Hui Li1, Yanhong Gong1, Jing Han2, Shengchao Zhang2, Shanquan Chen3, Xing Xu4, Zuxun Lu1, Xiaoxv Yin1. 1. Department of Social Medicine and Health Management, School of Public Health, Huazhong University of Science and Technology, Wuhan, P. R. China. 2. Department of Community Health Management, Baoan District Central Hospital, Shenzhen, P. R. China. 3. The School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom. 4. German Cancer Research Center (DKFZ), Heidelberg University, Heidelberg, Germany.
Abstract
BACKGROUND: After implementing the 2011 national antimicrobial stewardship campaign, few studies focused on evaluating its effect in China's primary care facilities. METHODS: We randomly selected 11 community health centers in Shenzhen, China, and collected all outpatient prescriptions of these centers from 2010 to 2015. To evaluate the impact of local interventions on antibiotic prescribing, we used a segmented regression model of interrupted time series to analyze 7 outcomes (ie, percentage of prescriptions with antibiotics, and percentages of prescriptions with broad-spectrum antibiotics, with parenteral antibiotics, and with 2 or more antibiotics in all prescriptions or antibiotic-containing prescriptions). RESULTS: Overall, 1 482 223 outpatient prescriptions were obtained. The intervention was associated with a significant immediate change (-5.2%, P = .04) and change in slope (-3.1% per month, P < .01) for the percentage of prescriptions with antibiotics, and its relative cumulative effect at the end of the study was -74.0% (95% confidence interval, -79.0 to -69.1). After the intervention, the percentage of prescriptions with broad-spectrum and with parenteral antibiotics decreased dramatically by 36.7% and 77.3%, respectively, but their percentages in antibiotic-containing prescriptions decreased insignificantly. Percentage of prescriptions with two or more antibiotics in all prescriptions or antibiotic-containing prescriptions only showed immediate changes, but significant changes in slope were not observed. CONCLUSIONS: A typical practice in Shenzhen, China, showed that strict enforcement of the antimicrobial stewardship campaign could effectively reduce antibiotic prescribing in primary care with a stable long-term effect. However, prescribing of broad-spectrum and parenteral antibiotics was still prevalent. More targeted interventions are required to promote appropriate antibiotic use.
BACKGROUND: After implementing the 2011 national antimicrobial stewardship campaign, few studies focused on evaluating its effect in China's primary care facilities. METHODS: We randomly selected 11 community health centers in Shenzhen, China, and collected all outpatient prescriptions of these centers from 2010 to 2015. To evaluate the impact of local interventions on antibiotic prescribing, we used a segmented regression model of interrupted time series to analyze 7 outcomes (ie, percentage of prescriptions with antibiotics, and percentages of prescriptions with broad-spectrum antibiotics, with parenteral antibiotics, and with 2 or more antibiotics in all prescriptions or antibiotic-containing prescriptions). RESULTS: Overall, 1 482 223 outpatient prescriptions were obtained. The intervention was associated with a significant immediate change (-5.2%, P = .04) and change in slope (-3.1% per month, P < .01) for the percentage of prescriptions with antibiotics, and its relative cumulative effect at the end of the study was -74.0% (95% confidence interval, -79.0 to -69.1). After the intervention, the percentage of prescriptions with broad-spectrum and with parenteral antibiotics decreased dramatically by 36.7% and 77.3%, respectively, but their percentages in antibiotic-containing prescriptions decreased insignificantly. Percentage of prescriptions with two or more antibiotics in all prescriptions or antibiotic-containing prescriptions only showed immediate changes, but significant changes in slope were not observed. CONCLUSIONS: A typical practice in Shenzhen, China, showed that strict enforcement of the antimicrobial stewardship campaign could effectively reduce antibiotic prescribing in primary care with a stable long-term effect. However, prescribing of broad-spectrum and parenteral antibiotics was still prevalent. More targeted interventions are required to promote appropriate antibiotic use.