Process quality of antibacterial drugs utilization among NRCMS acute appendicitis patients in one county of Shandong Province / 中国卫生政策研究

ABSTRACT

Objective:To explore means of process quality assessment for antibacterial drug utilization among a-cute appendicitis patients under the New Rural Cooperative Medical Scheme ( NCMS) through the use of the explicit method in order to provide evidence for the rationality of drug utilization in NRCMS. Methods: Data was collected from the NCMS information system of one county in Shandong Province from 2007 to 2011 and included 1 ,721 cases of acute appendicitis in county and town-level hospitals. The explicit method was employed, which adopted the ad-herence rate to represent drug process quality by comparing the actual antibacterial drug utilized with those recom-mended by quality standards. Descriptive statistics were used to analyze quantitative data with Excell2007, Microsoft SQL 2005 and SPSS 17 . 0 . Results: The average overall adherence rate from 2007 to 2011 was 22 . 4% ( SD =22. 3%) at the individual level. The overall adherence rate of township health centers was very low, between 14. 6%and 19. 6%, with no significant difference among the five years. The utilization of cephalosporin drugs was relatively stable at town-level hospitals, that is, third-generation cephalosporins was used most frequently, while cephalosporin, recommended by quality standards, was the least utilized in all five years. At county-level hospitals, fourth-genera-tion drugs were gradually substituted with second and third-generation drugs. Utilization of the recommended drug metronidazole of the nitromidazoles drug group decreased over time at both the town and county-level hospitals, and the drug was gradually substituted by tinidazole and ornidazole, especially in county-level hospitals. Conclusions:From 2007 to 2011 , the rationality of drug utilization was low in the NCMS designated hospitals at both town and county-level hospitals, particularly in town-level hospitals. The underuse of recommended quality standard drugs was the main issue at hand, and this situation experienced no significant changes during the study period.