title: Public reporting influences antibiotic and injection prescription in primary care: a segmented regression analysis.
abstract: OBJECTIVE
  Inappropriate use and overuse of antibiotics and injections are serious threats to the global population, particularly in developing countries. In recent decades, public reporting of health care performance (PRHCP) has been an instrument to improve the quality of care. However, existing evidence shows a mixed effect of PRHCP. This study evaluated the effect of PRHCP on physicians' prescribing practices in a sample of primary care institutions in China. Segmented regression analysis was used to produce convincing evidence for health policy and reform.
  
  
  METHODS
  The PRHCP intervention was implemented in Qian City that started on 1 October 2013. Performance data on prescription statistics were disclosed to patients and health workers monthly in 10 primary care institutions. A total of 326 655 valid outpatient prescriptions were collected. Monthly effective prescriptions were calculated as analytical units in the research (1st to 31st every month). This study involved multiple assessments of outcomes 13 months before and 11 months after PRHCP intervention (a total of 24 data points).
  
  
  RESULTS
  Segmented regression models showed downward trends from baseline on antibiotics (coefficient = -0.64, P = 0.004), combined use of antibiotics (coefficient = -0.41, P < 0.001) and injections (coefficient = -0.5957, P = 0.001) after PRHCP intervention. The average expenditure of patients slightly increased monthly before the intervention (coefficient = 0.8643, P < 0.001); PRHCP intervention also led to a temporary increase in average expenditure of patients (coefficient = 2.20, P = 0.307) but slowed down the ascending trend (coefficient = -0.45, P = 0.033). The prescription rate of antibiotics and injections after intervention (about 50%) remained high.
  
  
  CONCLUSIONS
  PRHCP showed positive effects on physicians' prescribing behaviour, considering the downward trends on the use of antibiotics and injections and average expenditure through the intervention. However, the effect was not immediately observed; a lag time existed before public reporting intervention worked.
authors.affiliation: Tongji Medical College, School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Chenxi
authors.initials: C
authors.lastname: Liu
authors.affiliation: Tongji Medical College, School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Xinping
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Tongji Medical College, School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Wan
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002681:China; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007267:Injections / Q000706:statistics & numerical data; D065186:Interrupted Time Series Analysis; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012044:Regression Analysis
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotics; injections; interrupted time series analysis; public reporting; rational use of medicine; segmented regression analysis