Application of propensity scores to explore the effect of public reporting of medicine use information on rational drug use in China: a quasi-experimental design.
Application of propensity scores to explore the effect of public reporting of medicine use information on rational drug use in China: a quasi-experimental design.
复制标题
DOI：
10.1186/s12913-014-0492-6
复制
发表时间：
2014-11-11
影响因子：
2.8
通讯作者：
Zhang X
中科院分区：
文献类型：
--
作者：
Zhang X;Wang L;Zhang X
透明度已成为全球医疗保健系统中最热门的话题和日益高涨的运动。本研究采用准实验设计方法，探讨公开用药信息是否能促进合理用药。以湖北省Y市20所乡镇卫生院和274名医生为研究对象，根据其特点将中国分为干预组和对照组。干预组每月以适当的格式向患者和医生公开每张处方的平均费用、需要抗生素的处方百分比和需要注射的处方百分比的数值和排名。在干预前四个月和干预后四个月都收集了数据。倾向得分匹配(PSM)被用来最小化观察到的协变量(性别、年龄、经验、教育水平、职称和月收入)在医生特征中的差异。PSM后共获得108对医生。采用卡方检验和t检验探讨用药信息公示对合理用药的影响。本研究由华中科技大学同济医学院委员会批准(国际组织编号：IORG0003571)。在基线水平下，274名医生的平均每张处方费用为42.82元(6.97美元)，需要抗生素的处方比例为63.00%，需要注射的处方比例为70.79%，均高于湖北省的平均水平和世界卫生组织推荐的标准。干预前三项指标均具有可比性(p>；0.05)，干预后需要注射处方的比例干预组(64.66%)与对照组(70.52%)有显著差异(p<；0.05)。不合理用药仍是研究区乡镇卫生院的政策问题。我们发现公开用药信息可以降低中国乡镇卫生院需要注射的处方比例，但在处方费用和抗生素使用方面没有观察到这种影响。建议对药品使用信息公开报告的机制和长期效果进行分析，以供进一步研究。
Transparency has become a hottest topic and a growing movement in the health care system worldwide. This study used a quasi-experimental design method to explore whether public reporting of medicine use information can improve rational drug use. 20 township hospitals and 274 doctors of City Y in Hubei Province, China were divided into the intervention and control groups on the basis of their characteristics. In the intervention group, the values and rankings of the average expenditure per prescription, percentage of prescriptions requiring antibiotics and percentage of prescriptions requiring injections of each hospital and doctor were publicly released to patients and doctors in an appropriate format monthly. Data were gathered both four months before and after the intervention. Propensity score matching (PSM) was used to minimize the observed covariate (gender, age, experience, education level, title, and monthly income) differences in the doctors’ characteristics. 108 pairs of doctors were obtained after PSM. Chi-square test and t-test were employed to explore the effect of public reporting of medicine use information on rational drug use. The study was approved by the Committee of Tongji Medical College, Hua Zhong University of Science and Technology (IORG No: IORG0003571). In baseline, the average expenditure per prescription of the 274 doctors was 42.82 RMB yuan (USD 6.97), the percentage of prescriptions requiring antibiotics was 63.00%, and the percentage of prescriptions requiring injections was 70.79%, all higher than the average of Hubei Province and the standard recommended by WHO. Before the intervention all the three indicators were all comparable (p > 0.05), whereas after the intervention, a significant difference (p < 0.05) was found for the percentage of prescriptions requiring injections between the intervention (64.66%) and control groups (70.52%). Irrational drug use remains a policy issue in township hospitals in the study area. We demonstrated that publicly reporting medicine use information could decrease the percentage of prescriptions requiring injections in township hospitals in China, but this effect was not observed on prescription costs and antibiotics use. Analyses of the mechanism and long-term effect of public reporting of medicine use information are recommended for further studies.
登录
查看更多内容
影响因子：
9.7
作者：
Marshall, MN;Shekelle, PG;Smith, PC
通讯作者：
Smith, PC
影响因子：
158.5
作者：
Schneider, EC;Epstein, AM
通讯作者：
Epstein, AM
国家基本药物政策对湖北省基层医疗机构处方行为的影响
影响因子：
3.2
作者：
Yang, Lianping;Liu, Chaojie;Zhang, Xinping
通讯作者：
Zhang, Xinping
影响因子：
120.7
作者：
Schneider, EC;Epstein, AM
通讯作者：
Epstein, AM
影响因子：
3.4
作者：
Hibbard, JH;Slovic, P;Finucane, ML
通讯作者：
Finucane, ML