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Xu X, Zhang K, Ma H, Shen X, Chai J, Tang M, Du Y, Xue Q, Guan X, Li G, Wang D. Differences in service and antibiotics use following symptomatic respiratory tract infections between 2016 and 2021 in rural Anhui, China. Epidemiol Infect 2022; 150:e117. [PMID: 35610736 PMCID: PMC9254148 DOI: 10.1017/s0950268822000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In the past 10-15 years, the government of China has made various efforts in tackling excessive antibiotics use. Yet, little is known about their effects at rural primary care settings. This study aimed to determine the impact of government policies and the COVID-19 pandemic on antibiotic prescribing practices at such settings utilizing data from separate studies carried out pre- and during the pandemic, in 2016 and 2021 in Anhui province, China, using identical sampling and survey approaches. Data on antibiotics prescribed, diagnosis, socio-demographic, etc., were obtained through non-participative observation and a structured exit survey. Data analysis comprised mainly descriptive comparisons of 1153 and 762 patients with respiratory infections recruited in 2016 and 2021, respectively. The overall antibiotics prescription rate decreased from 89.6% in 2016 to 69.1% in 2021, and the proportion of prescriptions for two or more classes of antibiotics was estimated as 35.9% in 2016 and 11.0% in 2021. There was a statistically significant decrease in the number of days from symptom onset to clinic visits between the year groups. In conclusion, measures to constrain excessive prescription of antibiotics have led to some improvements at the rural primary care level, and the COVID-19 pandemic has had varying effects on antibiotic use.
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Affiliation(s)
- Xiuze Xu
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
| | - Kexin Zhang
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
| | - Huan Ma
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
| | - Xingrong Shen
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
| | - Jing Chai
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
| | - Mengsha Tang
- School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yanan Du
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
| | - Qun Xue
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
| | - Xiaoqin Guan
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
| | - Guocheng Li
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
| | - Debin Wang
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
- Author for correspondence: Debin Wang, E-mail:
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Xingrong S, Rui F, Jing C, Jing C, Oliver I, Lambert H, Wang D. Relationships Between Diagnosis, Bacterial Isolation, and Antibiotic Prescription in Out Patients With Respiratory Tract Infection Symptoms in Rural Anhui, China. Front Public Health 2022; 10:810348. [PMID: 35223737 PMCID: PMC8864097 DOI: 10.3389/fpubh.2022.810348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesThis paper aims to explore the direct associations of antibiotics prescription with clinical diagnosis and bacterial detection. It also analyses the relations of clinical diagnosis with symptoms and bacterial detection, with a hope of revealing indirect links to antibiotic prescription.MethodsThe study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. Observations were conducted to record clinical diagnosis and antibiotic prescription. A semi-structured questionnaire survey was used to collected patients' sociodemographic information and reported symptoms. Sputum and throat swabs were collected for bacterial culture.ResultsAmong 1,068 patients presenting in the study settings who received a diagnosis of respiratory tract infection (RTI), 87.8% of prescriptions included an antibiotic and 35.8% included two or more antibiotics. Symptomatic RTI patients to the site clinics were diagnosed mainly as having upper respiratory tract infection (32.0%), bronchitis/tracheitis (23.4%), others (16.6%), pharyngitis (11.1%), common cold (8.0%), pneumonia/bronchopneumonia (4.6%) and tonsillitis (4.3%). These clinical diagnosis were associated with symptoms to a varied degree especially for upper respiratory tract infection and bronchitis/tracheitis. Prescription of any antibiotics was positively associated with diagnosis of bronchitis/tracheitis (OR: 5.00, 95% CI: 2.63–9.51), tonsillitis (OR: 4.63, 95% CI: 1.48–14.46), pneumonia/bronchopneumonia (OR: 4.28, 95% CI: 1.40–13.04), pharyngitis (OR: 3.22, 95% CI: 1.57–6.59) and upper respiratory tract infection (OR: 3.04, 95% CI: 1.75–5.27). Prescription of two or more antibiotics was statistically significant related to diagnosis of bronchitis/ tracheitis (OR: 2.20, 95% CI: 1.44–3.35) or tonsillitis (OR: 2.97, 95% CI: 1.47–6.00). About 30% of the patients were identified with some type of bacteria. Bacteria detection was linked with pharyngitis (OR: 0.50, 95% CI: 0.28–0.88) but not prescription of antibiotics.ConclusionsAntibiotics prescription were found with a strong relation to diagnosis of RTIs given by the clinician but was not associated with the presence of bacteria in patient samples. Part of the diagnosis may have been given by the clinician to justify their antibiotics prescription. There is clear need to use additional measures (e.g., symptoms) in conjunction with diagnosis to supervise or audit excessive antibiotics use.
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Affiliation(s)
- Shen Xingrong
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Feng Rui
- Department of Literature Review and Analysis, Library of Anhui Medical University, Hefei, China
| | - Chai Jing
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Cheng Jing
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Isabel Oliver
- National Infection Service, Public Health England, Bristol, United Kingdom
| | - Helen Lambert
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Debin Wang
- School of Health Service Management, Anhui Medical University, Hefei, China
- *Correspondence: Debin Wang
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