Chinese patient demand for intravenous therapy: a preliminary survey

Abstract

BackgroundTreatment of medically trivial disorders by intravenous drug infusion has been widespread in China. Children with common colds are routinely given antibiotics intravenously, and students faced with stressful exams receive amino acids intravenously. Adverse outcomes from intravenous infusion reached 0·74% in one study. In December 2011, China reported its citizens consumed on average 138 g antibiotics annually, ten-times the per capita use in the USA. 70% of inpatients in Chinese hospitals receive antibiotics compared with a maximum of 30% recommended by WHO. Overall, three times as many Chinese patients are prescribed penicillin compared with the international norm. Explanations for high rates of intravenous infusion usage range from market-based reforms rewarding physicians, hospitals, and manufacturers, to overwhelming patient demand. The aim of this study was to assess patient demand for intravenous infusion. MethodsWe collected qualitative information from participants in one health centre and one university: respectively, the Qilidian Community Health Service Center, Runzhou, Zhenjiang and Jiangsu University, Zhenjiang, Jiangsu Province, both of which reviewed and approved the project. We utilised the method of purposive sampling (a method used in the study of cultural phenomena) by selecting persons with knowledge or experience with intravenous infusion. Patients, health providers, and medical students served as respondents, each of whom provided informed verbal consent before discussing their views and experience with intravenous infusion (primary outcomes). People who were acutely sick and those unable to communicate in Mandarin or Cantonese were excluded. We observed the practice of and interviewed 30 patients (inpatients and outpatients), five nurses (including three head nurses), three pharmacists, 11 medical doctors and directors, and more than ten medical students. These participants were considered to form a representative group of stakeholders from which to obtain information for use in the design of a future formal research study. FindingsAbout 30% of outpatients received intravenous infusions, which is substantially lower than rates of up to 96% reported in Guangdong Province. Patients receiving drugs intravenously typically presented with illnesses of varying severity: childhood pneumonia, weakness, diarrhoea, a few days' history of coughing or fever, tonsillitis, and dizziness secondary to low blood pressure. Intravenous treatment spanned 2 h/day for 1–5 days depending on the drug. Despite this time commitment, patient preference for intravenous treatment was dominated by the desire for rapid recovery driven by the need to return to school (to maintain academic competitiveness) or work (to maintain an income stream). These considerations surmounted patient perceptions of procedural risk, although needle puncture, unpleasant sensations, nausea, fainting, bruising, rash, and even antibiotic resistance, were acknowledged on occasion. The cost of intravenous drug delivery was considered acceptable. Doctors described huge patient loads, insufficient time to discuss the benefits and risks of intravenous infusion, and potential physician endangerment for failing to comply with a patient's wishes. InterpretationAlthough overuse of intravenous therapy might cause adverse outcomes, including the potential for antibiotic resistance, patient perception of rapid therapeutic benefit still dominates demand. The public has been urged by health departments to use intravenous infusion as a last resort, and not the norm, yet this risky practice continues. These preliminary observations provide the foundation to design a formal research-education study of stakeholder understanding of the use, value, and risks of intravenous infusion in primary healthcare settings. FundingJiangsu University and OHSU Foundation Global Health Center Fund.