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Musuroi SI, Voinescu A, Musuroi C, Baditoiu LM, Muntean D, Izmendi O, Jumanca R, Licker M. The Challenges of The Diagnostic and Therapeutic Approach of Patients with Infectious Pathology in Emergency Medicine. J Pers Med 2023; 14:46. [PMID: 38248747 PMCID: PMC10821085 DOI: 10.3390/jpm14010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/23/2023] [Accepted: 12/24/2023] [Indexed: 01/23/2024] Open
Abstract
The emergency department (ED) represents an important setting for addressing inappropriate antimicrobial prescribing practices because of the time constraints and the duration of microbiological diagnosis. The purpose of this study is to evaluate the etiology and antimicrobial resistance (AMR) pattern of the community-acquired pathogens, as well as the epidemiological characteristics of patients admitted through the ED, in order to guide appropriate antibiotic therapy. METHODS A retrospective observational study was performed on 657 patients, from whom clinical samples (urine, purulent secretions, blood cultures, etc.) were collected for microbiological diagnosis in the first 3 days after presentation in the ED. The identification of pathogens and the antimicrobial susceptibility testing with minimum inhibitory concentration determination were carried out according to the laboratory protocols. RESULTS From the 767 biological samples analyzed, 903 microbial isolates were identified. E. coli was most frequently isolated (24.25%), followed by Klebsiella spp., S. aureus (SA), and non-fermentative Gram-negative bacilli. E. coli strains maintained their natural susceptibility to most antibiotics tested. In the case of Pseudomonas spp. and Acinetobacter spp., increased rates of AMR were identified. Also, 32.3% of SA strains were community-acquired MRSA. CONCLUSIONS The introduction of rapid microbiological diagnostic methods in emergency medicine is imperative in order to timely identify AMR strains and improve therapeutic protocols.
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Affiliation(s)
- Silvia Ioana Musuroi
- Doctoral School, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.I.M.)
- Internal Medicine Department, Municipal Emergency Clinical Hospital, 300254 Timisoara, Romania
| | - Adela Voinescu
- Doctoral School, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.I.M.)
- Microbiology Department, Multidisciplinary Research Center of Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.M.); (M.L.)
- Microbiology Laboratory, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Corina Musuroi
- Microbiology Department, Multidisciplinary Research Center of Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.M.); (M.L.)
- Microbiology Laboratory, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Luminita Mirela Baditoiu
- Epidemiology Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Delia Muntean
- Microbiology Department, Multidisciplinary Research Center of Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.M.); (M.L.)
- Microbiology Laboratory, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Oana Izmendi
- Doctoral School, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.I.M.)
- Microbiology Department, Multidisciplinary Research Center of Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.M.); (M.L.)
- Microbiology Laboratory, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Romanita Jumanca
- Romanian and Foreign Languages Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Monica Licker
- Microbiology Department, Multidisciplinary Research Center of Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.M.); (M.L.)
- Microbiology Laboratory, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
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Kiggundu R, Waswa JP, Nakambale HN, Kakooza F, Kassuja H, Murungi M, Akello H, Morries S, Joshi MP, Stergachis A, Konduri N. Development and evaluation of a continuous quality improvement programme for antimicrobial stewardship in six hospitals in Uganda. BMJ Open Qual 2023; 12:e002293. [PMID: 37336576 DOI: 10.1136/bmjoq-2023-002293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/27/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Appropriate antimicrobial use is essential for antimicrobial stewardship (AMS). Ugandan hospitals are making efforts to improve antibiotic use, but improvements have not been sufficiently documented and evaluated. METHODS Six Ugandan hospitals implemented AMS interventions between June 2019 and July 2022. We used the WHO AMS toolkit to set-up hospital AMS programmes and implemented interventions using continuous quality improvement (CQI) techniques and targeting conditions commonly associated with antibiotic misuse, that is, urinary tract infections (UTIs), upper respiratory tract infections (URTIs) and surgical antibiotic prophylaxis (SAP). The interventions included training, mentorship and provision of clinical guidelines to support clinical decision-making. Quarterly antibiotic use surveys were conducted. RESULTS Data were collected for 7037 patients diagnosed with UTIs. There was an increase in the proportion of patients receiving one antibiotic for the treatment of UTI from 48% during the pre-intervention to 73.2%, p<0.01. There was a 19.2% reduction in the number of antimicrobials per patient treated for UTI p<0.01. There was an increase in use of nitrofurantoin, the first-line drug for the management of UTI. There was an increase in the use of Access antibiotics for managing UTIs from 50.4% to 53.8%. The proportion of patients receiving no antimicrobials for URTI increased from 26.3% at pre-intervention compared with 53.4% at intervention phase, p<0.01. There was a 20.7% reduction in the mean number of antimicrobials per patient for URTI from the pre-intervention to the intervention phase, from 0.8 to 0.6, respectively, p<0.001 and reduction in the number of treatment days, p=0.0163. Among patients undergoing surgery, 49.5% (2212) received SAP during the pre-intervention versus 50.5% (2169) during the intervention. CONCLUSIONS Using CQI approaches to focus on specific causes of inappropriate antibiotic use led to desirable overall reductions in antibiotic use for URTI and UTI.
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Affiliation(s)
- Reuben Kiggundu
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kampala, Uganda
| | - J P Waswa
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kampala, Uganda
| | - Hilma N Nakambale
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Francis Kakooza
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Hassan Kassuja
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kampala, Uganda
| | - Marion Murungi
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kampala, Uganda
| | | | - Seru Morries
- Department of Pharmaceuticals and Natural Medicines, Ministry of Health, Kampala, Uganda
| | - Mohan P Joshi
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, Virginia, USA
| | - Andy Stergachis
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Pharmacy, University of Washington School of Pharmacy, Seattle, Washington, USA
| | - Niranjan Konduri
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, Virginia, USA
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Amponsah OKO, Ayisi-Boateng NK, Nagaraja SB, Nair D, Muradyan K, Hedidor GK, Labi AK, Opare-Addo MNA, Sarkodie E, Buabeng KO. Adherence to Prescribing Indicators at a District Hospital in Ghana: Do We Match WHO Standards? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12260. [PMID: 36231554 PMCID: PMC9566632 DOI: 10.3390/ijerph191912260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/16/2022] [Accepted: 09/24/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Rational use of medicines (RUM) and their assessment are important to ensure optimal use of resources and patient care in hospitals. These assessments are essential to identifying practice gaps for quality improvement. (2) Methods: Assessment of adherence to WHO/International Network for Rational Use of Drugs core prescribing indicators among outpatients in 2021 was conducted at the University Hospital of the Kwame Nkrumah University of Science and Technology in the Ashanti Region of Ghana. We reviewed electronic medical records (EMR) of 110,280 patient encounters in the year which resulted in 336,087 medicines prescribed. (3) Results: The average number of medicines prescribed per encounter was three, with generics being prescribed in 76% of prescriptions. Injections were prescribed in 7% of encounters while 90% of medicines were from Ghana's Essential Medicines List, 2017. (4) Conclusions: With the exception of patient encounters with injections, none of the prescribing indicators assessed in this study met WHO optimum levels, providing targets for quality improvement in RUM. Implementing prescribing guides and policies, regular audits and feedback as well as continuous professional development training may help to improve prescribing practices in the hospital.
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Affiliation(s)
- Obed Kwabena Offe Amponsah
- Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology, Kumasi 00233, Ghana
| | - Nana Kwame Ayisi-Boateng
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi 00233, Ghana
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi 00233, Ghana
| | | | - Divya Nair
- International Union Against TB and Lung Disease (The Union), 75006 Paris, France
| | - Karlos Muradyan
- Tuberculosis Research and Prevention Center, Yerevan 0014, Armenia
| | - George Kwesi Hedidor
- WHO Country Office, Ghana, 7 Ameda Street, Roman Ridge, Accra P.O. Box MB 142, Ghana
| | - Appiah-Korang Labi
- WHO Country Office, Ghana, 7 Ameda Street, Roman Ridge, Accra P.O. Box MB 142, Ghana
| | | | - Emmanuel Sarkodie
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi 00233, Ghana
| | - Kwame Ohene Buabeng
- Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology, Kumasi 00233, Ghana
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Yi S, Ramachandran A, Epps L, Mayah A, Burkholder TW, Jaung MS, Haider A, Whesseh P, Shakpeh J, Enriquez K, Bills C. Emergency department antimicrobial use in a low-resource setting: results from a retrospective observational study at a referral hospital in Liberia. BMJ Open 2022; 12:e056709. [PMID: 35437249 PMCID: PMC9016394 DOI: 10.1136/bmjopen-2021-056709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Data on antimicrobial use in low-income and middle-income countries (LMICs) remain limited. In Liberia, the absence of local data impedes surveillance and may lead to suboptimal treatment, injudicious use and resistance against antimicrobials. This study aims to examine antimicrobial prescribing patterns for patients in the emergency department (ED) of a large Liberian public hospital. Secondarily, this prescribing was compared with WHO prescribing indicators. DESIGN Retrospective observational study. SETTING An adult ED of a large public hospital in Monrovia, Liberia. PARTICIPANTS A total of 1082 adult patients (>18 years of age) were recorded in the ED, from 1 January to 30 June 2019. MAIN OUTCOME MEASURES Number, type and name of antimicrobials ordered per patient were presented as number and percentages, with comparison to known WHO prescribing indicators. Pearson χ2 tests were used to assess patient variables and trends in medication use. RESULTS Of the total patients, 44.0% (n=476) were female and the mean age was 40.2 years (SD=17.4). An average of 2.78 (SD=2.02) medicines were prescribed per patient encounter. At least one antimicrobial was ordered for 64.5% encounters (n=713) and two or more antimicrobials for 35.7% (n=386). All antimicrobial orders in our sample used the generic name. Ceftriaxone, metronidazole and ampicillin were the most common and accounted for 61.2% (n=743) of antimicrobial prescriptions. The majority (99.9%, n=1211) of antimicrobials prescribed were from the WHO Essential Drugs List. CONCLUSION This study is one of the first on ED-specific antimicrobial use in LMICs. We revealed a high rate of antimicrobial prescription, regardless of patient demographic or diagnosis. While empiric antimicrobial use is justified in certain acute clinical scenarios, the high rate from this setting warrants further investigation. The results of this study underscore the importance of ED surveillance to develop targeted antimicrobial stewardship interventions and improve patient care.
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Affiliation(s)
- Sojung Yi
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Anu Ramachandran
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Lane Epps
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Alex Mayah
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Taylor W Burkholder
- Department of Emergency Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael Senyu Jaung
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ahson Haider
- San Francisco State University, San Francisco, California, USA
| | | | | | - Kayla Enriquez
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Corey Bills
- Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
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The Pattern of Medicine Use in Ethiopia Using the WHO Core Drug Use Indicators. BIOMED RESEARCH INTERNATIONAL 2022; 2021:7041926. [PMID: 34980999 PMCID: PMC8720245 DOI: 10.1155/2021/7041926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 10/14/2021] [Accepted: 12/07/2021] [Indexed: 12/03/2022]
Abstract
Introduction Rational medicine use is an appropriate prescribing, dispensing, and patient use of medicines for the diagnosis, prevention, and treatment of diseases. It is affected by several factors. Irrational use of medicine is a widespread problem at all levels of care. This review is aimed at assessing the medicine use pattern in health facilities of Ethiopia using the medicine use pattern developed by WHO/INRUD. Methods Relevant literature was searched from Google Scholar, PubMed, Hinari, Web of Science, and Scopus using inclusion and exclusion criteria. A systematic review was used to summarize the medicine use pattern in health facilities of Ethiopia, and that WHO core drug use indicators were employed. Result From 188 searched studies, 30 literatures were reviewed. The average number of drugs per encounter was 2.11. The percentage of encounters with antibiotics and injection was 57.16% and 22.39%, respectively. The percentage of drugs prescribed by generic name and from an essential drug list was 91.56% and 90.19%, respectively. On average, patients spent 5.14 minutes for consultation and 106.52 seconds for dispensing. From prescribed drugs, 67.79% were dispensed, while only 32.25% were labeled adequately. The availability of key essential medicines was 64.87%. The index of rational drug use value was 7.26. Moreover, the index of rational drug prescribing, index of rational patient-care drug use, and index of rational facility-specific drug use were 3.74, 2.51, and 1.01, respectively. Conclusion Ethiopian health facilities were faced with antibiotic overprescribing, short consultation, and dispensing times, poor labeling of medicines, poor availability of key drugs, and nonadherence to the essential drug list. Routine, multidisciplinary awareness creation, and regulation should be implemented to promote rational medicine use at a national level.
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Alagha MA, Young-Gough A, Lyndon M, Walker X, Cobb J, Celi LA, Waters DL. AIM and Patient Safety. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dixon J, MacPherson EE, Nayiga S, Manyau S, Nabirye C, Kayendeke M, Sanudi E, Nkaombe A, Mareke P, Sitole K, de Lima Hutchison C, Bradley J, Yeung S, Ferrand RA, Lal S, Roberts C, Green E, Denyer Willis L, Staedke SG, Chandler CIR. Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe. BMJ Glob Health 2021; 6:e006920. [PMID: 34836911 PMCID: PMC8628329 DOI: 10.1136/bmjgh-2021-006920] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/12/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND As concerns about the prevalence of infections that are resistant to available antibiotics increase, attention has turned toward the use of these medicines both within and outside of formal healthcare settings. Much of what is known about use beyond formal settings is informed by survey-based research. Few studies to date have used comparative, mixed-methods approaches to render visible patterns of use within and between settings as well as wider points of context shaping these patterns. DESIGN This article analyses findings from mixed-methods anthropological studies of antibiotic use in a range of rural and urban settings in Zimbabwe, Malawi and Uganda between 2018 and 2020. All used a 'drug bag' survey tool to capture the frequency and types of antibiotics used among 1811 households. We then undertook observations and interviews in residential settings, with health providers and key stakeholders to better understand the stories behind the most-used antibiotics. RESULTS The most self-reported 'frequently used' antibiotics across settings were amoxicillin, cotrimoxazole and metronidazole. The stories behind their use varied between settings, reflecting differences in the configuration of health systems and antibiotic supplies. At the same time, these stories reveal cross-cutting features and omissions of contemporary global health programming that shape the contours of antibiotic (over)use at national and local levels. CONCLUSIONS Our findings challenge the predominant focus of stewardship frameworks on the practices of antibiotic end users. We suggest future interventions could consider systems-rather than individuals-as stewards of antibiotics, reducing the need to rely on these medicines to fix other issues of inequity, productivity and security.
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Affiliation(s)
- Justin Dixon
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Eleanor Elizabeth MacPherson
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Susan Nayiga
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Salome Manyau
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | | | - Esnart Sanudi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Alex Nkaombe
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Portia Mareke
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Kenny Sitole
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Coll de Lima Hutchison
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - John Bradley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Shunmay Yeung
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Rashida Abbas Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Sham Lal
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Chrissy Roberts
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Edward Green
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Sarah G Staedke
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare I R Chandler
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Alagha MA, Young-Gough A, Lyndon M, Walker X, Cobb J, Celi LA, Waters DL. AIM and Patient Safety. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_272-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chin MC, Sivasampu S, Wijemunige N, Rannan-Eliya RP, Atun R. The quality of care in outpatient primary care in public and private sectors in Malaysia. Health Policy Plan 2020; 35:7-15. [PMID: 31625556 DOI: 10.1093/heapol/czz117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 11/13/2022] Open
Abstract
In Malaysia, first-contact, primary care is provided by parallel public and private sectors, which are completely separate in organization, financing and governance. As the country considers new approaches to financing, including using public schemes to pay for private care, it is crucial to examine the quality of clinical care in the two sectors to make informed decisions on public policy. This study intends to measure and compare the quality of clinical care between public and private primary care services in Malaysia and, to the extent possible, assess quality with the developed economies that Malaysia aspires to join. We carried out a retrospective analysis of the National Medical Care Survey 2014, a nationally representative survey of doctor-patient encounters in Malaysia. We assessed clinical quality for 27 587 patient encounters using data on 66 internationally validated quality indicators. Aggregate scores were constructed, and comparisons made between the public and private sectors. Overall, patients received the recommended care just over half the time (56.5%). The public sector performed better than the private sector, especially in the treatment of acute conditions, chronic conditions and in prescribing practices. Both sectors performed poorly in the indicators that are most resource intensive, suggesting that resource constraints limit overall quality. A comparison with 2003 data from the USA, suggests that performance in Malaysia was similar to that a decade earlier in the USA for common indicators. The public sector showed better performance in clinical care than the private sector, contrary to common perceptions in Malaysia and despite providing worse consumer quality. The overall quality of outpatient clinical care in Malaysia appears comparable to other developed countries, yet there are gaps in quality, such as in the management of hypertension, which should be tackled to improve overall health outcomes.
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Affiliation(s)
- May Chien Chin
- Institute of Clinical Research, Ministry of Health Malaysia, Block B4, National Institutes of Health (NIH), No.1, Jalan Setia Murni U13/52, Seksyen U13, Shah Alam, 40170 Selangor Darul Ehsan, Malaysia
| | - Sheamini Sivasampu
- Institute of Clinical Research, Ministry of Health Malaysia, Block B4, National Institutes of Health (NIH), No.1, Jalan Setia Murni U13/52, Seksyen U13, Shah Alam, 40170 Selangor Darul Ehsan, Malaysia
| | | | | | - Rifat Atun
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
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Tang Y, Liu C, Zhang Z, Zhang X. Effects of prescription restrictive interventions on antibiotic procurement in primary care settings: a controlled interrupted time series study in China. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:1. [PMID: 29371833 PMCID: PMC5771140 DOI: 10.1186/s12962-018-0086-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 01/03/2018] [Indexed: 12/12/2022] Open
Abstract
Background The 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. Methods Data 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. Results Over 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). Conclusions Restrictive 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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Affiliation(s)
- Yuqing Tang
- 1School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 People's Republic of China
| | - Chaojie Liu
- 2School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Melbourne, VIC 3086 Australia
| | - Zinan Zhang
- 1School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 People's Republic of China
| | - Xinping Zhang
- 1School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 People's Republic of China
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Atif M, Scahill S, Azeem M, Sarwar MR, Babar ZUD. Drug utilization patterns in the global context: A systematic review. HEALTH POLICY AND TECHNOLOGY 2017. [DOI: 10.1016/j.hlpt.2017.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Performance associated effect variations of public reporting in promoting antibiotic prescribing practice: a cluster randomized-controlled trial in primary healthcare settings. Prim Health Care Res Dev 2017; 18:482-491. [PMID: 28606190 DOI: 10.1017/s1463423617000329] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim To evaluate the variations in effect of public reporting in antibiotic prescribing practice among physicians with different performance in primary healthcare settings. BACKGROUND Overprovision of antibiotics is a major public health concern. Public reporting has been adopted to encourage good antibiotic prescribing practices. However, which group, for instance, high, average or low antibiotic prescribers, accounted for antibiotic prescription reduction has not been fully understood. METHODS A cluster randomized-controlled trial was conducted. In total, 20 primary healthcare institutions in Qianjiang city were paired through a six indicators-synthesized score. Coin flipping was used to assign control-intervention status; 10 were then subjected to intervention where prescription indicators were publicly reported monthly over a one-year period. Prescriptions for upper respiratory tract infections (URTIs) before and after the intervention were collected. Physicians were divided into high, average and low antibiotic prescribers based on their antibiotic prescribing rates last month, which were publicly reported in intervention arm. Multilevel difference-in-differences logit regressions were performed to estimate intervention effect in each physician group on three outcome indicators: prescriptions containing antibiotics, two or more antibiotics and antibiotic injections. Findings In total, 31 460 URTI prescriptions were collected (16 170 in intervention arm and 15 290 in control arm). Reduction in antibiotic prescription attributed to intervention was 2.82% [95% confidence intervals (CI): -4.09, -1.54%, P<0.001], least significant in low prescribers (-1.41%, 95% CI: -3.81, 0.99%, P=0.249) and most significant in average prescribers (-5.01%, 95% CI: -6.94, -3.07%, P<0.001). Reduction in combined antibiotics prescriptions attributed to intervention was 3.81% (95% CI: -5.23, -2.39%, P<0.001), least significant in low prescribers (-2.42%, 95% CI: -4.39, -0.45%, P=0.016) and most significant in average prescribers (-5.01%, 95% CI: -7.47, -2.56%, P<0.001). CONCLUSION Public reporting can positively influence antibiotic prescribing patterns of physicians for URTIs in primary care settings, with reduction in antibiotic and combined antibiotic prescriptions. The reduction was mainly attributed to average and high antibiotic prescribers.
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Assessment of Medication Use among University Students in Ethiopia. ScientificWorldJournal 2017; 2017:4530183. [PMID: 28393101 PMCID: PMC5368397 DOI: 10.1155/2017/4530183] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/02/2017] [Accepted: 02/15/2017] [Indexed: 11/29/2022] Open
Abstract
Background. The extent, nature, and determinants of medication use of individuals can be known from drug utilization studies. Objectives. This study intended to determine medication consumption, sharing, storage, and disposal practices of university students in Northwest Ethiopia. Methods. A descriptive cross-sectional study was conducted on 404 university students selected through stratified random sampling technique. Data were collected using self-administered questionnaire and analyzed with SPSS version 20 statistical software. Pearson's Chi-square test of independence was conducted with P < 0.05 taken as statistically significant. Results. At 95.3% response rate, the prevalences of medication consumption and sharing were 35.3% (N = 136) and 38.2% (N = 147), respectively. One hundred (26%) respondents admitted that they often keep leftover medications for future use while the rest (N = 285, 74%) discard them primarily into toilets (N = 126, 44.2%). Evidence of association existed between medication taking and year of study (P = 0.048), medication sharing and sex (P = 0.003), and medication sharing and year of study (P = 0.015). Conclusion. There is a high prevalence of medication consumption, medication sharing, and inappropriate disposal practices which are influenced by sex and educational status of the university students. Thus medication use related educational interventions need to be given to students in general.
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Saha S, Hossain MT. Evaluation of medicines dispensing pattern of private pharmacies in Rajshahi, Bangladesh. BMC Health Serv Res 2017; 17:136. [PMID: 28193274 PMCID: PMC5307842 DOI: 10.1186/s12913-017-2072-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 02/07/2017] [Indexed: 11/21/2022] Open
Abstract
Background In developing country like BANGLADESH, people depend more on pharmacies due to expediency, shorter waiting time, cost reduction, availability of credit and flexible opening hours. The aim of this study was to investigate medicines dispensing patterns of the pharmacies in RAJSHAHI, BANGLADESH and to identify and analyze contribution of drugsellers and quacks in irrational drug use. Methods This cross-sectional study was conducted during January 2016 - April, 2016 in 75 randomly selected private pharmacies including both licensed and unlicensed pharmacies of covering LAKSHMIPUR area. Result During the whole study process, total 7944 clients visited the pharmacies under observation and 24,717 medicines were dispensed. 22.70% of all these drugs were sold without a prescription. Out of the 5610 items dispensed without prescription, 66.2% were dispensed on the request of clients themselves and 33.8% on the recommendation of a drug seller. Number of medicine in a prescription was highly variable ranging from 2 to 5 medicines per prescriptions (mean = 3.03). The average number of medicines dispensed from each of the pharmacies during the observation period was 392, varied pharmacy to pharmacy – ranging from 194 to 588. Lowest selling medicines were sedative and hypnotics and highest selling medicines were antimicrobials. The recommendation rate for antibiotics was highest for the quacks (26.48%) though the major amount of the antimicrobials (n = 3039, 65.83%) were dispensed on prescription. Macrolides, quinolones, metronidazoles and cephalosporins are most favourite drug of quacks, clients and pharmacists. Conclusion Majority of medicines were dispensed irrationally without any prescription and over the counter dispensing of many low safety profile drugs was common. The results and discussion presented in this paper will be helpful to provide a baseline to redirect further studies in this area. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2072-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shuvashis Saha
- Rajshahi Medical College, University of Rajshahi, 6002, Rajshahi, Bangladesh.
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Public reporting as a prescriptions quality improvement measure in primary care settings in China: variations in effects associated with diagnoses. Sci Rep 2016; 6:39361. [PMID: 27996026 PMCID: PMC5172199 DOI: 10.1038/srep39361] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 11/18/2016] [Indexed: 12/15/2022] Open
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.
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Yao Q, Liu C, Ferrier JA, Liu Z, Sun J. Urban-rural inequality regarding drug prescriptions in primary care facilities - a pre-post comparison of the National Essential Medicines Scheme of China. Int J Equity Health 2015. [PMID: 26219841 PMCID: PMC4518678 DOI: 10.1186/s12939-015-0186-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective To assess the impact of the National Essential Medicines Scheme (NEMS) with respect to urban-rural inequalities regarding drug prescriptions in primary care facilities. Methods A stratified two-stage random sampling strategy was used to sample 23,040 prescriptions from 192 primary care facilities from 2009 to 2010. Difference-in-Difference (DID) analyses were performed to test the association between NEMS and urban-rural gaps in prescription patterns. Between-Group Variance and Theil Index were calculated to measure urban-rural absolute and relative disparities in drug prescriptions. Results The use of the Essential Medicines List (EML) achieved a compliance rate of up to 90 % in both urban and rural facilities. An overall reduction of average prescription cost improved economic access to drugs for patients in both areas. However, we observed an increased urban-rural disparity in average expenditure per prescription. The rate of antibiotics and glucocorticoids prescription remained high, despite a reduced disparity between urban and rural facilities. The average incidence of antibiotic prescription increased slightly in urban facilities (62 to 63 %) and reduced in rural facilities (67 % to 66 %). The urban-rural disparity in the use of parenteral administration (injections and infusions) increased, albeit at a high level in both areas (44 %-52 %). Conclusion NEMS interventions are effective in reducing the overall average prescription costs. Despite the increased use of the EML, indicator performances with respect to rational drug prescribing and use remain poor and exceed the WHO/INRUD recommended cutoff values and worldwide benchmarks. There is an increased gap between urban and rural areas in the use of parenteral administration and expenditure per prescription.
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Affiliation(s)
- Qiang Yao
- School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei, 430072, China.
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - J Adamm Ferrier
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Zhiyong Liu
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
| | - Ju Sun
- School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei, 430072, China.
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Rannan-Eliya RP, Wijemanne N, Liyanage IK, Jayanthan J, Dalpatadu S, Amarasinghe S, Anuranga C. The quality of outpatient primary care in public and private sectors in Sri Lanka--how well do patient perceptions match reality and what are the implications? Health Policy Plan 2014; 30 Suppl 1:i59-74. [PMID: 25355069 DOI: 10.1093/heapol/czu115] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare the quality of clinical care and patient satisfaction in public and private outpatient primary care services in Sri Lanka. METHODS A prospective, cross-sectional comparison was done by direct observation of patient encounters and exit interviews of outpatients in 10 public hospital general outpatient clinics and 66 private practitioner clinics in three districts of Sri Lanka. A total of 1027 public sector patients and 944 private sector patients were surveyed. Data were collected for 39 quality indicators covering diarrhoea, cough, hypertension, diabetes, asthma, upper respiratory tract infections (URTI) and five other conditions, along with prescribing indicators. The exit interviews collected data for 10 patient satisfaction indicators. RESULTS The public sector performed better for some conditions (diarrhoea, cough and asthma) and the private sector performed better for others (hypertension, diabetes, URTI and tonsillitis). Overall quality was similar between the sectors in the domains of history taking, examination and investigations and management, but the private sector performed much better on patient education (57 vs 12%). Overall patient satisfaction was high in both sectors (98%), although the private sector performed much better in interpersonal satisfaction (94 vs 84%) and system-related indicators (95 vs 84%). Comparisons with studies from other countries suggest that both sectors perform considerably better than India, and similarly in many indicators to high-income countries. CONCLUSIONS Quality of outpatient primary care in Sri Lanka is generally high for a lower-middle income developing country. The public and private sectors perform similarly, except that private sector patients have longer consultations, are more likely to receive education and advice, and obtain better interpersonal satisfaction. The public system, with its limited funding, is able to deliver care in diagnosis and management that is similar to the private sector, while private sector patients, who spend more on their healthcare receive better quality care in non-clinical areas.
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