Effect Of Regional Prescription Audit Center On Rational Use Of Medicine In Primary Health Care Institutions Based On Interrupted Time Series

Background:Prescription audit plays a significant role in ensuring clinical rational use of medicines.The first regional prescription audit center in Guangzhou,Tianhe Prescription Audit Center preliminarily shows that it has effectively improved the rational rate of prescriptions in primary health care institutions.However,due to the limited efficacy of evaluation methods and dimension of evaluation indicators,it is difficult to fully explain the influence of Tianhe Prescription Audit Center on promoting the rational use of medicines.Therefore,it is necessary to conduct a more scientific study on the current situation of rational medicines use in Tianhe.Objective:Based on interrupted time series analysis,we evaluated the effect of Tianhe Prescription Audit Center on rational use of medicines in regional primary health care institutions,so far to provide evidence basis for promoting rational use of medicines in primary health care institutions,and improve the management of Tianhe Prescription Audit Center.Methods:All e-prescribing outpatient prescriptions were extracted from 13 public community health centers in Tianhe between 2018 and 2021.First,the descriptive analysis was conducted on outpatient prescriptions.Secondly,based on segmented regression analysis,we evaluated the instantaneous changes and long-term trends of rational use of medicines indicators after the implementation of Tianhe Prescription Audit Center.Finally,we evaluated the effect of Tianhe Prescription Audit Center on rational use of medicines based on literatures.Results:1.In this study,4,059,439 e-prescribing outpatient prescriptions were obtained from 13 public community health centers.Among these prescriptions,female patients accounted for 54.6%,and the patients between 60 to 79 years-old accounted for 30.4%.From 2018 to 2021,the medication days of per prescription increased from 6.73 to 12.01,and the average drug species decreased from 3.46 to 2.43.Meanwhile,the average medication cost of per prescription ranged from 95.65 yuan to 105.98 yuan.2.As segmented regression models analysis showed,Tianhe Prescription Audit Center had significantly transient reduction effects on the average drug species of prescription,the average daily cost of prescription and the percentage of prescription with antibiotics,but long-term trends increased.The subgroup analysis by sex or age showed that the transient and long-term effects of indicators above were consistent.After the intervention,the average drug species of prescription decreased by 0.951(P<0.0001),followed by a trend raise of 0.005 per week(P=0.0003).The average daily cost of prescription decreased by 10.072 yuan per day(P<0.0001),and then there was a weekly trend raise of positive 0.154 yuan per day(P<0.0001).The percentage of prescription with antibiotics decreased by 6.220%(P=0.0004),and then there was a weekly trend raise of positive 0.133%(P<0.0001).Except for the percentage of broad-spectrum antibiotics and antibacterial combination therapy,the other indicators were at a low level.After the intervention of Tianhe Prescription Audit Center,the percentage of antibiotic-containing prescription with broad-spectrum antibiotics decreased by 6.596%(P=0.2194),followed by a trend raise of 0.125%per week(P=0.0890).The percentage of antibacterial combination therapy increased by 13.608%(P<0.0001),followed by a trend raise of 0.058%per week(P<0.0001).Conclusions:1.Tianhe Prescription Audit Center can effectively improve the rational use of medicines in public community health centers in Tianhe,mainly in the average drug species of prescription,the average daily cost of prescription,the percentage of injectable antibiotics,and the percentage of prescription with antibiotics.2.However,irrational use of medicines still exists,for example,the percentage of broad-spectrum antibiotics and the percentage of antibacterial combination therapy are excessive.With the help of regional information center,we recommend to establish more comprehensive indicators to strengthen supervision of the medicine use in primary health care institutions.