Research Of Transparency Measurement On Medicine Use Information In Primary Health Care Facilities

[Background] Medicine use regulation is inadequate in primary health care facilities. Transparency is one method of regulation. Transparency on medicine use information could not only solve the problem of asymmetric information, but also promote the medicine use quality through accountability and competition. Researches about transparency measure on medicine use information were very few. To promote transparency regulation on medicine use in primary health care facilities, it is necessary to develop a scale on transparency measurement of medicine use information in primary health care facilities.[Objective] This study developed a scale on transparency measurement of medicine use information in primary health care facilities, and evaluated the transparency level of medicine use information in primary health care facilities, and also explored the relationship between transparency and rational use of medicines.[Methods] The relevant transparency literatures were searched in data bases such as Springer, Elsevier, Sage and Google scholarship, and37foreign literatures were reviewed. Important connotations about transparency definition were refined, and the logic relationship was indentified. Thus the definition and conceptual framework of transparency was formed. Base on the literature review and expert consultation, the dimensions and items of scale was determined, and the initial instrument was developed. Then, the scale was modified based on a pilot survey with10primary health care facilities in Wuhan. According to the results of survey and expert advice, the secondary initial scale was formed.The scale was used to investigate100township hospitals in eastern, central and western regions, including Hainan, Shandong, Hebei, Hubei, Henan, Anhui, Guiyang, Chengdu, and Chongqing. The public information on medicine use was observed. The transparency was scored by multiple raters. Correlation coefficient analysis, Cronbach’s coefficient, and exploratory factor analysis were used to select items. Five dimensions and20items were selected for the final scale. Cronbach’s coefficient, split-half reliability and rater reliability were used to evaluate the reliability of the formal scale. Factor analysis was used for construct validity evaluation.Formal scale was used to investigate the transparency of100township hospitals. ANOVA, t-test, and rank-sum test were use to compare transparency of facilities in different regions and categories. Outpatients’prescriptions on the current month were randomly sampled, with120prescriptions sampled for every township hospital, and totally12,000prescriptions were taken. The rational medicine use indexes, including average number of medicines per encounter, percentage of encounters with an antibiotic prescribed, percentage of encounters with an injection prescribed, percentage of medicines prescribed from essential medicines list, average medicine cost per encounter. Comprehensive index method was used to synthetically evaluate the rational medicine use. Partial correlation coefficient was used to analyze the relationship between transparency and the rational medicine use.Excel was used for data entry and reduction. SPSS12.0was used for data analysis.[Results]1. We developed a scale to measure transparency of medicine use information in primary health care facilities. Five dimensions was measured, including service processes, organization and regulation for pharmacy administration, patients informing and education, medicine catalogue, the economic burden of patients. The completeness, clarity, understandability, availability, and timeliness of information were measured in every dimension. The instrument had good reliability since overall Cronbach coefficient was0.844, Cronbach’s coefficient of each dimension was greater than0.8, split-half reliability was0.972, and rater reliability was0.983. Factor analysis extracted five common factors, total explained89.691%of the cumulative variance, and the item distribution in five common factors was completely consistent with formal scale, indicating good construct validity.2. The transparency score of surveyed primary health care facilities is low, and the scoring average was only32.24%. In five dimensions, the scoring average of service processes and medicine catalogue were higher with45%and40%, and the scoring average of patient cost burden was the lowest with22.5%. In five elements, the scoring average of availability and timeliness were higher with45.43%and40%, and the scoring average of completeness and understandability were the lowest with26.60%and22.14%. Significant differences between different regions were found in transparency scores.3. Correlation analysis results showed that the correlation between transparency and rational medicine use was not statistically significant. Medicine price transparency was significantly negatively related to average medicine cost per encounter. The medicines economic burden was significantly negatively related to average number of medicines per encounter and percentage of encounters with an antibiotic prescribed.[Conclusion]1. This scale had good reliability and validity as a measurement tool to evaluate the transparency level of primary health care facilities in China.2. The transparency score of medicine use information was low in surveyed primary health care facilities. The contents of information disclosure were unbalance, and the transparency on medicine use performance and the economic burden of patients was inadequate. Moreover, the completeness and understandability of information should be improved in primary health care facilities.3. The relationship between transparency score and rational medicine use indicators is complex, and need further research.[Advice]1. Transparent regulation should have clear policy objectives. Furthermore, the objective of transparency regulation on medicine use in primary health care facilities should be improving the quality and efficiency of medicine use.2. The performance information of medicine use should be better disclosure in primary health care facilities. To make the public truly understand and use the information, primary health care facilities should pay more attention to the quality and the forms of information.[Innovation]1. The transparency measurement scale filled the gap in the research field, and also provided a measurement tool for evaluation of the transparency on medicine use information in primary health care facilities.2. We used the scale to evaluate the transparency situation of medicine use information in primary health care facilities, and furthermore provided suggestions on the improvement of the transparency.3. The exploration of the relationship between the transparency and the rational medicine use established foundation for the effect evaluation of transparency regulation in future.