Investigating the mechanism of impact and differential effect of the Quality Premium scheme on antibiotic prescribing in England: a longitudinal study.
Investigating the mechanism of impact and differential effect of the Quality Premium scheme on antibiotic prescribing in England: a longitudinal study.
复制标题
DOI：
10.3399/bjgpopen20x101052
复制
发表时间：
2020-08-01
期刊：
影响因子：
--
通讯作者：
Costelloe, Ceire
中科院分区：
文献类型：
--
作者：
Anyanwu, Philip Emeka;Pouwels, Koen;Costelloe, Ceire
背景：2017年，英格兰约73%的抗生素是从初级保健实践中开出的。据估计，2013年至2015年期间，9%-23%的抗生素处方是不适当的。在2015- 2016年的财政激励计划中，减少初级保健中的抗生素处方被列为国家优先事项之一。目的：研究质量溢价（QP）的影响是否可以通过有助于抗生素处方变化的实践特征来解释，该质量溢价为临床调试组（CCG）提供了与绩效相关的财政激励。分析了2014年4月至2016年3月期间英格兰6251个初级保健诊所的纵向每月处方数据。方法：拟合线性广义估计方程模型，检查2015-2016年QP对每个特定治疗组年龄-性别相关处方单位（STAR-PU）处方的抗生素项目数量的影响，根据实施以来的季节性和月份进行调整。在进一步调整实践特征的变化后，还检查了效果的一致性，包括实践劳动力，合并症患病率，非抗生素药物的处方率和剥夺。英格兰初级保健实践中处方的抗生素减少了-0.172项/STAR-PU（95%置信区间[CI] = -0.180至-0.171），2015年4月后的几个月略有增加（每个STAR-PU +0.014项; 95% CI = +0.013至+0.014）。根据实践特征调整模型后，实施后的即时和逐月影响保持一致，即时减少略有衰减，从-0.172到-0.166个项目/STAR-PU。在亚组分析中，QP效应在前20%的处方实践中显著更大（相互作用p
BACKGROUND: In 2017, approximately 73% of antibiotics in England were prescribed from primary care practices. It has been estimated that 9%-23% of antibiotic prescriptions between 2013 and 2015 were inappropriate. Reducing antibiotic prescribing in primary care was included as one of the national priorities in a financial incentive scheme in 2015-2016.AIM: To investigate whether the effects of the Quality Premium (QP), which provided performance-related financial incentives to clinical commissioning groups (CCGs), could be explained by practice characteristics that contribute to variations in antibiotic prescribing.DESIGN & SETTING: Longitudinal monthly prescribing data were analysed for 6251 primary care practices in England from April 2014 to March 2016.METHOD: Linear generalised estimating equations models were fitted, examining the effect of the 2015-2016 QP on the number of antibiotic items per specific therapeutic group age-sex related prescribing unit (STAR-PU) prescribed, adjusting for seasonality and months since implementation. Consistency of effects after further adjustment for variations in practice characteristics were also examined, including practice workforce, comorbidities prevalence, prescribing rates of non-antibiotic drugs, and deprivation.RESULTS: Antibiotics prescribed in primary care practices in England reduced by -0.172 items per STAR-PU (95% confidence interval [CI] = -0.180 to -0.171) after 2015-2016 QP implementation, with slight increases in the months following April 2015 (+0.014 items per STAR-PU; 95% CI = +0.013 to +0.014). Adjusting the model for practice characteristics, the immediate and month-on-month effects following implementation remained consistent, with slight attenuation in immediate reduction from -0.172 to -0.166 items per STAR-PU. In subgroup analysis, the QP effect was significantly greater among the top 20% prescribing practices (interaction p