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

Yuqing Tang,Chaojie Liu,Xinping Zhang

doi:10.1038/srep39361

Yuqing Tang, Chaojie Liu + Show 1 more

Open Access

https://doi.org/10.1038/srep39361

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Abstract

The overprovision and irrational use of antibiotics and injections are a major public health concern. Public reporting has been adopted as a strategy to encourage good prescribing practices. This study evaluated the effects of public reporting on antibiotic and injection prescriptions in urban and rural primary care settings in Hubei province, China. A randomized control trial was conducted, with 10 primary care institutions being subject to public reporting and another 10 serving as controls. Prescription indicators were publicly reported monthly over a one-year period. Prescriptions for bronchitis, gastritis and hypertension before and after the intervention were collected. Difference-in-difference tests were performed to estimate the effect size of the intervention on five prescription indicators: percentage of prescriptions containing antibiotics; percentage of prescriptions containing two or more antibiotics; percentage of prescriptions containing injections; percentage of prescriptions containing antibiotic injections; and average prescription cost. Public reporting had varied effects on prescriptions for different diagnoses. It reduced antibiotic prescribing for gastritis. Prescriptions containing injections, especially antibiotic injections, also declined, but only for gastritis. A reduction of prescription costs was noted for bronchitis and gastritis. Public reporting has the potential to encourage good prescribing practices. Its effects vary with different disease conditions.

Highlights

The overprovision and irrational use of antibiotics and injections are a major public health concern
Unlike previous efforts made by Yang’s29 and Wang’s30 teams, where the impact of public reporting on prescriptions was examined through a single disease condition or using a single prescribing indicator over a short period of time (4 months), this study evaluated the impact of public reporting on the use of antibiotics and injections for a range of conditions over a relatively longer period of time (1 year)
This study provides new evidence on the potential of public reporting for encouraging good prescribing practices in primary care settings

Summary

Introduction

The overprovision and irrational use of antibiotics and injections are a major public health concern. This study evaluated the effects of public reporting on antibiotic and injection prescriptions in urban and rural primary care settings in Hubei province, China. Public reporting had varied effects on prescriptions for different diagnoses Antibiotic abuse and the overuse of injections has been identified as a major challenge involved in the irrational prescription of medicines[1] This has remained common, especially in low and middle income countries[1,2,3], and is associated with antimicrobial resistance (AMR), adverse drug events and the transmission of diseases. It is widely believed that public reporting can enable consumers to make better informed choices and improve health care practices Patients may modify their choice of providers or other decisions on the basis of the available performance measures[20]. Reporting of aggregated measures of quality and safety remains relatively uncommon

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