ResearchPad - Health Policy https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Easy to Perform Physical Performance Tests to Identify COPD Patients with Low Physical Activity in Clinical Practice]]> https://www.researchpad.co/product?articleinfo=N7893c44a-0acb-4251-a3a1-e288d8f5fcd5

Background

The study investigates which physical performance or muscle function/mass tests significantly correlate with objectively measured physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) and could potentially serve to identify physically inactive COPD patients in routine clinical practice.

Methods

A cross-sectional, observational study was conducted in outpatients with moderate to very severe COPD. PA was measured during one week with the StepWatch Activity Monitor®, an ankle-worn accelerometer, and expressed in steps per day. Physical fitness and peripheral muscle function/mass were evaluated by the 4-meter gait speed (4MGS) test, the 6-minute walk distance (6MWD), the 30-second chair stand test (30sCST), the timed up and go test (TUGT), handgrip strength, arm muscle area, calf circumference, the fat-free mass index (FFMI), and ultrasound measurement of the quadriceps muscle. Spearman’s rank correlation analysis and ROC analysis were performed.

Results

The study population (N=111, 69% men, mean age 68 years) walked a mean of 8059 steps/day. The daily step count strongly correlated with the 6MWD (rho=0.684, p<0.001) and moderately with the 4MGS (rho=0.464, p<0.001), the TUGT (rho= −0.463, p<0.001), and the 30sCST (rho=0.402, p<0.001). The correlation with the FFMI was weak (rho=0.210, p=0.027), while the other parameters did not significantly correlate with the daily step count. The 6MWD had the best discriminative power to identify patients with very low PA defined as <5000 steps/day (AUC=0.802 [95% CI: 0.720–0.884], p<0.001), followed by the TUGT, the 4MGS, and the 30sCST.

Conclusion

The 6MWD, the 4MGS, the TUGT, and the 30sCST are easy to perform in any clinical setting and may be used by clinicians in the screening of physically inactive COPD patients.

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<![CDATA[Clinical Significance of Bronchodilator Responsiveness Evaluated by Forced Vital Capacity in COPD: SPIROMICS Cohort Analysis [Corrigendum]]]> https://www.researchpad.co/product?articleinfo=Ne6aecc8c-6f9d-4300-bf6a-e574401cd20f ]]> <![CDATA[An Analytical Comparison of Knowledge, Attitudes, and Practices Regarding HIV/AIDS Among Medical and Non-Medical Students in Iran]]> https://www.researchpad.co/product?articleinfo=N7f4ea961-ce5d-4f5c-93ff-7d9409dd85ea

Background and Objectives

Young people are the main group at risk of HIV/AIDS due to factors such as curiosity, peer pressure, lack of knowledge and skills, unsafe sexual behaviors, and drug abuse. The present study was conducted to compare the knowledge, attitudes, and practices regarding HIV/AIDS among medical and non-medical students in Iran.

Methods

This cross-sectional descriptive-analytical study was conducted on a population consisting of the students of Shahid Beheshti University (SBU) and Shahid Beheshti University of Medical Sciences (SBMU). A total of 303 students were randomly selected from the two universities. Data were collected using a researcher-made HIV/AIDS knowledge, attitude, and practice questionnaire. Data were then analyzed using the independent t-test, Mann–Whitney’s U-test, the ANOVA, and the Kruskal–Wallis test in SPSS-18. P<0.05 was set as the level of significance for all the tests.

Findings

The frequencies of marital status, education, smoking, alcohol and psychotropic substance use, employment status, and source of information differed significantly between the medical and non-medical students. There was a significant difference between the two groups regarding knowledge (P<0.001) and practice (P=0.019) regarding HIV/AIDS. Meanwhile, there was no significant difference between the two groups in terms of their attitude toward HIV/AIDS (P=0.503). The results of the ANOVA revealed a significant correlation between marital status and practice (P=0.022), education and attitude (P=0.004), and smoking and knowledge (P=0.008) among the medical students. Meanwhile, there was no significant difference between the demographic variables and knowledge, attitudes and practices regarding HIV/AIDS among the non-medical students (P>0.005).

Conclusion

The present findings showed that designing and developing appropriate educational programs, offered through group media, scientific seminars, courses, lectures, and group discussions, can be effective in enhancing the students’ knowledge and changing their attitudes and should be incorporated into healthcare programs.

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<![CDATA[Management of L-Dopa Overdose in the Competitive Inhibition State [Expression of Concern]]]> https://www.researchpad.co/product?articleinfo=N3ccfecd6-2be6-4f71-a47a-120a83aa9129 ]]> <![CDATA[Security Risk Assessment of Healthcare Web Application Through Adaptive Neuro-Fuzzy Inference System: A Design Perspective]]> https://www.researchpad.co/product?articleinfo=N7e2a13fb-b843-4d08-b0de-fcd2ba5c0784

Introduction

The imperative need for ensuring optimal security of healthcare web applications cannot be overstated. Security practitioners are consistently working at improvising on techniques to maximise security along with the longevity of healthcare web applications. In this league, it has been observed that assessment of security risks through soft computing techniques during the development of web application can enhance the security of healthcare web applications to a great extent.

Methods

This study proposes the identification of security risks and their assessment during the development of the web application through adaptive neuro-fuzzy inference system (ANFIS). In this article, firstly, the security risk factors involved during healthcare web application development have been identified. Thereafter, these security risks have been evaluated by using the ANFIS technique. This research also proposes a fuzzy regression model.

Results

The results have been compared with those of ANFIS, and the ANFIS model is found to be more acceptable for the estimation of security risks during the healthcare web application development.

Conclusion

The proposed approach can be applied by the healthcare web application developers and experts to avoid the security risk factors during healthcare web application development for enhancing the healthcare data security.

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<![CDATA[Comparison of Characteristics Between ICS-Treated COPD Patients and ICS-Treated COPD Patients with Concomitant Asthma: A Study in Primary Care]]> https://www.researchpad.co/product?articleinfo=Nadf11f1f-3b1e-4775-ab93-d3de2ac444ea

Background and Objective

Inhaled corticosteroids (ICS) for COPD has been much debated. Our aim was to identify characteristics associated with prescribing ICS for patients with COPD alone compared to those with concomitant asthma in general practice.

Patients and Methods

Participating general practitioners (GPs) (n=144) recruited patients with COPD (ICPC 2nd ed. code R95) currently prescribed ICS (ACT code R03AK and R03BA). Data, if available, on demographics, smoking habits, spirometry, COPD medication, dyspnea score, and exacerbation history were retrieved from the medical records. Logistic regression analysis was used to identify possible differences in characteristics between patients with COPD alone compared to those having a concomitant diagnosis of asthma.

Results

A total of 2.289 (45% males) COPD patients on ICS were recruited. Compared to patients with COPD alone (n=1.749), those with COPD and concomitant asthma (n=540) were younger (p<0.001), had higher BMI, higher FEV1/FVC ratio, higher blood eosinophil count and less life-time tobacco exposure (36 and 26 pack-years, respectively). Compared to COPD alone, logistic regression analysis showed that COPD with concomitant asthma was significantly associated to age (OR 0.94; CI 0.92 to 0.97; p<0.001), pack-years of smoking (OR 0.98; CI 0.97 to 0.99; p<0.001), [TeX:] \documentclass[12pt]{minimal} \usepackage{wasysym} \usepackage[substack]{amsmath} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage[mathscr]{eucal} \usepackage{mathrsfs} \DeclareFontFamily{T1}{linotext}{} \DeclareFontShape{T1}{linotext}{m}{n} {linotext }{} \DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} \DeclareSymbolFontAlphabet{\mathLINOTEXT}{linotext} \begin{document} $${\rm{FE}}{{\rm{V}}_1}$$ \end{document}%pred (OR 1.02; CI 1.00 to 1.03; p=0.005), and doctor-diagnosed depression (OR 2.59; CI 1.20 to 5.58; p=0.015).

Conclusion

In COPD patients currently prescribed ICS, the presence of concomitant asthma was associated with being younger, having less tobacco exposure, more preserved lung function and a higher likelihood of doctor-diagnosed depression compared to COPD alone.

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<![CDATA[Health and long-term care of the elderly with dementia in rural Thailand: a cross-sectional survey through their caregivers]]> https://www.researchpad.co/product?articleinfo=N7ad3f43e-59ee-4bfd-9cd5-7773ee429fed

Objective

To describe the circumstances of the elderly with dementia and their caregivers’ characteristics in order to examine factors related to activities of daily living (ADL) and household income to propose a long-term care policy for rural areas of Thailand.

Setting

A cross-sectional study at the household level in three rural regions of Thailand where there were initiatives relating to community care for people with dementia.

Participants

Caregivers of 140 people with dementia were recruited for the study.

Primary and secondary outcome measures

Socioeconomic characteristics including data from assessment of ADL and instrumental ADL and the Thai version of Resource Utilisation in Dementia were collected. Descriptive statistics were used to explain the characteristics of the elderly with dementia and the caregivers while inferential statistics were used to examine the associations between different factors of elderly patients with dementia with their dependency level and household socioeconomic status.

Results

Eighty-six per cent of the dementia caregivers were household informal caregivers as half of them also had to work outside the home. Half of the primary caregivers had no support and no minor caregivers. The elderly with dementia with high dependency levels were found to have a significant association with age, dementia severity, chance of hospitalisation and number of hospitalisations. Though most of these rural samples had low household incomes, the patients in the lower-income households had significantly lower dementia severity, but, with the health benefit coverage had significantly higher chances of hospitalisation.

Conclusion

As the informal caregivers are the principal human resources for dementia care and services in rural area, policymakers should consider informal care for the Thai elderly with dementia and promote it as the dominant pattern of dementia care in Thailand.

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<![CDATA[Prevalence of occupational exposure and its influence on job satisfaction among Chinese healthcare workers: a large-sample, cross-sectional study]]> https://www.researchpad.co/product?articleinfo=N9c79913e-f6c5-418a-8f8e-664736c60c1c

Objectives

This study had three objectives: (1) describe the prevalence of occupational exposure among Chinese medical personnel in detail, (2) verify the partial mediating role of work environment satisfaction in the relationship between occupational exposure and job satisfaction, and (3) examine if stress symptoms moderate the relationship between occupational exposure and job satisfaction.

Design

A large cross-sectional online survey was conducted in July 2018 in China.

Setting

A survey was conducted in 54 cities across 14 provinces of China.

Participants

A total of 12 784 questionnaires were distributed, and 9924 healthcare workers (HCWs) completed valid questionnaires. The response rate was 77.63%.

Outcome measures

A confidential questionnaire was distributed to HCWs. The relationships among and the mechanisms of the variables were explored using descriptive statistical analyses, Pearson’s correlation coefficient and multiple linear regression analysis.

Results

The most common occupational exposures among HCWs in the past 12 months were psychosocial and organisational hazards (85.93%). Overall, physicians (93.7%) and nurses (89.2%) were the main victims of occupational exposure. Occupational exposure correlated negatively with work environment satisfaction and job satisfaction, and positively with stress symptoms. Moreover, work environment satisfaction fully mediated the relationship between occupational exposure and job satisfaction, and stress symptoms moderated the relationship between occupational exposure and job satisfaction.

Conclusion

The incidence of occupational exposure among HCWs is generally high. The high frequency of psychosocial and organisational hazards among physicians and nurses should be taken seriously and dealt with in a timely manner by hospital managers. The negative impact of occupational exposure on job satisfaction must be buffered by measures to reduce stress symptoms and enhance working environment satisfaction, ultimately improving the overall quality of life of HCWs and promoting comprehensive development of the medical team.

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<![CDATA[Concordance Between Electronic Health Record Data and Medicare Part D Claims Data for Oral Anticancer Drug Use]]> https://www.researchpad.co/product?articleinfo=N1471ba53-b3db-456b-a586-1aa1e4fa1a49

This cross-sectional study determines the concordance between electronic health record and Medicare Part D claims data for the receipt of oral anticancer agents.

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<![CDATA[State Policies on Access to Vaccination Services for Low-Income Adults]]> https://www.researchpad.co/product?articleinfo=Nf0e30db4-9107-4c99-90fa-82603b08d627

Key Points

Question

What level of access to vaccination services do Medicaid programs provide to adult beneficiaries enrolled in fee-for-service and managed care organization arrangements?

Findings

In this survey study of Medicaid programs, 22 of 51 programs covered all 13 adult vaccines recommended by the Advisory Committee on Immunization Practices for both fee-for-service and managed care organization enrollees. Reimbursement for vaccine administration was disparate; median vaccine purchase reimbursement was highly variable relative to manufacturer-reported private sector price.

Meaning

These findings suggest that most adult Medicaid beneficiaries do not have access to all 13 Advisory Committee on Immunization Practices–recommended adult vaccines; low reimbursement for vaccine administration and purchase may disincentivize health care professionals to vaccinate low-income adults.

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<![CDATA[Assessment of Expected Out-of-Pocket Spending for Rheumatoid Arthritis Biologics Among Patients Enrolled in Medicare Part D, 2010-2019]]> https://www.researchpad.co/product?articleinfo=N2cb4f709-b4f0-4862-8a23-b81d582f6810

Key Points

Question

Was the closure of the coverage gap in Medicare Part D from 2010 to 2019 associated with decreased annual out-of-pocket costs for specialty rheumatoid arthritis drugs?

Findings

In this cross-sectional study of 17 drug and strength combinations, projected annual mean out-of-pocket costs for rheumatoid arthritis treatments decreased 34% between 2010 and 2011 as the coverage gap began closing. By 2019, out-of-pocket spending was 21% lower than in 2010, suggesting that list price increases outpaced savings in subsequent years.

Meaning

Although the projected annual out-of-pocket cost of many rheumatoid arthritis biologics was lower in 2019 than it was before the coverage gap closed, much of the cost savings of closing the gap was already lost to yearly price increases.

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<![CDATA[Regional Variation in Rates of Total Knee Arthroplasty Among Medicare Beneficiaries]]> https://www.researchpad.co/product?articleinfo=Nfb494549-3b39-40d6-ba07-19690a5fe714

Key Points

Question

How variable are rates of total knee arthroplasty across the United States after accounting for the prevalence of knee arthritis and other patient risk factors?

Findings

In this cohort study of more than 24 million Medicare beneficiaries annually from 2011 to 2015, observed to expected ratios for total knee arthroplasty ranged from 0.61 in Newark, New Jersey, to 1.82 in Idaho Falls, Idaho, suggesting areas of relative underuse and overuse. Regions with higher than expected rates were also associated with high rates among patients having relative contraindications to knee arthroplasty.

Meaning

Decision-making thresholds for performing total knee arthroplasty appear to differ across the US in a pattern suggesting overuse in some regions.

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<![CDATA[Assessment of Completeness of Hospital Readmission Rates Reported in Medicare Advantage Contracts’ Healthcare Effectiveness Data and Information Set]]> https://www.researchpad.co/product?articleinfo=Nf2980fa8-aa8a-425a-b839-cf07d21eda88

This cross-sectional study evaluates the agreement between readmission rates reported by Medicare Advantage contracts and readmission rates calculated from their encounter data in the Healthcare Effectiveness Data and Information Set (HEDIS).

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<![CDATA[State Regulations Governing Firearms in Early Care and Education Settings in the US]]> https://www.researchpad.co/product?articleinfo=Nab89942a-0b75-4d88-8833-991dda7497ea

This cross-sectional study documents existing US state regulations governing the presence and storage of firearms in early care and education settings and the extent to which these regulations align with national standards.

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<![CDATA[Assessment of Clinical Trials Supporting US Food and Drug Administration Approval of Novel Therapeutic Agents, 1995-2017]]> https://www.researchpad.co/product?articleinfo=Ne166da18-4478-4a2c-902c-cbbf1916dd10

Key Points

Question

Have the number and characteristics of pivotal efficacy trials supporting US Food and Drug Administration approval of new drugs and biologics changed during the past 3 decades?

Findings

In this cross-sectional study of 273 new drugs and biologics approved by the Food and Drug Administration for 339 indications in 3 periods (1995-1997, 2005-2007, and 2015-2017), more recent approvals increasingly used special regulatory programs and were based on fewer pivotal trials. When aggregated by indication, these trials had less rigorous designs but longer trial durations over time.

Meaning

This study found changes in the evidence supporting Food and Drug Administration approval of new drugs and biologics that suggest an ongoing need for continued evaluation of therapeutic safety and efficacy after approval.

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<![CDATA[Population-Based Estimates of Health Care Utilization and Expenditures by Adults During the Last 2 Years of Life in Canada’s Single-Payer Health System]]> https://www.researchpad.co/product?articleinfo=N2a6d0a04-e49f-4a68-9e54-c48bb8991024

Key Points

Question

What are the population-level trends in health care utilization and expenditures in the 2 years before death among adults in Ontario, Canada?

Findings

This cohort study found that health care expenditures in the last 2 years of life increased in Ontario from CAD$5.12 billion in 2005 to CAD$7.84 billion in 2015, and the intensity of health care utilization and deaths in hospital varied by resource utilization gradients.

Meaning

In this study, the observed trends demonstrated that costs and hospital-centered care before death are high in Ontario.

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<![CDATA[Factors associated with professional confidence in Japanese public health nurses: A cross‐sectional survey]]> https://www.researchpad.co/product?articleinfo=Ndad67b08-f2bc-4756-9646-a6c4293c5532

Abstract

Objectives

To clarify factors associated with professional confidence in Japanese public health nurses (PHNs) and to examine the relationship between professional confidence and professional competency.

Design

A cross‐sectional study.

Sample

Public health nurses (N = 1,512) working in local government agencies.

Measurements

An anonymous, self‐administered questionnaire with questions on demographic characteristics (sex, age, experience as a PHN, educational background, affiliation, and position) and 34 items on professional confidence developed by the researchers based on a literature review was administered. Factors associated with the professional confidence were extracted through an exploratory factor analysis, and construct validity of the confidence was verified through a confirmatory factor analysis.

Results

In total, 883 responses (response rate, 58.4%) were received; only 467 (30.9%) of them were valid. On the basis of the exploratory factor analysis results, professional confidence included 17 items, with the following four factors: “technical practice,” “effortful learning,” “exploring the evidence,” and “educators in workplace.” The goodness‐of‐fit model in the confirmatory factor analysis proved the construct validity of professional confidence.

Conclusions

Professional confidence was gained by self‐improvement that reflects on public health practice. Professional confidence underpinned the generalist level of professional competency among PHNs.

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<![CDATA[Association of a Lay Health Worker Intervention With Symptom Burden, Survival, Health Care Use, and Total Costs Among Medicare Enrollees With Cancer]]> https://www.researchpad.co/product?articleinfo=Nf8e6f990-a29e-4509-9958-1df2dc167e41

Key Points

Question

Is a lay health worker–led screening and referral intervention associated with patient symptom burden, acute care use, and total costs of care?

Findings

In this multisite quality improvement study of 425 Medicare Advantage enrollees with a diagnosis of cancer who were provided usual cancer care augmented by a lay health worker trained to proactively screen patient symptoms, discuss symptoms with a physician assistant, and refer patients with uncontrolled symptoms to palliative care and behavioral medicine compared with 407 control patients diagnosed and treated in the year prior, patients in the intervention group were associated with significant reductions in symptom burden over time, and patients in the control group were associated with worsening symptoms over time. Patients who received the intervention were associated with fewer inpatient and emergency department visits and lower median total costs, and there were no differences in survival.

Meaning

The findings suggest that a lay health worker–led symptom screening and proactive referral intervention may improve value-based cancer care.

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<![CDATA[Legislative landscape for traditional health practitioners in Southern African development community countries: a scoping review]]> https://www.researchpad.co/product?articleinfo=Nf132c0bc-5a39-4c7c-9bd4-b953efb850da

Background and objectives

Globally, contemporary legislation surrounding traditional health practitioners (THPs) is limited. This is also true for the member states of the Southern African Development Community (SADC). The main aim of this study is to map and review THP-related legislation among SADC countries. In order to limit the scope of the review, the emphasis is on defining THPs in terms of legal documents.

Methods

This scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews methods. Two independent reviewers reviewed applicable legal definitions of THPs by searching the Southern African Legal Information Institute (SAFLII) database in April 2018 for legislation and bills. To identify additional legislation applicable in countries not listed on SAFLII and/or further relevant SADC legislation, the search engines, Google and PubMed, were used in August 2018 and results were reviewed by two independent reviewers. Full texts of available policy and legal documents were screened to identify policies and legislation relating to the regulation of THPs. Legislation was deemed relevant if it was a draft of or promulgated legislation relating to THPs.

Results

Four of 14 Southern African countries have legislation relating to THPs. Three countries, namely South Africa, Namibia and Zimbabwe, have acknowledged the roles and importance of THPs in healthcare delivery by creating a council to register and formalise practices, although they have not operationalised nor registered and defined THPs. In contrast, Tanzania has established a definition couched in terms that acknowledge the context-specific and situational knowledge of THPs, while also outlining methods and the importance of local recognition. Tanzanian legislation; thus, provides a definition of THP that specifically operationalises THPs, whereas legislation in South Africa, Namibia and Zimbabwe allocates the power to a council to decide or recognise who a THP is; this council can prescribe procedures to be followed for the registration of a THP.

Conclusions

This review highlights the differences and similarities between the various policies and legislation pertaining to THPs in SADC countries. Legislation regarding THPs is available in four of the 14 SADC countries. While South Africa, Tanzania, Namibia and Zimbabwe have legislation that provides guidance as to THP recognition, registration and practices, THPs continue to be loosely defined in most of these countries. Not having an exact definition for THPs may hamper the promotion and inclusion of THPs in national health systems, but it may also be something that is unavoidable given the tensions between lived practices and rigid legalistic frameworks.

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<![CDATA[Differences in reimbursement listing of anticancer therapies in China: an observational study]]> https://www.researchpad.co/product?articleinfo=N50f56119-91e5-478a-96a7-3705d790b06e

Objective

Access to highly priced anticancer medications usually requires insurance coverage. A first step towards coverage of such medications is their inclusion in reimbursement lists. We assessed listing for reimbursement in China between 2009 and 2018 of anticancer medications on the WHO’s Essential Medicines List.

Setting and study design

Using publicly available data, we assessed which anticancer medications listed in the 20th WHO Model List of Essential Medicines (EML) were included in China’s National Reimbursement Drug List (NRDL). For five targeted anticancer medications on the WHO EML, we also assessed inclusion in the 31 Chinese Provincial Reimbursement Drug Lists (PRDLs). Logistic regression was used to test whether inclusion of targeted anticancer medications was associated with provincial economic levels.

Primary outcome measures

Inclusion of five targeted anticancer medications in the NRDL and PRDLs before and after 2017.

Results

The 2017 NRDL included all anticancer medications on the WHO EML (except for one not approved in China at the time), and by 2018, all 31 PRDLs listed the targeted anticancer medications except for nilotinib; four provinces had covered all five targeted medications before the 2017 NRDL coverage mandate. Provincial economic level and regional incidence of specific cancers seemed unrelated to the inclusion of five targeted anticancer medications in PRDLs.

Conclusion

Our findings suggest that by including medications in the national and provincial reimbursement lists, China has taken an important first step in promoting access to targeted anticancer medications. Further research is needed to determine whether inclusion in PRDLs improved the availability, appropriate use and affordability of highly priced targeted anticancer medications in China.

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