Public reporting influences antibiotic and injection prescription in primary care: a segmented regression analysis
Public reporting influences antibiotic and injection prescription in primary care: a segmented regression analysis
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公开报告影响初级保健中的抗生素和注射处方：分段回归分析
DOI：
10.1111/jep.12343
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发表时间：
2015-08-01
影响因子：
2.4
通讯作者：
Wan, Jie
中科院分区：
文献类型：
--
作者：
Liu, Chenxi;Zhang, Xinping;Wan, Jie
理由、目的和目标抗生素和注射剂的不当使用和过度使用是对全球人口的严重威胁，特别是在发展中国家。近几十年来，卫生保健绩效的公开报告（PRHCP）已成为提高保健质量的一种手段。然而，现有的证据表明，PRHCP的效果好坏参半。本研究以中国基层医疗机构为样本，评估了PRHCP对医生处方行为的影响。采用分段回归分析为卫生政策和改革提供了令人信服的证据。方法于2013年10月1日起在迁市实施PRHCP干预。每月向10个初级保健机构的患者和卫生工作者披露处方统计方面的绩效数据。共收集有效门诊处方326655张。每月有效处方计算为研究分析单位（每月1日至31日）。本研究涉及对PRHCP干预前13个月和干预后11个月的结果进行多重评估（共24个数据点）。结果在分段回归模型中，抗生素的使用（系数= -0.64,P = 0.004）与基线相比呈下降趋势，抗生素的联合使用(系数=-0.41，P
Rationale, aims and objectivesInappropriate use and overuse of antibiotics and injections are serious threats to the global population, particularly in developing countries. In recent decades, public reporting of health care performance (PRHCP) has been an instrument to improve the quality of care. However, existing evidence shows a mixed effect of PRHCP. This study evaluated the effect of PRHCP on physicians' prescribing practices in a sample of primary care institutions in China. Segmented regression analysis was used to produce convincing evidence for health policy and reform.MethodsThe PRHCP intervention was implemented in Qian City that started on 1 October 2013. Performance data on prescription statistics were disclosed to patients and health workers monthly in 10 primary care institutions. A total of 326655 valid outpatient prescriptions were collected. Monthly effective prescriptions were calculated as analytical units in the research (1st to 31st every month). This study involved multiple assessments of outcomes 13 months before and 11 months after PRHCP intervention (a total of 24 data points).ResultsSegmented regression models showed downward trends from baseline on antibiotics (coefficient = -0.64, P = 0.004), combined use of antibiotics (coefficient=-0.41, P