Abstract
BackgroundTo understand the characteristics of prescriptions and costs in pediatric patients with acute upper respiratory infections (AURI) is important for the regulation of outpatient care and reimbursement policy. This study aims to provide evidence on these issues that was in short supply.MethodsWe conducted a retrospective cross-sectional study based on data from National Engineering Laboratory of Application Technology in Medical Big Data. All outpatient pediatric patients aged 0–14 years with an uncomplicated AURI from 1 January 2015 to 31 December 2017 in 138 hospitals across the country were included. We reported characteristics of patients, the average number of medications prescribed per encounter, the categories of medication used and their percentages, the cost per visit and prescription costs of drugs. For these measurements, discrepancies among diverse groups of age, regions, insurance types, and AURI categories were compared. Kruskal-Wallis nonparametric test and Student-Newman-Keuls test were performed to identify differences among subgroups. A multinomial logistic regression was conducted to examine the independent effects of those factors on the prescribing behavior.ResultsA total of 1,002,687 clinical records with 2,682,118 prescriptions were collected and analyzed. The average number of drugs prescribed per encounter was 2.8. The most frequently prescribed medication was Chinese traditional patent medicines (CTPM) (36.5% of overall prescriptions) followed by antibiotics (18.1%). It showed a preference of CPTM over conventional medicines. The median cost per visit was 17.91 USD. The median drug cost per visit was 13.84 USD. The expenditures of antibiotics and CTPM per visit (6.05 USD and 5.87 USD) were among the three highest categories of drugs. The percentage of out-of-pocket patients reached 65.9%. Disparities were showed among subgroups of different ages, regions, and insurance types.ConclusionsThe high volume of CPTM usage is the typical feature in outpatient care of AURI pediatric patients in China. The rational and cost-effective use of CPTM and antibiotics still faces challenges. The reimbursement for child AURI cases needs to be enhanced.
Highlights
To understand the characteristics of prescriptions and costs in pediatric patients with acute upper respiratory infections (AURI) is important for the regulation of outpatient care and reimbursement policy
The high volume of Chinese traditional patent medicines (CPTM) usage is the typical feature in outpatient care of AURI pediatric patients in China
Pediatric outpatient visits took up 9.8% of total outpatient visits in China in 2017, among which acute upper respiratory tract infection (AURI) is the first common cause of sicknesses, accounting for more than 60% of total outpatient visits [1]
Summary
To understand the characteristics of prescriptions and costs in pediatric patients with acute upper respiratory infections (AURI) is important for the regulation of outpatient care and reimbursement policy. Pediatric outpatient visits took up 9.8% of total outpatient visits in China in 2017, among which acute upper respiratory tract infection (AURI) is the first common cause of sicknesses, accounting for more than 60% of total outpatient visits [1]. As children are highly vulnerable to irrational drug use, the study of prescriptions in children with AURI is of great importance. The insufficient evidence made it hard to monitor and regulate outpatient services resulting in the lag of policy adjustment regarding prescribing behavior as well as reimbursement strategies [13,14,15]
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