title: Governance structure reform and antibiotics prescription in community health centres in Shenzhen, China.
abstract: BACKGROUND
  It is unclear whether changing the governance structure of community health centres (CHCs) could affect antibiotic prescribing behaviour.
  
  
  OBJECTIVE
  To explore how changes in governance structure affect antibiotic prescription for children younger than 5 years of age with acute upper respiratory tract infections (AURI) in CHCs in Shenzhen, China.
  
  
  METHODS
  This study used an interrupted time series design with a comparison series. On 1 June 2009, the Health Bureau of Shenzhen's Baoan District transferred CHCs from a hospital-affiliated model to a self-managed independent model regarding finance, personnel and employee compensation. We collected 23481 electronic medical records of children younger than 5 years of age who were treated for AURI on an outpatient basis 1 year before and 1 year after governance structure reform. We used segmented regression analysis to evaluate the effect of reform on antibiotic prescription.
  
  
  RESULTS
  After the reform, the proportion of patients receiving an antibiotic injection per month and the proportion of patients receiving two or more antibiotics conditional on receiving an antibiotic per month decreased 9.17% and 7.34%, respectively (P < 0.01 or P < 0.05). In the intervention series, the proportion of patients receiving an antibiotic injection per month and the monthly average cost of the antibiotics prescribed per patient continued to decrease over time compared with the control series (P < 0.001 or P < 0.05).
  
  
  CONCLUSIONS
  This study suggests that governance structure reform can have positive effects on behaviour for antibiotic prescribing. Moreover, this short-term effect might have important implications for further community health reforms in China.
authors.affiliation: School of Social Development and Public Policy, Beijing Normal University, Beijing and.
authors.forename: Xiaoyun
authors.initials: X
authors.lastname: Liang
authors.affiliation: Health Bureau of Baoan District, Shenzhen, China.
authors.forename: Tingsong
authors.initials: T
authors.lastname: Xia
authors.affiliation: School of Social Development and Public Policy, Beijing Normal University, Beijing and.
authors.forename: Xiulan
authors.initials: X
authors.lastname: Zhang
authors.affiliation: School of Social Development and Public Policy, Beijing Normal University, Beijing and cgjin2005@126.com.
authors.forename: Chenggang
authors.initials: C
authors.lastname: Jin
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D002675:Child, Preschool; D002681:China; D003151:Community Health Centers / Q000458:organization & administration*; D016527:Drug Costs; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D065186:Interrupted Time Series Analysis; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics prescription; China; community health centre; governance structure reform.