Volume 6, Issue 3, May 2018, Page: 75-81
Impacts of a National Action Plan on Antimicrobial Use in China: A Multi-Center Retrospective Study
Lidao Bao, Department of Pharmacy, Affiliated Hospital of Inner Mongolian Medical University, Hohhot, P. R. China
Gaowa Sharen, Department of Ultrasound, Affiliated Hospital of Inner Mongolian Medical University, Hohhot, P. R. China
Sha Li, Department of Pharmacy, Affiliated Hospital of Inner Mongolian Medical University, Hohhot, P. R. China
Xianhua Ren, Department of Pharmacy, Affiliated Hospital of Inner Mongolian Medical University, Hohhot, P. R. China
Ruilian Ma, Department of Pharmacy, Affiliated Hospital of Inner Mongolian Medical University, Hohhot, P. R. China
Received: May 10, 2018;       Published: May 10, 2018
DOI: 10.11648/j.sjph.20180603.12      View  303      Downloads  19
Abstract
This study retrospectively analyzed antimicrobial prescription and concomitant economic outcomes in 28 Chinese state-owned hospitals before and after the intervention introduced by the Action Plan. The outcomes of national intervention were evaluated by analyzing statistics collected before and after the Action Plan which came into effect as of July 1, 2011. The fourth quarters of 2010 and 2011 were set as the baseline and intervention periods, respectively. The percentage of patients receiving antimicrobial prescription, the intensity of antimicrobials prescribed, economic indexes related to antimicrobial prescribing, and antimicrobial prophylaxis in clean surgical procedures were investigated, respectively. First, during the intervention period, the percentage of patients receiving antimicrobial treatment dropped to 15.6% and 49.1% in outpatient and inpatient settings, respectively. The intensity of antimicrobial prescribed decreased to 50.29 DDD (defined daily dose) in outpatient setting. The defined daily doses (DDDs) per thousand patients per day decreased to 12914.33 DDDs in outpatient settings. The results were statistically significant as compared to those in the baseline period (P<0.001). Second, the expenses on antimicrobials significantly decreased (P<0.001). Finally, the percentage of patients receiving antimicrobial prophylaxis for clean surgical procedures decreased to 48.94% (P<0.001), while the infection rates did not differ significantly (P=0.581). This multi-center study suggests that the Action Plan launched by China’s government proved effective in state-owned medical institutions in promoting rational antimicrobial prescription.
Keywords
Antimicrobial Use, Multi-center Study, Action Plan
To cite this article
Lidao Bao, Gaowa Sharen, Sha Li, Xianhua Ren, Ruilian Ma, Impacts of a National Action Plan on Antimicrobial Use in China: A Multi-Center Retrospective Study, Science Journal of Public Health. Vol. 6, No. 3, 2018, pp. 75-81. doi: 10.11648/j.sjph.20180603.12
Reference
[1]
Ashley D, Brindle M. Penicillin resistance in staphylococci isolated in a casualty department. J Clin Pathol. 1960; 13: 336-338.
[2]
Standing Medical Advisory Committee Sub-Group on Antimicrobial Resistance. 1998. The path of least resistance. London: Department of Health. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009357.
[3]
World Health Organization. 2011. Antimicrobial resistance. Fact Sheet N 194. http://www.who.int/mediacentre/factsheets/fs194/en/index.html
[4]
Hui L, Li XS, Zeng XJ, Dai YH, Foy HM. Patterns and determinants of use of antimicrobials for acute respiratory tract infection in children in China. Paediatr Infect Dis J. 1997; 16: 560–564.
[5]
Xiao YH, Giske CG, Wei ZQ, Shen P, Heddini A, Li LJ. Epidemiology and characteristics of antimicrobial resistance in China. Drug Resist Update. 2011; 14: 236-250.
[6]
Alonso R, Padilla B, Sánchez-Carrillo C, Muñoz P, Rodríguez-Creixems M, Bouza E. Outbreak among HIV-infected patients of Staphylococcus aureus resistant to cotrimoxazole and methicillin. Infect Control Hosp Epidemiol. 1997; 18: 617–621.
[7]
Woods RK, Dellinger EP. Current guidelines for antimicrobial prophylaxis of surgical wounds. Am Fam Physician. 1998; 57: 2731–2740.
[8]
Swedish-Norwegian Consensus Group. Antimicrobial prophylaxis in surgery: summary of a Swedish-Norwegian Consensus Conference. Scand J Infect Dis. 1998; 30: 547–557.
[9]
Nichter M. Pharmaceuticals, health commodification and social relations: ramifications for primary health care, Anthropology and International Health, South Asian Case Studies, Kluwer Academic Publishers; 1989. Section 3, No. 9: 233–277.
[10]
Branthwaite A, Pechere JC. Pan-European survey of patients’ attitudes to antimicrobials and antimicrobial use. J Intern Med Res. 1996; 24: 229–238.
[11]
Zhan SK, Tang SL, Guo YD, Bloom G. Drug prescribing in rural health facilities in China: implications for service quality and cost. Trop Doct. 1998; 28: 42–48.
[12]
Geneva: World Health Organization. 2001. Global strategy for the containment of antimicrobial resistance. http://www.who.int/csr/resources/publications/drugresist/WHO_CDS_CSR_DRS_2001_2_EN/en/
[13]
Center for Disease Control and Prevention. 2001. US Public Health Action Plan to Combat Antimicrobial Resistance (Part 1: Domestic Issues). http://www.cdc.gov/drugresistance/actionplan/actionplan.html
[14]
Health Canada. Controlling Antimicrobial Resistance: An Integrated Action Plan for Canadians. Can Comm Dis Rep (CCDR). 1997; Suppl 23S7:1–32.
[15]
European Commission DGXXIV. 1999. Opinion of the Scientific Steering Committee on Antimicrobial Resistance. http://ec.europa.eu/food/fs/sc/ssc/out50_en.pdf
[16]
.Ma XW. 2011. Video Conference on “National Antimicrobial Action Plan”. http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohzcfgs/s7857/201106/52208.htm
[17]
State Council of the People’s Republic of China. 2011. National Antimicrobial Action Plan (trial, in Chinese). State Council Document 2011(75). http://bmyj.chinalaw.gov.cn/lismsPro/law_download/fulltext/1312360890480.doc
[18]
Ministry of Health. 2011. Regulation of pharmaceutical affairs administration in medical institutions (In Chinese). http://www.satcm.gov.cn/web2010/zhengwugongkai/zhengcefagui/falvfagui/guizhang/2011-04-07/13297.html
[19]
.Ministry of Health. 2009. National Essential Medicine List (In Chinese). http://www.gov.cn/gzdt/2009-08/18/content_1395524.htm.
[20]
Ministry of Health. Chinese National Formulary (In Chinese). Beijing: People’s Military Medical Press; 2010.
[21]
Chinese Medical Association, Pharmacy Professional Advisory Committee of Chinese Hospital Association, Hospital Pharmacy Advisory Committee of Chinese Pharmaceutical Association. Guiding Principles for Clinical Application of Antimicrobials. Adver Drug React J. 2005; 7: 42.
[22]
Surgery Branch of Chinese Academy of Medical Sciences, Editorial Board of Chinese Journal of Surgery. Guideline for Perioperative Antimicrobial Prophylaxis. Chin J Surg. 2006; 44: 1594.
[23]
Ministry of Health. 2009. Principles for perioperative prophylactic treatment in clean surgical procedures (In Chinese). http://www.moh.gov.cn/publicfiles/business/cmsresources/mohylfwjgs/cmsrsdocument/doc6647.doc
[24]
Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA, Small SD, Sweitzer BJ, Leape LL. The costs of adverse drug events in hospitalized patients. JAMA. 1997; 227: 307–311.
[25]
Bates DW, Leape LL, Cullen DJ, Laird N, Petersen LA, Teich JM, Burdick E, Hickey M, Kleefield S, Shea B, Vander Vliet M, Seger DL. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998; 280: 1311–1316.
[26]
Ministry of Health. 2010. National Antimicrobial Surveillance System (In Chinese). http://www.chinadtc.org.cn/index.php?option=com_content&module=24&sortid=0&artid=0&menuid=35
[27]
Allender S, Gleeson E, Crammond B, Sacks G, Lawrence M, Peeters A, Loff B, Swinburn B. Policy change to create supportive environments for physical activity and healthy eating: which options are the most realistic for local government? Health Promot Int. 2012; 27: 261-274.
[28]
Fobil JN, Soyiri IN. An assessment of government policy response to HIV/AIDS in Ghana. SAHARA J. 2006; 3: 457-465.
[29]
Bowen S, Zwi A, Sainsbury P. What evidence informs government population health policy? Lessons from early childhood intervention policy in Australia. N S W Public Health Bull. 2005; 16: 180-184.
[30]
Ministry of Health of the People’s Republic of China. 2011. Action Plan for the Clinical Use of antimicrobials in 2011. http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohyzs/s3578/201104/51283.htm
[31]
Oishi T, Hitomi S, Kamoshita M, Fukue H, Kawahata D, Fukutake K. [Comparison of antimicrobial use density (AUD) of carbapenem antimicrobial agents and investigation of the drug susceptibility of Pseudomonas aeruginosa in 3 hospitals in southern Ibaraki Prefecture, Japan]. Rinsho Byori. 2008; 56: 570-576.
[32]
Campbell DT, Stanley JC. Experimental and quasi-experimental designs for research. Chicago, IL: Rand-McNally; 1963.
[33]
Cook TD, Campbell DT. Quasi-experimentation: Design and analysis issues for field settings. Boston, MA: Houghton Mifflin Company; 1979.
[34]
Varkevisser CM, Pathmanathan I, Brownlee A. Designing and conducting health systems research. Health Systems Research Training Series. Vol. 2 Part 1. Ottawa: International Development Research Centre; 1991.
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