Xiaoyun Liang1, Tingsong Xia2, Xiulan Zhang1, Chenggang Jin3. 1. School of Social Development and Public Policy, Beijing Normal University, Beijing and. 2. Health Bureau of Baoan District, Shenzhen, China. 3. School of Social Development and Public Policy, Beijing Normal University, Beijing and cgjin2005@126.com.
Abstract
BACKGROUND: It is unclear whether changing the governance structure of community health centres (CHCs) could affect antibiotic prescribing behaviour. OBJECTIVE: To explore how changes in governance structure affect antibiotic prescription for children younger than 5 years of age with acute upper respiratory tract infections (AURI) in CHCs in Shenzhen, China. METHODS: This study used an interrupted time series design with a comparison series. On 1 June 2009, the Health Bureau of Shenzhen's Baoan District transferred CHCs from a hospital-affiliated model to a self-managed independent model regarding finance, personnel and employee compensation. We collected 23481 electronic medical records of children younger than 5 years of age who were treated for AURI on an outpatient basis 1 year before and 1 year after governance structure reform. We used segmented regression analysis to evaluate the effect of reform on antibiotic prescription. RESULTS: After the reform, the proportion of patients receiving an antibiotic injection per month and the proportion of patients receiving two or more antibiotics conditional on receiving an antibiotic per month decreased 9.17% and 7.34%, respectively (P < 0.01 or P < 0.05). In the intervention series, the proportion of patients receiving an antibiotic injection per month and the monthly average cost of the antibiotics prescribed per patient continued to decrease over time compared with the control series (P < 0.001 or P < 0.05). CONCLUSION: This study suggests that governance structure reform can have positive effects on behaviour for antibiotic prescribing. Moreover, this short-term effect might have important implications for further community health reforms in China.
BACKGROUND: It is unclear whether changing the governance structure of community health centres (CHCs) could affect antibiotic prescribing behaviour. OBJECTIVE: To explore how changes in governance structure affect antibiotic prescription for children younger than 5 years of age with acute upper respiratory tract infections (AURI) in CHCs in Shenzhen, China. METHODS: This study used an interrupted time series design with a comparison series. On 1 June 2009, the Health Bureau of Shenzhen's Baoan District transferred CHCs from a hospital-affiliated model to a self-managed independent model regarding finance, personnel and employee compensation. We collected 23481 electronic medical records of children younger than 5 years of age who were treated for AURI on an outpatient basis 1 year before and 1 year after governance structure reform. We used segmented regression analysis to evaluate the effect of reform on antibiotic prescription. RESULTS: After the reform, the proportion of patients receiving an antibiotic injection per month and the proportion of patients receiving two or more antibiotics conditional on receiving an antibiotic per month decreased 9.17% and 7.34%, respectively (P < 0.01 or P < 0.05). In the intervention series, the proportion of patients receiving an antibiotic injection per month and the monthly average cost of the antibiotics prescribed per patient continued to decrease over time compared with the control series (P < 0.001 or P < 0.05). CONCLUSION: This study suggests that governance structure reform can have positive effects on behaviour for antibiotic prescribing. Moreover, this short-term effect might have important implications for further community health reforms in China.
Authors: Liyan Shen; Oliver James Dyar; Qiang Sun; Xiaolin Wei; Ding Yang; Chengtao Sun; Yang Wang; Hongyu Li; Yuqing Liu; Yanbo Luo; Jia Yin; Cecilia Stålsby Lundborg Journal: Int J Environ Res Public Health Date: 2021-02-17 Impact factor: 3.390
Authors: Guanyang Zou; Xiaolin Wei; Joseph P Hicks; Yanhong Hu; John Walley; Jun Zeng; Helen Elsey; Rebecca King; Zhitong Zhang; Simin Deng; Yuanyuan Huang; Claire Blacklock; Jia Yin; Qiang Sun; Mei Lin Journal: BMJ Open Date: 2016-05-27 Impact factor: 2.692