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Decline in oral antimicrobial prescription in the outpatient setting after nationwide implementation of financial incentives and provider education: An interrupted time-series analysis

Published online by Cambridge University Press:  06 April 2022

Kazuaki Jindai
Affiliation:
Department of Healthcare Epidemiology, School of Public Health, Kyoto University, Japan Department of Virology, Tohoku University Graduate School of Medicine, Japan
Takahiro Itaya
Affiliation:
Department of Healthcare Epidemiology, School of Public Health, Kyoto University, Japan
Yusuke Ogawa
Affiliation:
Department of Healthcare Epidemiology, School of Public Health, Kyoto University, Japan
Tsukasa Kamitani
Affiliation:
Section of Education for Clinical Research, Kyoto University Hospital, Japan
Shunichi Fukuhara
Affiliation:
Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University, Japan Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Japan Shirakawa STAR for General Medicine, Fukushima Medical University, Japan
Michihiko Goto
Affiliation:
Iowa City VA Medical Center, Iowa City, Iowa, United States Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
Yosuke Yamamoto*
Affiliation:
Department of Healthcare Epidemiology, School of Public Health, Kyoto University, Japan
*
Author for correspondence: Yosuke Yamamoto MD, PhD, E-mail: yamamoto.yosuke.5n@kyoto-u.ac.jp

Abstract

Objectives:

To assess the impact of nationwide outpatient antimicrobial stewardship interventions in the form of financial incentives for providers and provider education when antimicrobials are deemed unnecessary for uncomplicated respiratory infections and acute diarrhea.

Methods:

We collected data from a large claims database from April 2013 through March 2020 and performed a quasi-experimental, interrupted time-series analysis. The outcome of interest was oral antimicrobial prescription rate defined as the number of monthly antimicrobial prescriptions divided by the number of outpatient visits each month. We examined the effects of financial incentive to providers (ie, targeted prescriptions for those aged ≤2 years) and provider education (ie, targeted prescriptions for those aged ≥6 years) on the overall antimicrobial prescription rates and how these interventions affected different age groups before and after their implementation.

Results:

In total, 21,647,080 oral antimicrobials were prescribed to 2,920,381 unique outpatients during the study period. At baseline, prescription rates for all age groups followed a downward trend throughout the study period. Immediately after the financial incentive implementation, substantial reductions in prescription rates were observed among only those aged 0–2 years (−47.5 prescriptions per 1,000 clinic visits each month; 95% confidence interval, −77.3 to −17.6; P = .003), whereas provider education immediately reduced prescription rates in all age groups uniformly. These interventions did not affect the long-term trend for any age group.

Conclusion:

These results suggest that the nationwide implementation of financial incentives and provider education had an immediate effect on the antimicrobial prescription but no long-term effect.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

a

Authors of equal contribution.

PREVIOUS PRESENTATION: Part of this study was presented at Society for Clinical Epidemiology Fourth Annual Meeting, on October 30, 2021, in Tokyo, Japan.

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