Investigating the mechanism of impact of the Quality Premium initiative on antibiotic prescribing in primary care practices in England: a study protocol.
Investigating the mechanism of impact of the Quality Premium initiative on antibiotic prescribing in primary care practices in England: a study protocol.
复制标题
调查质量溢价计划对英格兰初级保健实践中抗生素处方的影响机制：一项研究方案。
DOI：
10.1136/bmjopen-2019-030093
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发表时间：
2019
期刊：
影响因子：
2.9
通讯作者：
Anyanwu PE
中科院分区：
文献类型：
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作者：
Anyanwu PE
在英国和全球，抗生素耐药性的持续发展和传播仍然是一个重要的公共卫生问题。2016年，英格兰约74%的抗生素处方用于初级保健。质量奖励（QP）倡议是根据所委托的特定卫生服务的质量在财政上奖励临床委托小组（ccg），这是英国国家卫生服务（NHS）通过减少处方来减少抗菌素耐药性的干预措施之一。新出现的证据表明，减少抗生素处方在初级保健实践在英国继QP倡议。本研究旨在探讨这种高成本卫生系统水平干预对英格兰初级保健实践中抗生素处方的影响机制。该研究将对2013年至2018年期间英国几乎所有初级保健实践的抗生素处方数据进行二次分析，这些数据来自NHS英格兰抗生素质量溢价监测仪表板和开放处方。主要结果是每个实践或CCG中每个特定治疗组年龄-性别相关处方单位（STAR-PU）每月处方的抗生素项目数量。我们将首先使用普通最小二乘回归方法进行中断时间序列，以检查英格兰抗生素处方率是否随时间变化，以及这种变化（如果有的话）如何与QP实施相关。将采用统一的方法对自然直接和间接效应进行单一和顺序多介质模型，以调查QP主动性、潜在介质和抗生素处方率之间的关系，并根据实践和CCG特征进行调整。伦理和传播本研究将使用匿名的二手数据，这些数据要么来自经过伦理审查的研究，要么来自常规收集系统的数据。将利用多种渠道向学术和非学术受众传播本研究的结果。
IntroductionThe persistent development and spread of resistance to antibiotics remain an important public health concern in the UK and globally. About 74% of antibiotics prescribed in England in 2016 was in primary care. The Quality Premium (QP) initiative that rewards Clinical Commissioning Groups (CCGs) financially based on the quality of specific health services commissioned is one of the National Health Service (NHS) England interventions to reduce antimicrobial resistance through reduced prescribing. Emerging evidence suggests a reduction in antibiotic prescribing in primary care practices in the UK following QP initiative. This study aims to investigate the mechanism of impact of this high-cost health-system level intervention on antibiotic prescribing in primary care practices in England.Methods and analysisThe study will constitute secondary analyses of antibiotic prescribing data for almost all primary care practices in England from the NHS England Antibiotic Quality Premium Monitoring Dashboard and OpenPrescribing covering the period 2013 to 2018. The primary outcome is the number of antibiotic items per Specific Therapeutic group Age-sex Related Prescribing Unit (STAR-PU) prescribed monthly in each practice or CCG. We will first conduct an interrupted time series using ordinary least square regression method to examine whether antibiotic prescribing rate in England has changed over time, and how such changes, if any, are associated with QP implementation. Single and sequential multiple-mediator models using a unified approach for the natural direct and indirect effects will be conducted to investigate the relationship between QP initiative, the potential mediators and antibiotic prescribing rate with adjustment for practice and CCG characteristics.Ethics and disseminationThis study will use secondary data that are anonymised and obtained from studies that have either undergone ethical review or generated data from routine collection systems. Multiple channels will be used in disseminating the findings from this study to academic and non-academic audiences.