ABSTRACT
OBJECTIVE:To examine the influence of key monitoring drugs policy in Anhui province and Sichuan province on the change of adjuvant drugs for promoting its rational use and providing a basis for policy formulation. METHODS: Based on the key monitoring drug libraries formed in the monitoring catalogs of all the provinces, combining with the key monitoring drug catalogs in Anhui province and Sichuan province, this study selected the characteristics of drug-typicality and data availability through the selection of adjuvant drug selection criteria. Eight drugs of Anhui province and 10 drug of Sichuan province were selected as research objects. The study extracted monthly data from 3 hospitals in Anhui province from November 2014 to September 2017 and quarterly data from 9 hospitals in Chengdu, Sichuan province in the first quarter of 2014 to the first quarter of 2017. Interrupted Time Series (ITS) model was used to analyze the changes of dosage and amount of sample drugs and reference drugs. RESULTS: ①After the implementation of the key monitoring drugs policy in Anhui province in November 2015, the usage trend of adjuvant drugs changed from rising to declining, with a significant decrease in the dosage (β3=-0.035, P0.1) and the amount of money (β3=-0.001, P>0.1). ③After the implementation of the key monitoring drugs policy in the first quarter of 2016 in Sichuan Province, the declining trend of the use of adjuvant drugs was widened with a decrease of the dosage (β3=-0.045, P<0.001) and the amount (β3=-0.037,P<0.001). CONCLUSION: The implementation of key monitoring drugs policy in Anhui province and Sichuan province can effectively control the use of most adjuvant drugs, with a significantly decrease of the dosage and amount.
ABSTRACT
Objective To observe the current status of secondary prevention medication usage and their relation with on-treatment platelet reactivity in patients with Acute Coronary Syndrome(ACS) treated with aspirin and clopidogrel. Methods A total of 176 patients hospitalized from 2014 to 2015 due to ACS in the Department of Cardiology, Peking University People's Hospital were enrolled and on-treatment platelet reactivity was tested by thromboelastography(TEG)and CYP2C19*2,*3 and*17 alleles were analysed. Details of secondary prevention medication and patients' clinical characteristics were recorded. The relation of secondary prevention medication and on-treatment platelet reactivity was analyzed by multi-logistic regression after adjusting for CYP2C19 alleles and clinical characteristics covariates.Results A 94.89% of patients was treated with statins while 80.68% with beta blocker. The platelet inhibition rate were (45.33±28.78)% and the high on-treatment platelet reactivity (HTPR) rate tested by TEG was 37.50%. In the multivariate logistic regression analysis, usage of β-blockers during hospitalization as well as phenotypes of CYP2C19*2,*3 and *17,clinical presentation with ST-segment elevation myocardial infarction and the length of stents were associated with HTPR defi ned by TEG. The percentage of HTPR rate was signifi cantly lower in patients treated with than those without β-blockers (72.73% vs. 85.45%,OR 0.18,95%CI 0.06-0.53,P=0.002)after adjusting genetic factors and other covariates.Conclusions There was a signifi cant correlation between beta blockers usage and high clopidogrel on-treatment platelet reactivity.