Public reporting improves antibiotic prescribing for upper respiratory tract infections in primary care: a matched-pair cluster-randomized trial in China

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.

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

“…A previous study of patients with upper respiratory tract infections29 found a significant reduction in combined use of antibiotics as a result of a four-month reporting intervention; but no changes in injection prescriptions were observed. These results are similar to our findings in this study.…”

“…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 (upper respiratory tract infections) or using a single prescribing indicator (percentage of prescriptions containing injections) 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). We chose three conditions for the purpose of this study: bronchitis, gastritis and hypertension.…”

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

“…The intervention hospital translated the policies into a local AMS programme through training for doctors on guidelines, prescription review and restricting non‐compliant doctors – which may be associated with reduced APR for outpatients. We knew that limited administrative measures, such as posting individual doctor's APRs publicly, were ineffective . This has to be a combined effort.…”

General practitioners’ perceptions of public reporting of institution and individual medicine prescribing data

“…Similar to emphasizing the importance of process measures, several studies stressed the significance of patient education during public reporting. Yang indicated that consumer education was required to maximize the impact of public reporting [27]. Stephanie et al suggested that education was required to help assist patients interpret quality data, and an improved public education on quality data was required to increase the use of reporting data in the future [28].…”