Healthcare Providers’ Accounts of Influences of Antibiotic-Related Reforms on their Behavior with Respect to the Use of Antibiotics for Children: A Qualitative Study in China

Abstract

Purpose: High and inappropriate pediatric use of antibiotics by healthcare providers is a key driver of antibiotic resistance in China. The Chinese government initiated a programme of antibiotic-related reforms in 2011 after a wider healthcare reform in 2009. However, very few studies shed light on the influence of these reforms on providers' antibiotic-related behavior; only one qualitative study of providers' perspectives and experiences has been undertaken. Therefore, our qualitative study aims to explore the influence of the 2009 and 2011 reforms on providers' pediatric antibiotic use.Methods: Qualitative interviews were conducted with 26 providers in Taiyuan city, a typical Chinese city in central China in 2016. Interviews were transcribed verbatim, translated from Chinese to English, and analyzed using framework analysis. Results:Healthcare providers described how their behavior was influenced by the availability of diagnostic testing. They also pointed to financial considerations and pressures, as well as other healthcare institutions within China's healthcare system that influence their antibiotic-related behavior. Conclusions:As far as we are aware, this is the first city-based qualitative study in China providing evidence of the influences of the 2009 and 2011 reforms on providers' antibiotic-related behavior. It points to issues around the enforcement of antibiotic-related reforms in community health institutions and retail pharmacies, and highlights the importance of understanding the reforms' influences on provider behavior within China's healthcare system as a whole.

Antimicrobial resistance, inflammatory responses: a comparative analysis of pathogenicities, knowledge hybrids and the semantics of antibiotic use

“…There is considerable evidence that antibiotics are overused in the healthcare system (Yin et al, 2013;Li et al, 2012;Zhang et al, 2006;Cui et al, 2017;Jin et al, 2011) of China. Despite government healthcare reforms that have been linked to reductions in prescribing at county and higher level public hospitals (Sun et al, 2015) and a series of policies and initiatives that have begun to modify antimicrobial use (Wang et al, 2016;Zhang et al 2018), China is estimated to have some of the highest rates of AMR in the world (Cui et al, 2017;Center for Disease Dynamics, 2018). Legislation to prevent over the counter (OTC) sales of antibiotics is in place, but antibiotics can often still be obtained via direct OTC purchasing from pharmacies as well as via medical prescription.…”

Antibiotic Stewardship in Retail Pharmacies and the Access-Excess Challenge in China: A Policy Review

“…Antibiotic sales volumes in clinical settings decreased from 23.80% in 2009 to 19.40% in 2011 [ 57 ]. Tighter enforcement of regulations in hospitals and primary health care may result in the only lightly regulated retail pharmacies becoming more significant as a source of antibiotics as consumers may request antibiotics from retail pharmacies when doctors refuse their request for antibiotics [ 58 ]. Therefore, policies to reduce excessive use of antibiotics in clinical settings in China may have increased demand in retail pharmacies, pushing excess use into less regulated community settings.…”