Abstract
BackgroundAntimicrobial resistance (AMR) is a serious global public health challenge. Physicians’ over-prescription of antibiotics is a major contributor, and intravenous (IV) antibiotic use has been a particular concern in China. To address the rapid fallout of antibiotic overuse, the Chinese government has piloted a ban of IV antibiotics in the outpatient department (OD) with the exemption of paediatrics, emergency department (ED), and inpatient ward of secondary and tertiary hospitals in several provinces.MethodsTo assess the potential impact of the policy, we conducted a mixed-methods study including 1) interviews about the ban of IV antibiotic use with 68 stakeholders, covering patients, health workers, and policy-makers, from two cities and 2) a hospital case study which collected routine hospital data and survey data with 207 doctors.ResultsOur analyses revealed that the ban of IV antibiotics in the OD led to a reduction in the total and IV antibiotic prescriptions and improved the rational antibiotic prescribing practice in the OD. Nevertheless, the policy has diverted patient flow from OD to ED, inpatient ward, and primary care for IV antibiotic prescriptions. We also found that irrational antibiotic use in paediatrics was neglected. Radical policy implementation, doctors circumvented the regulations, and lack of doctor-patient communication during patient encounters were barriers to the implementation of the ban.ConclusionsFuture efforts may include 1) to de-escalate both oral and IV antibiotic therapy in paediatric and reduce oral antibiotic therapy among adults in outpatient clinics, 2) to reduce unnecessary referrals by OD doctors to ED, primary care, or inpatient services and better coordinate for patients who clinically need IV antibiotics, 3) to incorporate demand-side tailored measures, such as public education campaigns, and 4) to improve doctor-patient communication. Future research is needed to understand how primary care and other community clinics implement the ban.
Highlights
Antimicrobial resistance (AMR) is a serious global public health challenge
Non-restricted antibiotics refer to the antibiotics which are cheap, clinically safe and effective and have little effect on AMR; restricted antibiotics are relatively expensive and with a higher risk of AMR; special-grade antibiotics are for advanced infections and only recommended for situations when all alternative antibiotics are unlikely to be effective and can only be prescribed by chief physicians [17, 18]
This study aimed to evaluate the impact of the above Antimicrobial stewardship programs (ASPs) with a focus on the policy’s targeted IV antibiotic use levels in secondary and tertiary hospitals in Zhejiang province
Summary
Antimicrobial resistance (AMR) is a serious global public health challenge. Physicians’ overprescription of antibiotics is a major contributor, and intravenous (IV) antibiotic use has been a particular concern in China. AMR resulted in prolonged illness, Wang et al BMC Public Health (2020) 20:1794 physicians’ uncertainty to distinguish bacterial from viral infections, perverse incentives to over-prescribe, patient expectations of antibiotic use, and over-the-counter antibiotic sales in pharmacies [7, 8]. In 2004, the NHC released a guideline that classified antibiotics into three categories based on the affordability, clinical effectiveness, clinical safety, and AMR concern – non-restricted-, restricted-, and special-grade [17]. Two national surveillance systems for clinical antibiotic use [19] and AMR [20] covering 31 provinces and 1412 health facilities were established in 2005. In 2011, NHC launched another three-year national scheme to reduce clinical antibiotic use in tertiary hospitals [22,23,24]. The scheme mainly consists of establishing mandatory administrative strategies for rational antibiotic use, setting targets for antibiotic use management, developing audit and inspection systems, and assigning hospital leadership for achieving these targets
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