Public reporting as a prescriptions quality improvement measure in primary care settings in China: variations in effects associated with diagnoses

Tang, Yongming; Liu, George; Zhang, Xiaopeng

doi:10.1038/srep39361

Cited by 18 publications

(15 citation statements)

References 42 publications

(47 reference statements)

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“…However, an audit and feedback plus the distribution of a pocket version of the guidelines increased the prescribing compliance in a Norwegian hospital in terms of the right choice of empirical antibiotics, appropriate treatment duration, and decreased use of high-dose benzyl penicillin [ 37 ]. Public reporting may also help enhance the effects of practice guidelines, albeit in a small effect size [ 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, it has resulted in a substantial loss of revenue for primary care facilities [ 41 , 42 ] due to a shortage of government subsidies. These facilities have to turn their attention to other avenues to compensate for the loss, including user charges for the parenteral administration of medicines [ 38 ]. The regional centralized procurement arrangement does not forfeit the autonomy of health facilities to decide what and how much they can spend on medicines [ 43 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of prescription restrictive interventions on antibiotic procurement in primary care settings: a controlled interrupted time series study in China

Tang

Liu

Zhang

et al. 2018

Cost Eff Resour Alloc

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BackgroundThe overuse of antibiotics has been identified as a major challenge in regard to the rational prescription of medicines in low and middle income countries. Extensive studies on the effectiveness of persuasive interventions, such as guidelines have been undertaken. There is a dearth of research pertaining to the effects of restrictive interventions. This study aimed to evaluate the impacts of prescription restrictions in relation to types and administration routes of antibiotics on antibiotic procurement in primary care settings in China.MethodsData were drawn from the monthly procurement records of medicines for primary care institutions in Hubei province over a 31-month period from May 2011 to November 2013. We analyzed the monthly procurement volume and costs of antibiotics. Interrupted time series analyses with a difference-in-difference approach were performed to evaluate the effect of the restrictive intervention (started in August 2012) on antibiotic procurement in comparison with those for cardiovascular conditions. Sensitivity tests were performed by replacing outliers using a simple linear interpolation technique.ResultsOver the entire study period, antibiotics accounted for 33.65% of the total costs of medicines procured for primary care institutions: mostly non-restricted antibiotics (86.03%) and antibiotics administered through parenteral routes (79.59%). On average, 17.14 million defined daily doses (DDDs) of antibiotics were procured per month, with the majority (93.09%) for non-restricted antibiotics and over half (52.38%) for parenteral administered antibiotics. The restrictive intervention was associated with a decline in the secular trend of costs for non-restricted oral antibiotics (− 0.36 million Yuan per month, p = 0.029), and for parenteral administered restricted antibiotics (− 0.28 million Yuan per month, p = 0.019), as well as a decline in the secular trend of procurement volume for parenteral administered non-restricted antibiotics (− 0.038 million DDDs per month, p = 0.05).ConclusionsRestrictive interventions are effective in reducing the procurement of antibiotics. However, the effect size is relatively small and antibiotic consumptions remain high, especially parenteral administered antibiotics.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of prescription restrictive interventions on antibiotic procurement in primary care settings: a controlled interrupted time series study in China

Tang

Liu

Zhang

et al. 2018

Cost Eff Resour Alloc

Self Cite

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“…Public opinion/expectations and peer comparison appear to influence prescribing behaviours but in contrasting ways depending on the disease, patient cohort and doctor’s ranking. Liu et al [58], Tang et al [59], Tang et al [60], and Yang et al [61] reported effects of public reporting in primary care settings in China. Data on antibiotic prescribing (percentage of prescriptions including antibiotics or injections, and cost) were collected and individual doctors and facilities were compared and rankings were published publicly, e.g., on posters outside facilities.…”

Section: Table A1mentioning

confidence: 99%

Interventions to Reduce Antibiotic Prescribing in LMICs: A Scoping Review of Evidence from Human and Animal Health Systems

2018

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This review identifies evidence on supply-side interventions to change the practices of antibiotic prescribers and gatekeepers in low- and middle-income countries (LMICs). A total of 102 studies met the inclusion criteria, of which 70 studies evaluated interventions and 32 provided insight into prescribing contexts. All intervention studies were from human healthcare settings, none were from animal health. Only one context study examined antibiotic use in animal health. The evidence base is uneven, with the strongest evidence on knowledge and stewardship interventions. The review found that multiplex interventions that combine different strategies to influence behaviour tend to have a higher success rate than interventions based on single strategies. Evidence on prescribing contexts highlights interacting influences including health system quality, education, perceptions of patient demand, bureaucratic processes, profit, competition, and cultures of care. Most interventions took place within one health setting. Very few studies targeted interventions across different kinds of providers and settings. Interventions in hospitals were the most commonly evaluated. There is much less evidence on private and informal private providers who play a major role in drug distribution in LMICs. There were no interventions involving drug detailers or the pharmaceutical companies despite their prominent role in the contextual studies.

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“…Equitable access as devised through paradigms such as "accountability for reasonableness" (Daniels and Sabin 2002) is arguably more likely to enable and encourage relevant stakeholders -particularly the broader community -to be interested and proactively involved in national antibiotics policies and related infection prevention and control programmes. As we shall elaborate on below, an equitable regulatory lever is crucial in support bottom-up approaches to promoting high-value use of antimicrobials (Tang et al 2016).…”

Section: Ensuring Appropriate Affordable and Equitable Accessmentioning

confidence: 99%

Global Governance of Anti-microbial Resistance: A Legal and Regulatory Toolkit

Lee

2020

Ethics and Drug Resistance: Collective Responsibility for Global Public Health

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Recognizing that antimicrobial resistance (AMR) poses a serious threat to global public health, the World Health Organization (WHO) has adopted a Global Action Plan (GAP) at the May 2015 World Health Assembly. Underscoring that systematic misuse and overuse of drugs in human medicine and food production is a global public health concern, the GAP-AMR urges concerted efforts across governments and private sectors, including pharmaceutical industry, medical professionals, agricultural industry, among others. The GAP has a threefold aim: (1) to ensure a continuous use of effective and safe medicines for treatment and prevention of infectious diseases; (2) to encourage a responsible use of medicines; and (3) to engage countries to develop their national actions on AMR in keeping with the recommendations. While the GAP is a necessary step to enable multilateral actions, it must be supported by effective governance in order to realize the proposed aims. This chapter has a threefold purpose: (1) To identify regulatory principles embedded in key WHO documents relating to AMR and the GAP-AMR; (2) To consider the legal and regulatory actions or interventions that countries could use to strengthen their regulatory lever for AMR containment; and (3) To highlight the crucial role of the regulatory lever in enabling other levers under a whole-of-system approach. Effective AMR containment requires a clearer understanding of how the regulatory lever could be implemented or enabled within health systems, as well as how it underscores and interacts with other levers within a whole-of-system approach.

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Public reporting as a prescriptions quality improvement measure in primary care settings in China: variations in effects associated with diagnoses

Cited by 18 publications

References 42 publications

Effects of prescription restrictive interventions on antibiotic procurement in primary care settings: a controlled interrupted time series study in China

Effects of prescription restrictive interventions on antibiotic procurement in primary care settings: a controlled interrupted time series study in China

Interventions to Reduce Antibiotic Prescribing in LMICs: A Scoping Review of Evidence from Human and Animal Health Systems

Global Governance of Anti-microbial Resistance: A Legal and Regulatory Toolkit

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