Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, China.
Department of Clinical Medicine, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7TH, UK.
BMC Public Health. 2020 Nov 25;20(1):1794. doi: 10.1186/s12889-020-09948-z.
Antimicrobial 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.
To 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.
Our 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.
Future 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.
抗菌药物耐药性（AMR）是一个严重的全球公共卫生挑战。医生对抗生素的过度处方是一个主要因素，静脉（IV）抗生素的使用在中国一直是一个特别令人关注的问题。为了解决抗生素滥用的迅速蔓延，中国政府在几个省份的二级和三级医院的儿科、急诊部门（ED）和住院病房豁免的情况下，试点了门诊部门（OD）禁止静脉使用抗生素。
为了评估该政策的潜在影响，我们进行了一项混合方法研究，包括 1）对来自两个城市的 68 位利益相关者（包括患者、卫生工作者和政策制定者）进行关于禁止静脉使用抗生素的访谈，以及 2）对一家医院进行案例研究，收集了 207 名医生的常规医院数据和调查数据。
我们的分析表明，OD 禁止静脉使用抗生素导致总处方和 IV 抗生素处方减少，并改善了 OD 中的合理抗生素处方实践。然而，该政策导致患者从 OD 流向 ED、住院病房和初级保健机构开 IV 抗生素处方。我们还发现，儿科不合理使用抗生素的问题被忽视了。激进的政策执行、医生规避规定以及患者就诊时缺乏医患沟通，这些都是该禁令实施的障碍。
未来的努力可能包括 1）在儿科中减轻口服和 IV 抗生素治疗的强度，并减少门诊诊所中成年人口服抗生素治疗，2）减少 OD 医生向 ED、初级保健或住院服务的不必要转诊，并更好地协调那些临床需要 IV 抗生素的患者，3）实施针对需求方的定制措施，如公众教育活动，以及 4）改善医患沟通。未来需要研究初级保健和其他社区诊所如何实施该禁令。
