Evaluation Of The Effect Of Antibiotic Stewardship Policy In Primary Health Centers Based On Interruption Time Series Method

Objective:This study aimed to analyse the trend of antibacterials use in outpatient of Shenzhen Community Health Centers(CHCs)before and after the implementation of antibiotic stewardship policy,and to evaluate the effect of antibiotic stewardship policy on antibiotic using in CHCs,and provide evidence basis for promoting the rational use of antibacterials and improving stewardship policies.Methods:In this study,we randomly selected 11 CHCs in Xixiang Street,Shenzhen,and we obtained a total of 1,482,223 e-prescribing outpatient prescriptions between 2010 and2015.First,the descriptive methods was used to analyse the trend of antibacterials use in outpatient from 2010 to 2015.The main analytical indicators included the percentage of antibacterials use,the percentage of antibacterials combination therapy,the percentage of injection,and the percentage of broad-spectrum antibacterials used.Then Cochran-Armitage trend test and linear regression were employed to analyse the trends of categorical variables and continuous variables.On this basis,interrupted time series method was used to evaluate the instantaneous and long-term trends of the above indicators after the implementation of antibiotic stewardship policy.Results:1.The basic information of outpatient prescriptions.In this study,a total of1482,223 outpatient prescriptions were collected from 11 CHCs,the prescriptions of female patients accounted for 52.18%,and prescriptions of patients aged 18-40 years accounted for 63.45%.In 2010-2015,the average number of drugs per prescriptiondecreased from 3.96 in 2010 to 2.68 in 2015,and the number of medication days per prescription was about 2 days.The average medication costs per prescription fluctuated greatly,and remained at 24~38 yuan level after 2012.2.The trend analysis of outpatient antibacterials use.The percentage of antibacterials use,the percentage of antibacterials combination therapy,the percentage of injection and the proportion of antibacterials cost decreased from 71.5%,28.03%,58.48%,and 61.72% in 2010 to 17.4%,14.81%,45.21%,49.02% in 2015,and the downward trend was statistically significant.However,the percentage of broad-spectrum antibacterials use did not change significantly,and it fluctuated between48.80% and 58.50%.The consumption frequency of cephalosporin antibacterials was the highest,and the proportion ranged from 32.40% to 42.90%.3.The effect of antibiotic stewardship policy on outpatient antibacterials use.The results of the segmented regression model analysis showed that antibiotic stewardship policy have significant transient and long-term effects on reducing the use of antibacterials.After the implementation of antibiotic stewardship policy,the percentage of antibacterials use decreased by 5.24% immediately(P=0.0435),and then continued to decrease with an average monthly trend of 3.05% until September 2012(P<0.0001).The subgroup analysis showed that antibiotic stewardship policy had consistent transient and long-term effects on reducing the use of antibacterials in different gender and age groups.The percentage of antibacterials combination therapy and the percentage of injection decreased by 6.07% and 8.53%,respectively,after the implementation of the antibiotic stewardship policy,and the difference was statistically significant(P=0.0007,P<0.0001),but the long-term downward trend was not obvious.The percentage of broad-spectrum antibacterials use decreased by 0.57% immediately after the implementation of antibiotic stewardship policy,but the difference was not statistically significant(P=0.859),and the long-term downward trend was not obvious.In addition,the proportion of antibacterials costs did not show significant transient and long-term declines after the implementation of antibiotic stewardship policy.Conclusions:The antibiotic stewardship policy can effectively reduce the use of antibacterials in primary health centers and have a stable long-term effect in Shenzhen.However,the percentage of broad-spectrum antibacterials use is excessive and requires more targeted stewardship policies to promote the accuracy and effectiveness of antibacterials use.Highlights and limitations:Studies focusing on evaluating the effect of antibiotic stewardship policies on antibiotic use in China is relatively rare particularly in primary health centers.The highlight of this study is that it evaluated the effect of the antibiotic stewardship policy based on the long-term outpatient prescription data.In addition,the interrupted time series method used in this study is a quasi-experimental design method for evaluating the effect of longitudinal data intervention,which can obtained objective evaluation results.Several limitations of this study should be noted.First,this study was conducted in Shenzhen only,and further research is needed in other regions to comprehensively evaluate the effects of antibiotic stewardship policy in primary health centers in China.Second,there are many indicators for evaluating the use of antibacterial.In addition to the indicators selected in this study,some other indicators are needed to analyse in the future,such as the intensity of antibacterials use,the frequency of antibacterials use,and the percentage of antibacterials use in different disease,etc.