健康中国2020药物政策研究合理用药研究报告
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Hospitals in IG were required to collect all the medical records of patients who underwent one of the three targeted surgeries. Two trained clinical pharmacists were responsible for evaluating the rationality of antibiotic prophylaxis of these cases based on the National Guideline. If no antibiotic was used in a case, it was judged as rational. Nonindicated cases treated with antibiotics were judged as irrational. A rational use measurement system was formulated by a group of senior clinical specialists. Each indicator was given a weight, and important factors received higher scores. The value range of the rationality score ranged 1-100, the higher the score, the more rational the antibiotic use was.
glmrepeatedmeasuretrendtestrationalityscorespretimeselectionconfoundingfactordueselfcontrolleddesignstudytookexternalcontrolgroupcgconductedmultifactoranalysisusingglmministryhealthpeoplesrepublicchinapagerationalityevaluationsystemcasesenrolledusingantibioticsusingantibioticswithoutindicationsrationalityscoresindicatedcasesmeansdindicatedcasesmajorirrationalantibioticprophylaxisproblemsministryhealthpeoplesrepublicchinapage10中华人民共和国itemsweightsitemsweightsantibioticsselection025combination008singledoseantibiotics011premedicationbeforesurgicalprocedure014dailyfrequencyofmedication007medicationinsurgicalprocedure007solventselectionanddose005postoperativemedication012routesadministration005changeantibiotics006indicatorsrationalityevaluationsystemministryhealthpeoplesrepublicchinapage11中华人民共和国studyperiodigcgthyroidectomybaseline382398324338253264959212stintervention317389320393178218815ndintervention4233954354062131991071445rdintervention4694204373922101881116total159140215163838542163961657numbercasesenrolledpr
Ministry of Health People’s Republic of China
Page 5
中华人民共和国 卫 生 部
2.4. Interventions
Intervention strategies include administrative and technical interventions implemented by both the central authority and the local hospitals. Central authority administrative interventions Enhance management of rational application of antimicrobials in clinic Ministry of Health's views about management of application of antimicrobials in clinics Central authority technical interventions launching the Drug and Therapeutics Committee (DTC) to train course circulating to physicians with materials and literatures on rational antibiotic prophylaxis
Ministry of Health People’s Republic of China
Page 7
中华人民共和国 卫 生 部
2.5. Post intervention data collection and analysis
The scope and objective of the data collection were the same as that of the baseline survey. Rationality scores were calculated statistically based on the weight of each of the ten indicators, in order to evaluate the effect of the intervention. The general linear model (GLM) statistical tool was applied for multiple factor analysis on numerical data. GLM of Repeated Measure was used to trend test rationality scores pre- and post-intervention.
2.2. Target surgeries
Thyroidectomy Mastectomy Hernia
Ministry of Health People’s Republic of China
Paቤተ መጻሕፍቲ ባይዱe 4
中华人民共和国 卫 生 部
2.3. Baseline survey and evaluation of rationality
Ministry of Health People’s Republic of China
Page 6
中华人民共和国 卫 生 部
2.4. Interventions
Hospital administrative interventions
Formulating the rules of Antimicrobials' application in hospitals Compiling the Management catalogue of antimicrobials in hospitals Hospital technical interventions Establishing focused groups and using the Monitoring/ Training/ Planning (MTP) method Identifying and setting targets and strategies for those outliers of antibiotic prophylaxis in the three targeted clean surgeries
中华人民共和国 卫 生 部
Ministry of Health People’s Republic of China
Antibiotics are often used in wrong doses, for too long, and with too broad a spectrum of antimicrobial activity. Antimicrobial resistance, superinfection and unnecessary costs are common consequences of inappropriate surgical antibiotic prophylaxis. Hence, rational use of antibiotics is essential. World Health Assembly urged WHO Member States to formulate measures to encourage appropriate and cost-effective use of medicines. The Chinese Ministry set series of regulations and rules, improving the use of medicines, especially antibiotics. To monitor the volume and patterns of antibiotic use and the impact of control measures, a National Monitoring Network on Clinical Antibiotics Use (Network) was established in China in 2005.
Promoting Rational Antibiotic Prophylaxis in Clean Surgeries in China
Zheng, Yingdong; Sun, Jing; Yan, Qin, Zhou Ying , Nov 16,2011 Turkey Antalya
Page 1
Ministry of Health People’s Republic of China
Page 3
中华人民共和国 卫 生 部
2.1. Hospital sampling
The study was conducted in 176 tertiary hospitals in China totally. The sampling frame is within the Network which consists of 164 tertiary hospitals as control group (CG). A total of 12 tertiary general hospitals were included in intervention group (IG).
2.6. External control
To avoid the time selection confounding factor due to the selfcontrolled design, this study took the Network as the external control group (CG), and conducted multi-factor analysis using the GLM.
Ministry of Health People’s Republic of China
Page 2
中华人民共和国 卫 生 部
The network has been regularly collecting antibiotic use data from 120 tertiary general hospitals around the country. The monitoring report from 2006 to 2007 showed that the proportion of irrational antibiotic use in surgical practice was widespread and serious. With the support of WHO, the Ministry of Health initiated an intervention project to promote rational antibiotic prophylaxis in clean surgeries from 2008 to 2009.
Ministry of Health People’s Republic of China
Page 8
中华人民共和国 卫 生 部
Indicators and weights of the rationality evaluation system Number and percentage of cases enrolled in the project Duration of medication and combination of antibiotics Composition of cases not using antibiotics and using antibiotics with and without indications Rationality scores of the indicated cases (mean ± SD (N)) Proportion of indicated cases with major irrational antibiotic prophylaxis problems
glmrepeatedmeasuretrendtestrationalityscorespretimeselectionconfoundingfactordueselfcontrolleddesignstudytookexternalcontrolgroupcgconductedmultifactoranalysisusingglmministryhealthpeoplesrepublicchinapagerationalityevaluationsystemcasesenrolledusingantibioticsusingantibioticswithoutindicationsrationalityscoresindicatedcasesmeansdindicatedcasesmajorirrationalantibioticprophylaxisproblemsministryhealthpeoplesrepublicchinapage10中华人民共和国itemsweightsitemsweightsantibioticsselection025combination008singledoseantibiotics011premedicationbeforesurgicalprocedure014dailyfrequencyofmedication007medicationinsurgicalprocedure007solventselectionanddose005postoperativemedication012routesadministration005changeantibiotics006indicatorsrationalityevaluationsystemministryhealthpeoplesrepublicchinapage11中华人民共和国studyperiodigcgthyroidectomybaseline382398324338253264959212stintervention317389320393178218815ndintervention4233954354062131991071445rdintervention4694204373922101881116total159140215163838542163961657numbercasesenrolledpr
Ministry of Health People’s Republic of China
Page 5
中华人民共和国 卫 生 部
2.4. Interventions
Intervention strategies include administrative and technical interventions implemented by both the central authority and the local hospitals. Central authority administrative interventions Enhance management of rational application of antimicrobials in clinic Ministry of Health's views about management of application of antimicrobials in clinics Central authority technical interventions launching the Drug and Therapeutics Committee (DTC) to train course circulating to physicians with materials and literatures on rational antibiotic prophylaxis
Ministry of Health People’s Republic of China
Page 7
中华人民共和国 卫 生 部
2.5. Post intervention data collection and analysis
The scope and objective of the data collection were the same as that of the baseline survey. Rationality scores were calculated statistically based on the weight of each of the ten indicators, in order to evaluate the effect of the intervention. The general linear model (GLM) statistical tool was applied for multiple factor analysis on numerical data. GLM of Repeated Measure was used to trend test rationality scores pre- and post-intervention.
2.2. Target surgeries
Thyroidectomy Mastectomy Hernia
Ministry of Health People’s Republic of China
Paቤተ መጻሕፍቲ ባይዱe 4
中华人民共和国 卫 生 部
2.3. Baseline survey and evaluation of rationality
Ministry of Health People’s Republic of China
Page 6
中华人民共和国 卫 生 部
2.4. Interventions
Hospital administrative interventions
Formulating the rules of Antimicrobials' application in hospitals Compiling the Management catalogue of antimicrobials in hospitals Hospital technical interventions Establishing focused groups and using the Monitoring/ Training/ Planning (MTP) method Identifying and setting targets and strategies for those outliers of antibiotic prophylaxis in the three targeted clean surgeries
中华人民共和国 卫 生 部
Ministry of Health People’s Republic of China
Antibiotics are often used in wrong doses, for too long, and with too broad a spectrum of antimicrobial activity. Antimicrobial resistance, superinfection and unnecessary costs are common consequences of inappropriate surgical antibiotic prophylaxis. Hence, rational use of antibiotics is essential. World Health Assembly urged WHO Member States to formulate measures to encourage appropriate and cost-effective use of medicines. The Chinese Ministry set series of regulations and rules, improving the use of medicines, especially antibiotics. To monitor the volume and patterns of antibiotic use and the impact of control measures, a National Monitoring Network on Clinical Antibiotics Use (Network) was established in China in 2005.
Promoting Rational Antibiotic Prophylaxis in Clean Surgeries in China
Zheng, Yingdong; Sun, Jing; Yan, Qin, Zhou Ying , Nov 16,2011 Turkey Antalya
Page 1
Ministry of Health People’s Republic of China
Page 3
中华人民共和国 卫 生 部
2.1. Hospital sampling
The study was conducted in 176 tertiary hospitals in China totally. The sampling frame is within the Network which consists of 164 tertiary hospitals as control group (CG). A total of 12 tertiary general hospitals were included in intervention group (IG).
2.6. External control
To avoid the time selection confounding factor due to the selfcontrolled design, this study took the Network as the external control group (CG), and conducted multi-factor analysis using the GLM.
Ministry of Health People’s Republic of China
Page 2
中华人民共和国 卫 生 部
The network has been regularly collecting antibiotic use data from 120 tertiary general hospitals around the country. The monitoring report from 2006 to 2007 showed that the proportion of irrational antibiotic use in surgical practice was widespread and serious. With the support of WHO, the Ministry of Health initiated an intervention project to promote rational antibiotic prophylaxis in clean surgeries from 2008 to 2009.
Ministry of Health People’s Republic of China
Page 8
中华人民共和国 卫 生 部
Indicators and weights of the rationality evaluation system Number and percentage of cases enrolled in the project Duration of medication and combination of antibiotics Composition of cases not using antibiotics and using antibiotics with and without indications Rationality scores of the indicated cases (mean ± SD (N)) Proportion of indicated cases with major irrational antibiotic prophylaxis problems