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Public reporting as a prescriptions quality improvement measure in primary care settings in China: variations in effects associated with diagnoses.

ABSTRACT: The overprovision and irrational use of antibiotics and injections are a major public health concern. Public reporting has been adopted as a strategy to encourage good prescribing practices. This study evaluated the effects of public reporting on antibiotic and injection prescriptions in urban and rural primary care settings in Hubei province, China. A randomized control trial was conducted, with 10 primary care institutions being subject to public reporting and another 10 serving as controls. Prescription indicators were publicly reported monthly over a one-year period. Prescriptions for bronchitis, gastritis and hypertension before and after the intervention were collected. Difference-in-difference tests were performed to estimate the effect size of the intervention on five prescription indicators: percentage of prescriptions containing antibiotics; percentage of prescriptions containing two or more antibiotics; percentage of prescriptions containing injections; percentage of prescriptions containing antibiotic injections; and average prescription cost. Public reporting had varied effects on prescriptions for different diagnoses. It reduced antibiotic prescribing for gastritis. Prescriptions containing injections, especially antibiotic injections, also declined, but only for gastritis. A reduction of prescription costs was noted for bronchitis and gastritis. Public reporting has the potential to encourage good prescribing practices. Its effects vary with different disease conditions.

SUBMITTER: Tang Y

PROVIDER: S-EPMC5172199 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

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Public reporting as a prescriptions quality improvement measure in primary care settings in China: variations in effects associated with diagnoses.

Tang Yuqing Y Liu Chaojie C Zhang Xinping X

Scientific reports 20161220

The overprovision and irrational use of antibiotics and injections are a major public health concern. Public reporting has been adopted as a strategy to encourage good prescribing practices. This study evaluated the effects of public reporting on antibiotic and injection prescriptions in urban and rural primary care settings in Hubei province, China. A randomized control trial was conducted, with 10 primary care institutions being subject to public reporting and another 10 serving as controls. P ...[more]

PMID: 27996026

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Project description:BackgroundsMaster of public health (MPH) plays an important role in Chinese medical education, and the dissertations is an important part of MPH education. In MPH dissertations, most are observational studies. Compared with randomized controlled trial (RCT), observational studies are more prone to information bias. So, the reporting of the observational studies should be transparent and standard. But, no research on evaluating the reporting quality of the MPH dissertation has been found.MethodsA systematic literature search was performed in the Wanfang database from January 1, 2014 to May 31, 2019. The Strengthening the Reporting of Observation Studies in Epidemiology (STROBE) statement was adopted to evaluate the reporting quality of the selected studies. Articles that met the following criteria were selected: (1) observational studies, including cross-sectional studies, case-control studies, and cohort studies; (2) original articles; (3) studies on humans, including both adults and children.ResultsThe Median of compliance to individual STROBE items was 74.79%. The mean (standard deviation) of STROBE score was 14.29 (1.84). Five items/sub-items were 100% reported ("reported" and "partly reported" were combined): background, objectives, study design, report numbers of individuals at each stage, and key result. Fifteen items/sub-items were reported by 75% or more. Reporting of methods and results was often omitted: missing data (6.67%), sensitivity analyses (3.63%), flow diagram (15.15%), and absolute risk (0%). Logistic regression analysis indicated that cohort studies (OR = 3.41, 95% CI = 1.27-9.16), funding support (OR = 4.37, 95% CI = 1.27-9.16) and more published papers during postgraduate period (OR = 3.46, 95% CI = 1.40-8.60) were related to high reporting quality.ConclusionIn short, the reporting quality of observational studies in MPH's dissertations in China is suboptimal. However, it's necessary to improve the reporting of method and results sections. We recommend that authors should be stricter to adhere STROBE statement when conducting observational studies.

Project description:BackgroundQuality improvement (QI) initiatives such as accreditation, public reporting, inspection and pay-for-performance are increasingly being implemented globally. In Flanders, Belgium, a government policy for acute-care hospitals incorporates aforementioned initiatives. Currently, questions are raised on the sustainability of the present policy.ObjectiveFirst, to summarise the various initiatives hospitals have adopted under government encouragement between 2008 and 2019. Second, to study the perspectives of healthcare stakeholders on current government policy.MethodsIn this multi-method study, we collected data on QI initiative implementation from governmental and institutional sources and through an online survey among hospital quality managers. We compiled an overview of QI initiative implementation for all Flemish acute-care hospitals between 2008 (n = 62) and 2019 (n = 53 after hospital mergers). Stakeholder perspectives were assessed via a second survey available to all healthcare employees and a focus group with healthcare policy experts was consulted. Variation between professions was assessed.ResultsQI initiatives have been increasingly implemented, especially from 2016 onwards, with the majority (87%) of hospitals having obtained a first accreditation label and all hospitals publicly reporting performance indicators, receiving regular inspections and having entered the pay-for-performance initiative. On the topic of external international accreditation, overall attitudes within the survey were predominantly neutral (36.2%), while 34.5% expressed positive and 29.3% negative views towards accreditation. In examining specific professional groups in-depth, we learned 58% of doctors regarded accreditation negatively, while doctors were judged to be the largest contributors to quality according to the majority of respondents.ConclusionsHospitals have demonstrated increased efforts into QI, especially since 2016, while perceptions on currently implemented QI initiatives among healthcare stakeholders are heterogeneous. To assure quality of care remains a top-priority for acute-care hospitals, we recommend a revision of the current multicomponent quality policy where the adoption of all initiatives is streamlined and co-created bottom-up.

Dataset Information

Public reporting as a prescriptions quality improvement measure in primary care settings in China: variations in effects associated with diagnoses.

Publications

Public reporting as a prescriptions quality improvement measure in primary care settings in China: variations in effects associated with diagnoses.

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