Impact of China's essential medicines scheme and zero‐mark‐up policy on antibiotic prescriptions in county hospitals: a mixed methods study

Abstract

The national essential medicines scheme and zero-mark-up policy, when implemented with an antimicrobial stewardship programme, may be associated with reductions in outpatient antibiotic prescribing and intravenous infusions.

An antibiotic stewardship programme to reduce inappropriate antibiotic prescribing for acute respiratory infections in rural Chinese primary care facilities: study protocol for a clustered randomised controlled trial

“…Despite the implementation of the National Essential Medicines Policy and Zero-Mark-Up Policy in 2009 and the Administrative Regulation for Clinical Antibiotic Use in 2012 [16], their effects on reducing inappropriate antibiotic prescribing have been limited to large hospitals where the enforcement of appropriate prescribing practices is much better [53]. No change was observed in primary care facilities due to the knowledge gap in primary care providers, loose regulation enforcement and a high demand from patients [17,18,54]. Our previous trial in rural Guangxi proved the effectiveness and longterm benefits of educational interventions and prescribing peer-reviews in this setting [25,26].…”

“…However, no operational details have been given. The policy has not been proven effective at improving appropriate antibiotic prescribing [17]. Additionally, the policy only focussed on large hospitals and neglected primary care facilities [18,19].…”

“…Our primary outcome is the proportion of prescriptions for eligible patients (aged 0-75 years with a diagnosed ARI, excluding pneumonia and other complicationssee the 'Eligibility criteria' section) that contain one or more antibiotics, which (as per related literature) we refer to as the antibiotic prescription rate (APR). As in previous trials [17,34] we will use the APR to measure the proportion of unnecessary antibiotic prescribing/use, given that most patients with URTIs and acute bronchitis do not benefit from antibiotics.…”

“…We will also collect and create the following secondary outcomes based on all eligible prescriptions. In our previous trial, we observed an increased use of Traditional Chinese Medicines, likely as alternatives to antibiotics, and a widespread misuse of glucocorticoids [17]. Thus, we will also measure: (6) the proportion containing any Traditional Chinese Medicines and (7) the proportion containing any glucocorticoids.…”

Cost‐effectiveness analysis of a multi‐dimensional intervention to reduce inappropriate antibiotic prescribing for children with upper respiratory tract infections in China

“…However, intervention studies to reduce antibiotic prescribing in primary care are rare in low resource settings . In a natural experimental study, we found that including peer‐review within a stewardship programme may reduce antibiotic prescribing . Thus, we developed an intervention package that aimed to reduce prescribing of antibiotics for URTIs in 2–14‐year‐old outpatients, attending primary care facilities in rural Guangxi, China.…”