Exploring The Transparency Mechanism Of Public Reporting Of Prescription Data In Primary Care Institutions

[Purpose]Exploring the transparency mechanism and to test the robustness and effectiveness of this mechanism of public reporting on prescription in primary care institutions.[Methods]Literature review and focus group discussion was used to establish the theory frame of the transparency mechanism,and define the elements concept of the mechanism.We used a systematic four-phase process to develop and validate the instrument of the transparency mechanism:(1)the content domain specification and initial pool of instrument items were developed through literature reviews;(2)all the items in the instrument were reviewed and checked for content validity by experts and a pilot study;(3)based on the principle of cluster random sampling,all eligible GPs was surveyed,who came from 20 township hospitals of Q city,Hubei Province.(4)Reliability was indicated by Cronbach’s alpha and all Cronbach’s alpha for the five constructs were higher than 0.70 indicating adequate levels of reliabilities;validities of the instrument was tested by average variance extracted(AVE)and composite reliability(CR),and all AVE higher than 0.5 and CR higher than 0.7 indicated that the instrument has a perfect validity.Based on model development strategy,structural equation model(SEM)was used to test the hypothesized model.Absolute fit measures and relative fit measures were used to assess the model’s overall goodness of fit.Data at different time points(whether public reporting of prescription data or not,before and after public reporting of prescription data)were collected by the instrument.Several medicine use transparency mechanism models were established,and we test the robustness of this mechanism from the indicators of path number and model effect.We used the causal steps approach to explore the effectiveness of transparency regulation mechanism.Generalized Liner Model(GLM)and Generalized Estimating Equation(GEE)was used to evaluate the effect of public reporting on doctors’intention and the effect of intention on the actual prescription practice.Difference in difference(DID)analysis was used in regression models to control the time change and baseline uncomparable.Interview method and induction method were used to induce the operating conditions of the transparency regulation mechanism.[Results]1.The theory frame of the transparency mechanism was established and consisted of five constructs:information accessibility,perceived value,attitude,perceived risk and behavioral intention.2.The final instrument consisted of five constructs and 17 items was developed.The 290 doctors’ survey data revealed that the Cronbach’s alpha was higher than 0.70,and all AVE and CR were higher than 0.5 and 0.7,respectively,and indicated that the instrument has a perfect reliability and validity.3.All the hypotheses in this study were tested by SEM,and the model fit indexes were aligned with the theories and to be an acceptable model statistically(x/df<2.26;RMSEA<0.07;GFI>0.9;AGFI>0.87;CFI>0.97;NNFI>0.96;IFI>0.97).The results support that the information accessibility has significant effects on perceived value(r=0.27,p<0.001).The results also indicated that significant relationships exist between perceived value and behavioral intention(r=0.53,p<0.001),and between information accessibility and attitude(r=0.22,p<0.001).The attitude has a significant effect on perceived value(r=0.44,p<0.001).But there were no significant relationships between attitude and behavioral intention,attitude and perceived risk,information accessibility and perceived risk,perceived risk and behavioral intention.4.Seven transparency regulation mechanism models were established based on different time point’s data.All of the model fit indexes were within an acceptable level and indicated that the theory model was fit well with actual data.Every transparency regulation mechanism model has a through path at least,and indicating that the mechanism was robust.5.Based on the causal steps approach,the unit of analysis was set at the level of prescriptions(N=889647),and we established the GLM.The results demonstrated that the public reporting of prescription data led to a reduction in antibiotic prescribing(OR=0.88,p=0.016,95%CI=[0.80,0.98])and drug expenditure per prescription(OR=-0.05,p=0.016,95%CI=[-0.09,-0.01]).No significant effect of the public reporting on injection prescriptions was found(p>0.05).6.Nearly half interviewees argued that the current public reporting indicators was not appropriate for the reasons that there was less consideration of the disease type,severity of the disease,and the amount of patients.Most interviewees believed that it was necessary to disclose prescription information and they had a high intention to improve their prescription practice.However,the doctors’ perceived value and perceived risk was in a low level.[Conclusions]This research establishes the theory of the transparency regulation mechanism in primary care institutions.Based on the theory model,an instrument was developed that with perfect reliability and validity.All the hypotheses in this study are tested by SEM,and proved that the robustness of the transparency regulation mechanism.Public reporting of prescription information improves prescribing practices in terms of reducing antibiotic prescriptions and drug expenditure.No significant changes in intention scores were found as a result of public reporting.The role of intention on the changing prescription outcomes is still need future study.[Innovation and Deficiency]Based on the Berwick’s two pathways model,we establish the medicine transparency regulation mechanism from the point of view of information accessibility,perception and behavioral intention at the first time.It enriches the original transparency theory and provides a new idea for the study of transparency regulation theory.Meanwhile,instrument is developed to measure the key constructs of the transparency mechanism and fill a gap in transparency mechanism research to a certain degree.This research conducts a useful exploration by investigating the robustness and effectiveness of the transparency mechanism in the field of medicine use.It provides a reference for future research.However,as the study is only conduct in 20 township hospitals of Hubei province,it can’t represent the national level and should be carefully generalized the conclusions drawn from this research.