Public reporting improves antibiotic prescribing for upper respiratory tract infections in primary care: a matched-pair cluster-randomized trial in ChinaReportar como inadecuado




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Health Research Policy and Systems

, 12:61

First Online: 10 October 2014Received: 15 June 2014Accepted: 25 September 2014

Abstract

BackgroundInappropriate use and overuse of antibiotics is a serious concern in the treatment of upper respiratory tract infections URTIs, especially in developing countries. In recent decades, information disclosure and public reporting PR has become an instrument for encouraging good practice in healthcare. This study evaluated the impact of PR on antibiotic prescribing for URTIs in a sample of primary care institutions in China.

MethodsA matched-pair cluster-randomized trial was undertaken in QJ city, with 20 primary care institutions participating in the trial. Participating institutions were matched into pairs before being randomly assigned into a control and an intervention group. Prescription statistics were disclosed to patients, health authorities, and health workers monthly within the intervention group, starting from October 2013. Outpatient prescriptions for URTIs were collected from both groups before 1 March to 31 May, 2013 and after the intervention 1 March to 31 May, 2014. A total of 34,815 URTI prescriptions were included in a difference-in-difference analysis using multivariate linear or logistic regression models, controlling for patient attributes as well as institutional characteristics.

ResultsOverall, 90% URTI prescriptions required antibiotics and 21% required combined use of antibiotics. More than 77% of URTI prescriptions required intravenous IV injection or infusion of drugs. PR resulted in a 9 percentage point 95% CI -17 to -1 reduction in the use of oral antibiotics adjusted RR =39%, P =0.027, while the use of injectable antibiotics remained unchanged. PR led to a 7 percentage point reduction 95% CI -14 to 0; adjusted RR =36% in combined use of antibiotics P =0.049, which was largely driven by a significant reduction in male patients -7.5%, 95% CI -14 to -1, P =0.03. The intervention had little impact on the use of IV injections or infusions, or the total prescription expenditure.

ConclusionsThe results suggest that PR could improve prescribing practices in terms of reducing oral antibiotics and combined use of antibiotics; however, the impacts were limited. We suggest that PR would probably be enhanced by provider payment reform, management and training for providers, and health education for patients.

KeywordsAntibiotics China Primary care Public reporting Upper respiratory tract infection AbbreviationsDIDDifference-in-difference

HISHealth information system

IVIntravenous injection

NCMSNew Cooperative Medical Scheme

PRPublic reporting

TOPSISTechnique for Order Preference by Similarity to Ideal Solution

URTIsUpper respiratory tract infections

WHOWorld Health Organization.

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Autor: Lianping Yang - Chaojie Liu - Lijun Wang - Xi Yin - Xinping Zhang

Fuente: https://link.springer.com/



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