug use, drug utilisation, free healthcare, Sierra Leone

Background Recently, legislative shifts in cannabis regulation away from exclusively prohibitionist controls have been seen in sub-Saharan African countries. However, the extent to which public perceptions are aligned with policy trends is unclear. Given that views concerning cannabis may be influenced by associated legislation we aimed to compare public opinion towards cannabis amongst countries with legislatively different cannabis policies. Methods We conducted an online survey of the general adult population in six purposively selected countries representative of maximum policy variation across sub-Saharan Africa i.e., Ghana, Nigeria, Sierra Leone, South Africa and Zimbabwe. Survey questions covered perceptions towards users, risks and benefits, regulations and public health impacts as well as sociodemographic characteristics. Chi square tests were used to analyse the association between categorical variables and explore country level differences. Results Totally 1216 responses were received. Large variations were noted in responses towards user stereotypes, risks and preferred legislation. In relation to users being honest (X2=43.316, P), most in Sierra Leone(52.9%), Nigeria (45.6%) and Uganda(48.6%) disagreed whereas in Ghana(39.4%), South Africa(43.3%) and Zimbabwe(40.1%) most agreed. Differences in smoking cannabis and smoking tobacco products(X2= 27.712, P=0.002) saw respondents from Ghana(51.4%), Nigeria(58.8%), Uganda(50.9%) and Zimbabwe(46.8%) agreeing that smoking cannabis is more harmful to health, whereas majorities in Sierra Leone(45.7%) and South Africa(49.8%) disagreed. Apart from South Africa were the greater proportion opted to allow cannabis for all purposes(28.8%), majorities in other countries supported only medicinal legalisation(X2= 96.631, P). Conclusion Dependent upon the question of focus, at the liberal end of the policy spectrum are Ghana, South Africa and Zimbabwe whilst Nigeria, Sierra Leone and Uganda were more conservative. Responses tended to reflect the policy position of respective countries, however our findings suggest overall increasing medicinal cannabis support. Greater understanding of policy dynamics may help create frameworks for countries contemplating reforms.

ObjectiveThis study aimed to explore pharmacists’ perceptions on drug shortages and its impingement on the Pakistani healthcare system, in particular on patient care.DesignOnline questionnaire survey.Setting and participantsHospital pharmacists from five out of seven regions of Pakistan were approached; including the federal territory (Islamabad) and four provinces (Khyber Pakhtunkhwa, Balochistan, Punjab and Sindh).Primary and secondary outcome measuresPrevalence and type of shortages were identified along with strategies to reduce its effect on patient care.MethodA validated questionnaire was distributed through various online platforms to 800 registered hospital pharmacists. A convenience sampling technique was used to obtain information on drug shortages, the reporting system for shortages, the impact on patients and policy solutions for managing drug shortages.ResultsOut of 800 hospital pharmacists, 708 completed the questionnaire (response rate: 88.5%). Of these hospital pharmacists, 47% came from hospitals of Punjab, 26% from Khyber Pakhtunkhwa, 13% from Sindh, 11% from Balochistan and 4% from Islamabad; 72% and 28% worked in tertiary and secondary hospitals, respectively. The majority (32%) interacted with shortages daily. The top three drug categories reported in shortage were oncology drugs (54%), cardiovascular drugs (53%) and antimicrobials (42%). 58% of the respondents have seen care delayed as a negative consequence of shortages. ‘Creating new communication system’ (65%) and ‘readjust budget plans’ (41%) were the two most frequently indicated recommendations for shortages management at hospital, while ‘circulars or alerts from the regulatory authority’ (60%) and ‘time to time directives from local health statuaries’ (48%) were two most widely suggested policy solutions.ConclusionDrug shortage is a serious concern in Pakistani hospitals, experienced on a daily basis endangering patients’ health. Enhanced communication is required, connecting the key stakeholders. Health policies should be reviewed; adequate funds should be allocated to the health sector preventing future shortages.

Background: Diabetes is among the top ten most prevalent diseases in Pakistan, and the availability of medicines to treat the disease is vital for a great percentage of the country’s population. Insulin was discovered a century ago; however, its access in several parts of the globe remains an issue. This study aims to evaluate prices, availability, and affordability (access components) of insulin and five comparator medicine access in Pakistan.Methods: A nationwide cross-sectional survey was conducted to evaluate the access to insulin and some comparator medicines in eight cities of Pakistan, using a modified WHO/HAI methodology. The survey included 80 medicine outlets, i.e., 40 private pharmacies and 40 public hospitals. Data for every unique insulin product available in the Pakistani market were obtained, including five comparator medicines. Percentage availability, median unit prices (MUPs), and affordability (the number of days’ wages (NDWs) required for a month’s course by the lowest-paid unskilled government worker) of all products were calculated, including originator brands (OBs) and biosimilar (BS) products.Results: Of all insulin products surveyed (n = 320), 87.5% were manufactured by foreign multinational companies (MNCs). None of the insulin products had an ideal availability of 80% in any of the surveyed health facilities. In the public sector, none of the insulin products had an availability of more than 50%. In the public sector, the overall availability of human insulin was 70% (including OB and BS). While in the private sector, the overall availability of human insulin was 90% and that of analog insulin was 62.5%. The analog insulin products were 72.8% costlier than the human insulin products. The median prices of BS insulin were 25.4% lower than the OB products, indicating that almost one-fourth of the cost could be saved by switching to BS human insulin from OB human insulin. All oral anti-diabetic medicines were found to be affordable, whereas none of the insulin was affordable. The NDWs for human and analog insulin were 1.38 and 5.06.Conclusion: In Pakistan, the insulin availability falls short of the WHO’s benchmark of 80%. Insulin continues to be unaffordable in both private and government sectors. To increase insulin access, the government should optimize insulin procurement at all levels, promote local production, enforce biosimilar prescribing, and provide financial subsidies for these products.

In this paper, we deal with a disassembly line balancing problem (DLBP), using an AND/OR graph (AOG) to represent the precedence relations between tasks. The decision maker needs to select a proper processing alternative and assign the corresponding tasks among stations to minimise the number of stations, without violating the cycle time constraint and the precedence relations. The problem was first formulated by Koc et al. (2009) and is denoted as type 1 simple DLBP (SDLBP-1) in this study. We prove that an SDLBP-1 with no parallel tasks is polynomially solvable and develop a branch, bound, and remember (BB&R) algorithm for the general SDLBP-1 with parallel tasks. Moreover, two lower bounding schemes, a strengthened Koc's integer programming (IP) model and a new benchmark instance generation scheme are proposed. Computational results show that the BB&R algorithm is the state-of-the-art exact algorithm for SDLBP-1, and that it can be easily truncated into a state-of-the-art heuristic which optimally solves most instances in very short time. In addition, the lower bounds and the strengthened IP model are also demonstrated to be effective.

With the continuous development and improvement of the level of medical technology in our country in recent years, the treatment of epilepsy has been constantly updated and developed. Nerve electrical stimulation is considered to be a very effective method for treating epilepsy with anxiety and depression. There are many traditional methods for the treatment of epilepsy. For example, vagus nerve stimulation (VNS) has been applied earlier, and the therapeutic effect has been confirmed, but it will cause serious complications and is easier to be uncomfortable; deep brain stimulation for epilepsy is still in the immature stage, and there is no final conclusion. Therefore, this article proposes a clinical study on the treatment of patients with epilepsy with anxiety and depression based on the electronic medical nerve stimulation of the Internet of Things. First of all, this article uses the literature method to study the causes of epilepsy and previous treatment methods. Then, we designed an experimental study of epilepsy with depression based on the Internet of Things electronic medical neuroelectric stimulation therapy and selected the core quality of life questionnaire, SDS, and SAS as observation indicators. Finally, the comparison of epilepsy symptoms and depression and anxiety between the control group and the observation group before and after treatment was analyzed. The results of the experiment showed that, among the 50 subjects in the study, the observation group that used electrical nerve stimulation therapy had 5 people who stopped seizures after treatment, accounting for 10%, while in the control group of traditional drug treatment methods, after treatment, only one person stopped the seizure, accounting for 2%. In addition, the SAS and SDS scores of the observation group were also lower than those of the control group. Therefore, the use of nerve electrical stimulation to treat epilepsy with anxiety and depression symptoms has better performance and can help patients recover as soon as possible.

BackgroundThere is widespread use of quinolones to treat various infectious diseases due to their broad-spectrum nature and optimal pharmacokinetic characteristics. Nevertheless, the risk of bacterial resistance has also amplified as a consequence of their judicial use in hospitals and the community. The current study investigated the consumption and expenditure of quinolone antibiotics during 2015–2018 in various health settings in China.MethodsWe used the China Drug Supply Information Platform (CDSIP) to analyze the drug procurement data of national healthcare institutions, focusing on determining the trend and pattern of quinolone consumption. The standard Anatomical Therapeutic Chemical (ATC)/Defined daily dose (DDD) methodology was opted to quantify antibiotic usage.ResultsA slight decrease in J01M antibiotics consumption (25.7% to 23.5%) was observed over four years (2015–2018). The use of quinolones was significantly higher in rural primary health centers (53.9%) and tertiary hospitals (22.1%). In 2017, levofloxacin (61.4%) was the most commonly consumed quinolone, followed by norfloxacin (27.1%) and moxifloxacin (4.1%). The total spending on J01M antibiotics gradually increased from 21.4% in 2015 to 27.9% in 2018. ConclusionsFrom 2015 to 2018, the general use of J01M antibiotics decreased marginally, but the use of the paternal type of J01M and its expenditure is continuously growing. There is a need to enforce stringent antibiotic management programs to restrict the irrational use of antibiotics.

ObjectiveThe 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.DesignThis was a retrospective observational study of trends in drug expenses and use in the context of the ZMDP using an interrupted time series analysis.SettingTwelve hospitals (three tertiary hospitals and nine secondary hospitals) in Xi’an, which is the capital of Shaanxi Province in Western China.Data and participantsThe prescription information for all outpatients and inpatients in the study hospitals from January 2016 to April 2018 was used in this study.InterventionsThe Chinese government announced the policy intervention measure of the ZMDP, which was implemented in all public hospitals as of 1 April 2017.Primary measuresMonthly 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.ResultsMonthly 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 (pConclusionsThe 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.

ObjectiveTo evaluate the impact of new National Drug Pricing Policy (NDPP) 2018 on access to medicines in terms of prices, availability and affordability.DesignTwo cross-sectional surveys were undertaken before and after the launch of NDPP 2018, using a modified WHO/Health Action International (WHO/HAI) methodology.SettingFour districts of Lahore division, Pakistan.Participants16 public sector hospitals and 16 private sector retail pharmacies.MeasuresThe pre and post survey data on prices and availability of lowest price generics (LPGs) and originator brands (OBs) of 50 medicines were obtained by visiting the same public and private sector health facilities (n=32). Out of 50, 46 surveyed medicines were from the National Essential Medicines List. Inflation-adjusted median unit prices (MUPs) and median price ratios (MPRs) from 2019 were used for price comparison. Affordability was calculated in terms of number of days’ wages required to get a standard treatment by the lowest paid unskilled government worker.ResultsThe overall mean percent availabilities remained poor in both years, that is, far less than 80%. In the public sector, the mean percent availability of OBs improved from 6.8% to 33.1%, whereas, in the case of LPGs, it was reduced from 35.1% to 9%. In the private sector, the mean percent availability of both OBs and LPGs demonstrated slight improvements in 2019, that is, 55.0%–58.3% and 20.3%–32.3%. The adjusted MUPs and MPRs of OBs significantly increased by a median of 4.29% (Wilcoxon test p=0.001, p=0.0001), whereas the adjusted MUPs and MPRs of LPGs increased by a median of 15.7% (p=0.002, p=0.0002). Overall, the affordability of many medicines for common ailments was reduced significantly in 2019.ConclusionsThe availability of medicines slightly improved, except in the case of LPGs, which was reduced in the public sector. The implementation of NDPP 2018 led to increase in drug prices, making the standard treatment for some of the most prevalent ailments unaffordable. So verily, the drug pricing policy must be reviewed to ensure access to essential medicines.

Antimicrobial resistance is one of the most significant challenges of the twenty-first century, and the illegal sale of antimicrobial drugs at community pharmacies is a driver of antimicrobial resistance. This study explores the knowledge, attitudes, and practices (KAP) of pharmacy staff toward antimicrobial stewardship programs (ASPs).We conducted a descriptive cross-sectional study among community pharmacy staff in Northeastern China, from April 1 to 31 May 2019, using a self-administered KAP questionnaire comprising 20 items. The data analysis was carried out by employing Mann-Whitney and Kruskal-Wallis tests.A response rate of 98.5% (394/400) was obtained. The majority of participants (94.9%) demonstrated a good understanding of antimicrobial use, but they lacked an adequate understanding of ASPs. Nearly half of the participants (40.6%) reported that they sold antimicrobials to patients without a prescription. Education level, age, occupation, and experience were all significantly associated (P 0.05) with participants' median ASPs scores. Besides, the presence of a licensed pharmacist (OR 46.327, 95% CI 2.443-878.451, P = 0.011) was the main factor associated with the pharmacy staff's understanding of antimicrobial use policies.The participants' knowledge of antimicrobials was good, and their attitudes regarding ASPs were positive, but their practices regarding ASPs were poor.

In the current outbreak of novel coronavirus (COVID-19), healthcare professionals (HCPs) have a primary role in combating the epidemic threat. HCPs are at high risk of not only contracting the infection but also spreading it unknowingly. It is of utmost importance to evaluate their knowledge, attitudes, and practices (KAP) and the ability to assess the risks associated with the outbreak. A cross-sectional online survey involving physicians, pharmacists, and nurses was conducted. A 39-itemed questionnaire based on the World Health Organization (WHO)COVID-19 risk assessment tool was shared with healthcare professionals in three purposively selected key divisions of Punjab province. Out of 500 healthcare professionals, 385 responded to the survey. The majority (70%) were aged 22&ndash, 29 years, 144 (37.4%) physicians, 113 (29.4%) nurses, and 128 (33.2%) pharmacists completed the survey. Overall, 94.8% of healthcare professionals scored adequately (&gt, 14) for COVID-19-related knowledge, 97.9% displayed an optimistic attitude (&gt, 42) and 94.5% had an adequate practice score (&gt, 28). Kruskal&ndash, Wallis and Jonckheere&ndash, Terpstra tests showed significant differences (p &lt, 0.05) in KAP and risk assessment scores among groups, physicians and nurses scored higher as compared to pharmacists. Further research and follow-up investigations on disaster management and risk assessment can help policy-makers better tackle future epidemics.

Background: Resistance to antibiotics is one of the major global health challenges. An adequate understanding of the public regarding rational antibiotic use is a prerequisite to limit progression in antibiotic resistance. This study aimed to investigate the knowledge, attitude, and practices (KAP) of antibiotics and antibiotic resistance among customers visiting community pharmacies. Methods: This study was undertaken in three capital cities in China during March 2019 and July 2019 by using a questionnaire of 28 items. The questionnaire had four parts, including sociodemographic characteristics, KAP about antibiotics, and antibiotic resistance. A systematic random sampling approach was used to recruit the participants. Kruskal&ndash, Wallis and Mann&ndash, Whitney tests were carried out for data analysis. Results: The response rate was 66.7% (1800/2700). Out of the total, only 9.7% of the customers had good knowledge about antibiotics. Nearly half of the participants were unable to differentiate between antibiotics, and anti-inflammatory drugs (n = 820, 45.6%, Median = 2, IQR = 1). Most of the customers were of the view that the use of over the counter antibiotics in pregnant women is unsafe (n = 1307, 72.6%, Median = 2, IQR = 0). Almost half of the participants disagreed that costly antibiotics are more effective and have fewer side effects (n = 897, 49.9%, Median = 3, IQR = 1). Only 22.3% of participants said that they always finish the course of antibiotic treatment (n = 401, 22.3%, Median = 3, IQR = 1). Conclusion: The knowledge of Chinese pharmacy consumers was inadequate, and a lack of good attitudes and practices in certain aspects of antibiotic use was observed. Educational interventions are needed to increase public knowledge of antibiotics.

Managing medicine shortages consumes ample time of pharmacists worldwide. This study aimed to explore the strategies and resources being utilized by community pharmacists to tackle a typical shortage problem. Qualitative face-to-face interviews were conducted. A total of 31 community pharmacists from three cities (Lahore, Multan, and Dera Ghazi Khan) in Pakistan were sampled, using a purposive approach. All interviews were audio taped, transcribed verbatim, and subjected to thematic analysis. The analysis yielded five broad themes and eighteen subthemes. The themes highlighted (1) the current scenarios of medicine shortages in a community setting, (2) barriers encountered during the shortage management, (3) impacts, (4) corrective actions performed for handling shortages and (4) future interventions. Participants reported that medicine shortages were frequent. Unethical activities such as black marketing, stockpiling, bias distribution and bulk purchasing were the main barriers. With respect to managing shortages, maintaining inventories was the most common proactive approach, while the recommendation of alternative drugs to patients was the most common counteractive approach. Based on the findings, management strategies for current shortages in community pharmacies are insufficient. Shortages would continue unless potential barriers are addressed through proper monitoring of the sale and consumption of drugs, fair distribution, early communication, and collaboration.

Background: Community pharmacies are an integrated part of healthcare systems worldwide. In low and middle income countries like Pakistan, the paradigm of pharmacy practice is shifting from dispensing medicines to clinical activities. There are disparities in these practices according to location. Pharmacies in urban localities are better than those in rural areas. This qualitative study was conducted to explore patients&rsquo, expectations and current practices in rural pharmacies. Methods: A cohort of adult pharmacy visitors (aged &gt, 18 years) that reside in rural community was selected. Consenting participants were recruited by purposive sampling technique until thematic saturation level was achieved. A total of 34 patients were interviewed. Face-to-face interviews were conducted using a semi structured interview guide. All the data were transcribed and used to originate the themes. Results: On analysis, a total of 20 themes were obtained. Sixteen themes pronounced the current provided services. Four themes provided some suggestions for the development of better pharmacies. On call services to provide medicines, limited free extended pharmacy services, interest in patients&rsquo, wellbeing, appropriate referral, vaccination, free medical camp, medical services at home, first aid, and counseling were appreciated by patients. Patients stated that medicines are inappropriately stored in unhygienic conditions, prices of medicines are comparatively high, and medicines are substandard. Unavailability of medicines, inept dispensing, limited staffing with poor knowledge, limited working hours, and quackery promotion are challenges in rural pharmacy practice. Patients say that non marginal pricing, informative services, new legislation, and proper vigilance by officials can improve the pharmacy services in rural communities. Conclusions: Patients alleged that rural pharmacies perform deprived practices. To improve service, new legislation and the proper implementation of existing law is needed.

In this study, we investigated the trends and patterns of antibiotic consumption (macrolides and lincosamides) in China&rsquo, s healthcare institutions from 2015 to 2017. The China Drug Supply Information Platform (CDSIP) was officially launched in 2015. We collected records from this national centralized bidding procurement system between 2015 and 2017. The use of J01F antibiotics (macrolides or lincosamides) was calculated in a defined daily dose per 1000 inhabitants per day (DID).Purchase data from 70,366 national medical facilities included in the CDSIP were collected. The procurement data of 66,007 medical facilities have not changed over 3 years. There is a slight decline in the consumption of J01F antibiotics, which decreased from 3.03 DID in 2015 to 2.91 DID in 2017. Azithromycin (20.6%) was the most commonly used antibiotic in 2017 among all classes, followed by clindamycin (17.9%) and erythromycin (13.7%). Parenteral antibiotics accounted for 32.0% of total antibiotic consumption and 59.6% of total antibiotics expenditure in 2017. The overall consumption of most antibiotics decreased slightly over the 3-yearstudy period. This may be owing to China&prime, s health-related policies in the past few years. A gap still exists in antibiotic use between regions and dosage forms. Further studies are needed to optimize antibiotic prescribing and reduce antibiotic resistance.

The internationalization of markets and increased sophistication of consumers have led to an increase in the variety and uncertainty of products demand. It spurs the wide use of flexible production systems in producers. In this study, we aim to present a flexible mixed-model assembly line with adjacent workforce cross-training policy to account for this issue. With the adjacent cross-training, the skill of each task can be learned by two workers in adjacent stations and then task reallocation is possible when demand varies. Whenever the production volume or product mix changes, the only modification of the line is shifting some tasks to the adjacent stations where the workers can deal with. In this way, the line can achieve quick response to demand variation with high efficiency without additional trainings or great changes (such as: employment or layoff). The problem is formulated and some important properties are characterized. Then, a branch, bound and remember (BB&R) algorithm is developed to solve the problem. The efficiency and effectiveness of the proposed algorithm and this policy are tested on 450 representative instances, which are randomly generated on the basis of 25 well-known benchmark problems. This paper presents a contribution related to a straight-paced MAL with adjacent cross-training to meet the variation in production demand.With adjacent cross-training, tasks can be reallocated to adjacent stations where workers can deal with when demand changes. The assembly line can achieve quick response to the new demand without too many changes.For all the 450 instances, our algorithm can find the optimal solution for 388 instances in 100s, and the gaps between the obtained objective values and the lower bounds are 1.62 for the remaining 62 instances on average.In total, 83 out of the 388 instances use fewer stations with the adjacent cross-training policy than without the policy.

Objective To evaluate price, availability and affordability of insulin products in Shaanxi Province, western China. Methods We used a simplified and adapted WHO/Health Action International method to obtain the availability and prices of insulin products and five oral anti-diabetic medicines as comparators in public general hospitals and private retail outlets. In addition, we investigated the price components of eight selected insulin products by tracing the supply chain. Results All three kinds of insulin products, prandial, basal and premixed insulin, are 100% available in public hospitals, and have fairly high availability in the private sector (62.5-68.8%). The prices of most insulin products were higher than international reference prices in both sectors (ranging from 0.95 times to 2.33 times). All insulin products were unaffordable as they would cost 3.5-17.1 days' wage of the lowest-paid government workers in Shaanxi. The manufacturer's markup (selling price), which comprised more than 60% of the final price of all insulin products surveyed, was the largest price component. Conclusions Although availability of insulin products was high in public general hospitals and private retail pharmacies, their high price made them unaffordable to diabetes patients, especially low-income patients. The government should increase insurance compensation for those who need these life-saving medicines or decrease the cost of insulin products through negotiation with suppliers.

Background: Low knowledge about diabetes risk factors coupled with high disease prevalence is common in low-resource countries. This study evaluated diabetes-related knowledge, attitudes, and practices in the general population in Punjab (Pakistan). Methods: A cross-sectional study was conducted in five districts in Punjab from January to March 2017. Data were collected from 2019 adults aged 18&ndash, 90 years through face-to-face interviews using a semi-structured questionnaire. The total knowledge score ranged from 0&ndash, 9, a score &ge, 6 was considered adequate diabetes awareness. Descriptive statistics, chi-square tests, and linear and binary logistic regression were used for the analyses. Results: Respondents&rsquo, mean age was 32.92 &plusmn, 11.4 years. In total, 85.9% of respondents had heard of diabetes, and 30.1% knew about the glucose tolerance test. We found 2.3% of respondents scored zero for diabetes knowledge, 11.3% scored 9, and 47.4% scored &ge, 6 (adequate awareness). Being female (&beta, = 0.37, 95% confidence interval [CI]: 0.16, 0.05, p = 0.001), socioeconomic status (&beta, = 0.24, 95% CI: 0.12, 0.36, p &lt, 0.001), being diabetic (&beta, = 0.82, 95% CI: 0.53, 1.10, 0.001), and higher education (&beta, = 0.25, 95% CI: 0.17, 0.33, 0.001) were significantly associated with knowledge score. Respondents with high socioeconomic status showed significantly higher positive attitudes compared with those with low socioeconomic status (adjusted odds ratio 1.57, 95% CI: 1.12, 2.24). Only 8.7% (30/343) of those diagnosed with diabetes had never undergone blood glucose screening since diagnosis. Conclusions: Knowledge of diabetes risk factors, management, and care is low in Pakistan&rsquo, s general population. Targeted public education programs should be instigated at a national level to increase understanding of diabetes prevention and treatment.

Background: Diabetes mellitus (DM) has a very high prevalence and poses a huge financial encumbrance on patients. This study aimed to evaluate the cost of diabetes care among patients with type 2 diabetes in private clinics of southern Punjab, Pakistan. Research design and methods: This was a descriptive, cross-sectional, prevalence-based, cost-of-illness (COI) study conducted in six private clinics of southern Punjab from July to September 2016, using a pretested questionnaire. Study participants were recruited using a random selection method. Continuous variables, including direct and indirect costs, were summarized using descriptive statistics. Inferential statistics were also used to analyze the correlation between the variables and cost. Results: The mean annual direct cost per patient with diabetes was estimated to be 332 USD. Medications accounted for the largest share (60.4%) of this cost. Age, locality, high socioeconomic status, and prolonged disease duration were significantly associated with the direct costs of illness (p?0.05). Moreover, 19% of total earnings among very low-income patients were spent on diabetes care. Conclusions: A substantial proportion of patients? income is spent on diabetes care in Punjab. Our findings support the substantial individual and societal burden caused by diabetes. This study was approved by the Ethics Committee for Medical Research of Xi?an Jiaotong University in Shaanxi, China. Permission was obtained from all practitioners in private clinics. Literate patients were asked to sign the consent form approved by the ethics committee. Illiterate patients received clarification about the contents of the written consent form, and a data collector received the patient?s permission to sign the consent form on their behalf. Scopus

OBJECTIVE To investigate the long-term trend of disparity of monthly average out-of-pocket inpatient expenditures (OOP) between areas with different developing levels since the new healthcare reform. METHODS Time series regression was used to assess the trend of disparities of OOP and monthly average inpatient expenditures (AIE) between areas with different developing levels in rural Shaanxi Province, western China. The data of OOP and AIE in primary health institutions, secondary hospitals, tertiary hospitals and also all levels of the hospital were analysed separately covering the period 2011 through to 2014. RESULTS The disparity of AIE at all levels of hospitals was increasing (coefficient = 0.003, P = 0.029), and only the disparity of AIE in secondary hospitals was statistical significant (coefficient = 0.003, P = 0.012) when separately considering different levels of the hospital. The disparity of OOP in all levels of the hospital was increasing (coefficient = 0.007, P = 0.001), and the OOP in primary hospitals contributed most of the disparity (coefficient = 0.019, P = 0.000), followed by OOP in secondary (coefficient = 0.008, P = 0.003) and tertiary hospitals (coefficient = 0.004, P = 0.091). CONCLUSIONS A statistically significant absolute increase in the trend of disparities of OOP and AIE at all levels of hospital was detected after the new healthcare reform in Shaanxi Province, western China. The increase rate of disparity of OOP was bigger than that of AIE. A modified health insurance plan should be proposed to guarantee equity in the future.

Background: Antibiotic resistance is a global threat. Scarce knowledge about safe and appropriate antibiotic use is coupled with frequent self-administration, e.g., in China. This repeated self-medication poses potential risk in terms of antibiotic resistance. Low-resource countries are facing an elevated burden of antibiotic self-medication as compared to developed ones. Thus, this study focused on evaluating the pervasiveness of antibiotic self-medication in 3 universities of Southern Punjab, Pakistan. Methods: We conducted a descriptive cross-sectional survey in three government sector universities of Southern Punjab, Pakistan. The study was carried out with self-administered paper-based questionnaires. Data was analyzed using SPSS version 18.0 (IBM, Chicago, IL, USA). Results: Seven hundred twenty-seven students out of 750 (response rate 97%) with a mean age ± SD of 23.0 ± 3.4 years agreed to participate in the study. The proportion of females was slightly greater (52%) compared with males (48%), and almost one-third of the respondents (36%) were in their 2nd year of university. Out of the total, 58.3% practiced self-medication in the preceding six months, and 326 (45%) confirmed the use of antibiotics. Metronidazole was the most frequently self-medicated antibiotic (48%). Out of the total, 72% demonstrated awareness regarding the side effects of antibiotics. Diarrhea was the well-known adverse effect (38%). Forty-three percent affirmed having antibiotic resistance knowledge, and 30% knew that the irregular use of antibiotics would lead to increased antibiotic resistance. Conclusion: Despite having ample awareness of the adverse antibiotic reactions, self-medication among the university students was high and antibiotic resistance was a fairly unknown term.

Objectives To assess the availability and affordability of oral anti-diabetic medicines in Shaanxi Province, Western China. Methods In 2015, the prices and availability of 8 anti-diabetic medicines covering 31 different dosage forms and strengths were collected in six cities of Shaanxi Province. A total of 72 public hospitals and 72 private pharmacies were sampled, using a modified methodology developed by the World Health Organization (WHO) and Health Action International (HAI). Medicine prices were compared with international reference prices to obtain a median price ratio. For urban residents, affordability was assessed as the lowest-paid unskilled government workers to purchase cost of standard treatment in days’ wages; for rural residents, days’ net income was used. Results The mean availabilities of originator brands (OBs) and generics were 34.3% and 28.7% in public hospitals, and 44.1% and 64.4% in the private pharmacies. OBs and the lowest priced generics (LPGs) were procured at 12.38 and 4.52 times the international reference price in public hospitals, and 10.26 and 2.81 times the international reference prices in private pharmacies. Treatments with OBs were unaffordable even for urban residents. The affordability of the LPGs was good, except for acarbose, repaglinide and pioglitazone. Conclusions Most anti-diabetic medicines cannot met the WHO’s availability target (80% availability) in Shaanxi Province. The high prices of OBs had severely influenced the affordability of medicines, especially for the rural residents. Effective policies should be initiated to ensure the Chinese people a better access to more affordable anti-diabetic medicines.

IntroductionThe irrational use of antibiotics is a major driver of antimicrobial resistance. This study aimed to explore how antibiotics were used in secondary and tertiary hospitals in Shaanxi Province, western China from 2013 to 2015.MethodA retrospective study was conducted with a sample of 16 hospitals in Shaanxi Province (2 tertiary and 14 secondary hospitals; 8 public and 8 private hospitals) using a stratified random sampling method. All of the macro data from these hospitals from 2013 to 2015 were analyzed. All collected data were double-entered and analyzed using Excel 2007.ResultsThe percentage of injectable antibiotic prescriptions was 26.6% of all of the antibiotic prescriptions in the secondary hospitals and 14.2% in the tertiary hospitals. Injectable antibiotic prescriptions in private tertiary hospitals (enter %) were more than two times that of public tertiary hospitals (enter %). In both tertiary and secondary hospitals, the percentage of antibiotic prescriptions for outpatients, emergency patients and inpatients were within the scope of the national standards, while the intensity of antibiotic use was higher than the national standard of 40 DDD/100 bed-days. The prophylactic antibiotic use rate in clean surgery was 40.4% in tertiary hospitals and 60.7% in secondary hospitals, which were both higher than the national standard of 30%. The preventive use rate of antibiotics in private tertiary hospitals (55.00%) was more than two times that of public tertiary hospitals (25.90%), and the rate was also higher in private secondary hospitals (61.50%) than in public secondary hospitals (59.70%).ConclusionsSubstantial antibiotic abuse occurred in the sample Chinese hospitals, especially in secondary hospitals. The government should continue to strengthen the administration of antimicrobial use in hospitals. At the same time, medical professional training and interventions for physicians should be conducted to fundamentally reduce the irrational use of antibiotics.

When demand structure or production technology changes, a mixed-model assembly line (MAL) may have to be reconfigured to improve its efficiency in the new production environment. In this paper, we address the rebalancing problem for a MAL with seasonal demands. The rebalancing problem concerns how to reassign assembly tasks and operators to candidate stations under the constraint of a given cycle time. The objectives are to minimize the number of stations, workload variation at each station for different models, and rebalancing cost. A multi-objective genetic algorithm (moGA) is proposed to solve this problem. The genetic algorithm (GA) uses a partial representation technique, where only a part of the decision information about a candidate solution is expressed in the chromosome and the rest is computed optimally. A non-dominated ranking method is used to evaluate the fitness of each chromosome. A local search procedure is developed to enhance the search ability of moGA. The performance of moGA is tested on 23 reprehensive problems and the obtained results are compared with those by other authors.

Objectives To assess the long-term effects of the introduction of China's zero-markup drug policy on hospitalisation expenditure and hospitalisation expenditures after reimbursement. Methods An interrupted time series was used to evaluate the impact of the zero-markup drug policy on hospitalisation expenditure and hospitalisation expenditure after reimbursement at primary health institutions in Fufeng County of Shaanxi Province, western China. Two regression models were developed. Monthly average hospitalisation expenditure and monthly average hospitalisation expenditure after reimbursement in primary health institutions were analysed covering the period 2009 through to 2013. Results For the monthly average hospitalisation expenditure, the increasing trend was slowed down after the introduction of the zero-markup drug policy (coefficient = −16.49, P = 0.009). For the monthly average hospitalisation expenditure after reimbursement, the increasing trend was slowed down after the introduction of the zero-markup drug policy (coefficient = −10.84, P = 0.064), and a significant decrease in the intercept was noted after the second intervention of changes in reimbursement schemes of the new rural cooperative medical insurance (coefficient = −220.64, P < 0.001). Conclusions A statistically significant absolute decrease in the level or trend of monthly average hospitalisation expenditure and monthly average hospitalisation expenditure after reimbursement was detected after the introduction of the zero-markup drug policy in western China. However, hospitalisation expenditure and hospitalisation expenditure after reimbursement were still increasing. More effective policies are needed to prevent these costs from continuing to rise.

Background In 2009, Chinese government launched a new healthcare reform, one of the key points of which is to establish National Essential Medicine System (NEMS). Hospital pharmacists are directly related to the implementation of NEMS. This study is to examine knowledge of and attitudes towards the implementation of the NEMS among hospital pharmacists in western China. Methods We conducted a questionnaire survey of pharmacists from different types of medical institutions in Shaanxi Province in November 2014. We gathered demographic information about the participants, collected the data about their knowledge of and attitudes towards the implementation of NEMS, and identified the influencing factors of cognitive level. We analyzed the data and compared public secondary/tertiary hospitals and primary healthcare institutions. Results Of the 704 participants (response rate = 70.2 %), the majority had positive and moderate knowledge (39.2 and 53.3 %) and attitudes (35.8 and 62.9 %) towards NEMS. The most participants were aware of the implementation time of NEMS (89.8 %) and zero mark-up policy (85.5 %) while the least learned of the adjustment time of National Essential Medicines List (NEML). Pharmacists from public secondary/tertiary hospitals tended to know more and have more positive attitudes. There was no statistical correlation between knowledge and attitude scores. The education level (p = 0.022) and number of training sessions attended (p = 0.028) were the only demographic variables linked to knowledge scores. Conclusions Hospital pharmacists in Shaanxi Province had moderate knowledge of and attitudes towards the implementation of NEMS. Pharmacists from public secondary/tertiary hospitals showed better understanding. The government should therefore focus on improving the understanding of pharmacists in primary healthcare institutions and also address existing problems, especially the supply and distribution systems.