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 (1st March to 31st May, 2013) and after the intervention (1st March to 31st 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.
Highlights
Inappropriate use and overuse of antibiotics is a serious concern in the treatment of upper respiratory tract infections (URTIs), especially in developing countries
Those patients prescribed with antibiotics had a mean age of 23.6 years (Standard deviation =23.5); about half (49.5%) of them were male and over 85.9% were enrolled with the New Cooperative Medical Scheme (NCMS)
Prescriptions requiring antibiotics High rates of antibiotic prescription were noted in both intervention and control groups (Table 2)
Summary
Inappropriate use and overuse of antibiotics is a serious concern in the treatment of upper respiratory tract infections (URTIs), especially in developing countries. This study evaluated the impact of PR on antibiotic prescribing for URTIs in a sample of primary care institutions in China. Inappropriate use and overuse of antibiotics is a serious concern, especially in developing countries such as China [1]. It is perhaps the most prominent manifestation of irrational drug prescribing and contributes to bacterial resistance, which is an emergent threat to the. Upper respiratory tract infections (URTIs) are one of the most common health conditions seen by primary care workers, and the associated overuse of antibiotics is widespread [7]. Several systematic reviews have shown that antibiotics are of limited effectiveness in the treatment of URTIs [11] and suggested no benefit in colds [12]
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