title: Retrospective survey of the efficacy of mandatory implementation of the Essential Medicine Policy in the primary healthcare setting in China: failure to promote the rational use of antibiotics in clinics.
abstract: The objective of this study was to understand the impact of implementation of the Essential Medicine Policy (EMP) on the rational use of antibiotics in primary medical institutions in China. A retrospective survey was conducted in 39 primary medical institutions to compare the efficacy of EMP in rational antibiotic use. All institutions completed the survey 1 year before and 1 year after implementation of the EMP. In particular, antibiotic use and its rationality were closely examined. The institutions mainly dealt with common diseases, especially non-infectious chronic diseases. Antibiotic usage was very inappropriate both before and after EMP implementation. Before and after EMP implementation, respectively, the median outpatient cost was US$6.34 and US$5.05, 52.50% (2005/3819) and 53.41% (1865/3492) of the outpatient prescriptions contained antibiotics, and 76.23% (1132/1485) and 78.83% (1106/1403) of inpatients were administered antibiotics. In addition, 98.38% (425/432) and 97.52% (512/525) of surgical inpatients were administered antibiotics, respectively, and 80.76% (638/790) and 75.19% (503/669) of patients with a cold were prescribed antibiotics, respectively. The most commonly used antibiotics were broad-spectrum and injectable agents, including cephalosporins, fluoroquinolones and penicillins. This profile showed little change following implementation of the EMP. In conclusion, inappropriate antibiotic use is a serious problem in primary medical institutions in China. Whilst enforcing the EMP reduced the cost of medical services, it had little effect on promoting the rational use of antibiotics.
authors: Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China. Electronic address: xiao-yonghong@163.com.
authors: Yonghong
authors: Y
authors: Xiao
authors: Phase I Clinical Centre, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
authors: Jin
authors: J
authors: Wang
authors: Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
authors: Ping
authors: P
authors: Shen
authors: Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
authors: Beiwen
authors: B
authors: Zheng
authors: School of Public Health, Peking University, Beijing 100191, China.
authors: Yingdong
authors: Y
authors: Zheng
authors: Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China. Electronic address: ljli@zju.edu.cn.
authors: Lanjuan
authors: L
authors: Li
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002681:China; D004363:Drug Utilization / Q000592:standards*; D006291:Health Policy; D011320:Primary Health Care / Q000379:methods*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents
keywords: China; Essential Medicine Policy; Primary healthcare institutions; Rational antibiotic use