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Effects of prescription restrictive interventions on antibiotic procurement in primary care settings: a controlled interrupted time series study in China

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      Abstract

      BackgroundThe overuse of antibiotics has been identified as a major challenge in regard to the rational prescription of medicines in low and middle income countries. Extensive studies on the effectiveness of persuasive interventions, such as guidelines have been undertaken. There is a dearth of research pertaining to the effects of restrictive interventions. This study aimed to evaluate the impacts of prescription restrictions in relation to types and administration routes of antibiotics on antibiotic procurement in primary care settings in China.MethodsData were drawn from the monthly procurement records of medicines for primary care institutions in Hubei province over a 31-month period from May 2011 to November 2013. We analyzed the monthly procurement volume and costs of antibiotics. Interrupted time series analyses with a difference-in-difference approach were performed to evaluate the effect of the restrictive intervention (started in August 2012) on antibiotic procurement in comparison with those for cardiovascular conditions. Sensitivity tests were performed by replacing outliers using a simple linear interpolation technique.ResultsOver the entire study period, antibiotics accounted for 33.65% of the total costs of medicines procured for primary care institutions: mostly non-restricted antibiotics (86.03%) and antibiotics administered through parenteral routes (79.59%). On average, 17.14 million defined daily doses (DDDs) of antibiotics were procured per month, with the majority (93.09%) for non-restricted antibiotics and over half (52.38%) for parenteral administered antibiotics. The restrictive intervention was associated with a decline in the secular trend of costs for non-restricted oral antibiotics (− 0.36 million Yuan per month, p = 0.029), and for parenteral administered restricted antibiotics (− 0.28 million Yuan per month, p = 0.019), as well as a decline in the secular trend of procurement volume for parenteral administered non-restricted antibiotics (− 0.038 million DDDs per month, p = 0.05).ConclusionsRestrictive interventions are effective in reducing the procurement of antibiotics. However, the effect size is relatively small and antibiotic consumptions remain high, especially parenteral administered antibiotics.

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      Segmented regression analysis of interrupted time series studies in medication use research

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        Outpatient antibiotic use in Europe and association with resistance: a cross-national database study

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          • Article: not found

          Interrupted time series designs in health technology assessment: lessons from two systematic reviews of behavior change strategies.

          In an interrupted time series (ITS) design, data are collected at multiple instances over time before and after an intervention to detect whether the intervention has an effect significantly greater than the underlying secular trend. We critically reviewed the methodological quality of ITS designs using studies included in two systematic reviews (a review of mass media interventions and a review of guideline dissemination and implementation strategies). Quality criteria were developed, and data were abstracted from each study. If the primary study analyzed the ITS design inappropriately, we reanalyzed the results by using time series regression. Twenty mass media studies and thirty-eight guideline studies were included. A total of 66% of ITS studies did not rule out the threat that another event could have occurred at the point of intervention. Thirty-three studies were reanalyzed, of which eight had significant preintervention trends. All of the studies were considered "effective" in the original report, but approximately half of the reanalyzed studies showed no statistically significant differences. We demonstrated that ITS designs are often analyzed inappropriately, underpowered, and poorly reported in implementation research. We have illustrated a framework for appraising ITS designs, and more widespread adoption of this framework would strengthen reviews that use ITS designs.
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            Author and article information

            Affiliations
            [1 ]ISNI 0000 0004 0368 7223, GRID grid.33199.31, School of Medicine and Health Management, , Tongji Medical College, Huazhong University of Science and Technology, ; Wuhan, 430030 People’s Republic of China
            [2 ]ISNI 0000 0001 2342 0938, GRID grid.1018.8, School of Psychology and Public Health, , La Trobe University, Kingsbury Drive, ; Melbourne, VIC 3086 Australia
            Contributors
            dr_tyq@163.com
            c.liu@latrobe.edu.au
            zinan19880609@126.com
            xpzhang602@hust.edu.cn
            Journal
            Cost Eff Resour Alloc
            Cost Eff Resour Alloc
            Cost Effectiveness and Resource Allocation : C/E
            BioMed Central (London )
            1478-7547
            16 January 2018
            16 January 2018
            2018
            : 16
            5771140
            86
            10.1186/s12962-018-0086-y
            © The Author(s) 2018

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

            Funding
            Funded by: Fundamental Research Funds for the Central Universities of Ministry of Education of China
            Award ID: 2017WKYXQY003
            Award Recipient :
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            Research
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            © The Author(s) 2018

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