Sustainable Financial Incentives To Improve Prescription Practices For Malaria

描述（由申请人提供）：控制疟疾的全球投资已经导致疟疾负担的一些令人兴奋的减少。在一些地区，与疟疾有关的死亡人数下降了90%以上。随着疟疾传播的减少，更大比例的儿科发热是由其他原因引起的。然而，这些发烧继续被当作疟疾治疗，尽管往往有诊断检测。在肯尼亚的一个典型的农村卫生设施中，超过90%的发热患者在没有诊断测试的情况下被开了抗疟药。即使有显微镜检查或快速诊断测试（RDTs），50-80%的阴性测试患者仍然被处方抗疟药。儿童发烧治疗不当可能会给患者带来严重后果，并加速耐药性的传播。除了给病人带来风险外，过度使用抗疟药物也给政府卫生系统带来财政压力。虽然各国政府有很大的动力减少药物费用和浪费，但在适当的决策层并没有感受到财政压力。该项目旨在测试一种创新的、可持续的财政激励措施，以减少非疟疾发热患者因使用抗疟药物治疗不当的人数。我们将测试针对卫生设施的财政激励措施，以确定它是否能提高对诊断结果和临床协议的遵守。将在肯尼亚西部的18个农村卫生设施登记，并随机分配到两个分支之一。我们将比较单独诊断疟疾的临床和技术培训（第1组）与培训加与处方实践相关的经济激励（第2组）在改善疟疾和非疟疾发热的诊断和治疗方面的有效性。将在有激励结构和没有激励结构的设施之间比较为阴性诊断患者开抗疟药的做法。次要结果将包括卫生中心常规显微镜检查的敏感性和特异性，玻片阴性发热的替代治疗方法的使用，以及抗疟药物缺货的频率。

DESCRIPTION (provided by applicant): Global investments in controlling malaria have led to some exciting reductions in the burden of malaria. In some areas, malaria-related deaths have dropped by more than 90%. As malaria transmission declines, a greater fraction of pediatric fevers are from other causes. However, these fevers continue to be treated as malaria, often despite the availability of diagnostic testing. In a typical rural health facility in Kenya, more tan 90% of febrile patients are prescribed an antimalarial when no diagnostic tests are available. Even when microscopy or rapid diagnostic tests (RDTs) are available, between 50-80% of patients with a negative test are nonetheless prescribed antimalarials. Inappropriately treated fevers in children can lead to serious consequences for the patient and can accelerate the spread of drug resistance. In addition to the risk to patients, overuse of antimalarials also puts financial strain on the government health system. Although there is considerable incentive for governments to reduce drug costs and wastage, the financial pressure is not experienced at the appropriate levels of decision- making. This project aims to test an innovative, sustainable financial incentive designed to reduce the number of non-malarial fevers that are treated inappropriately with antimalarial drugs. We will test a financial incentive targeted at the health facility to determine if it improves adherence to diagnostic results and clinical protocols. Eighteen rural health facilities in Western Kenya will be enrolled and randomly allocated to one of two arms. We will compare the effectiveness of clinical and technical training in diagnosis of malaria alone (Arm 1) to training plus financial incentives linked to prescription practices (Arm 2 in improving diagnosis and treatment of malaria and non-malaria fevers. The practice of prescribing antimalarials to patients with a negative diagnostic will be compared between facilities with and without the incentive structure. Secondary outcomes will include sensitivity and specificity of routine microscopy at health centers, use of alternative treatments for slide negative fevers, and frequency of stock-outs of antimalarial drugs.