三明医改对中国县级医院抗生素合理使用的影响。

The Impact of Sanming Healthcare Reform on Antibiotic Appropriate Use in County Hospitals in China.

机构信息

Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.

International Research Center for Medicinal Administration, Peking University, Beijing, China.

出版信息

Front Public Health. 2022 Jun 27;10:936719. doi: 10.3389/fpubh.2022.936719. eCollection 2022.

DOI:10.3389/fpubh.2022.936719

PMID:35832279

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9271699/

Abstract

BACKGROUND

The excessive use of resources and poor quality of care are great concerns worldwide, particularly in China. In 2013, a model of systematic reforms was developed in Sanming to address the inefficiency and waste in public hospitals. However, limited empirical studies have evaluated the effect of Sanming healthcare reform on antibiotic appropriate use. This study aims to evaluate the impact of the healthcare reform on the appropriate use of antibiotics in county-level public hospitals in Sanming, China.

METHODS

We conducted a retrospective observational study exploring trends in antibiotic use with an interrupted time series design. We selected three county-level hospitals in Sanming and extracted outpatient prescriptions of the Departments of Internal Medicine and the Department of Pediatrics between January 2011 and December 2017. Acute Upper Respiratory Tract Infection (AURI), Acute Bronchitis (AB) and Community Acquired Pneumonia (CAP) were selected as the sample diseases for our analysis. The primary outcome was the percentage of prescriptions conformed with standard treatment guidelines (STGs).

RESULTS

A total of 142,180 prescriptions were included in the analysis. During the study period, the percentage of antibiotics prescriptions conformed with STGs boosted from 32.4% in 2011 to 82.3% in 2017. Moreover, after the reform, the rate of prescriptions that conformed with STGs showed significant increasing trends in children with AURI (β = 1.624, < 0.001), children with AB (β = 3.123, < 0.001), adult with AB (β = 1.665, < 0.001), children with CAP (β = 3.123, < 0.001), adult with CAP (β = 4.385, < 0.001), but not in adult patients with AURI (β = -0.360, = 0.022).

CONCLUSION

Our study confirmed that the Sanming healthcare reform helped to promote the appropriate use of antibiotics in county-level hospitals. This systematic approach to healthcare reform, characterized by an effective governance structure, dynamic financial compensation mechanisms, and specialized drug stewardship, is promising for future public hospital reforms.

摘要

背景

资源过度使用和医疗服务质量差是全世界都非常关注的问题，在中国尤其如此。2013 年，三明市制定了系统改革模式，以解决公立医院效率低下和浪费问题。然而，有限的实证研究评估了三明市医疗改革对抗生素合理使用的影响。本研究旨在评估三明市县级公立医院医疗改革对抗生素合理使用的影响。

方法

我们进行了一项回顾性观察研究，采用中断时间序列设计探讨抗生素使用趋势。我们选择三明市的三家县级医院，提取 2011 年 1 月至 2017 年 12 月内科和儿科门诊处方。选择急性上呼吸道感染（AURI）、急性支气管炎（AB）和社区获得性肺炎（CAP）作为分析的样本疾病。主要结局是符合标准治疗指南（STGs）的处方比例。

结果

共纳入 142180 份处方。研究期间，符合 STGs 的抗生素处方比例从 2011 年的 32.4%上升至 2017 年的 82.3%。此外，改革后，AURI 患儿（β=1.624，<0.001）、AB 患儿（β=3.123，<0.001）、AB 成人患者（β=1.665，<0.001）、CAP 患儿（β=3.123，<0.001）、CAP 成人患者（β=4.385，<0.001）符合 STGs 的处方率呈显著上升趋势，但 AURI 成人患者（β=-0.360，=0.022）则无显著变化。