Top

Published in:

01-12-2020 | Antibiotic | Research article

Impact of antimicrobial stewardship fee on prescribing for Japanese pediatric patients with upper respiratory infections

Authors: Yuichi Muraki, Yoshiki Kusama, Masaki Tanabe, Kayoko Hayakawa, Yoshiaki Gu, Masahiro Ishikane, Daisuke Yamasaki, Tetsuya Yagi, Norio Ohmagari

Published in: BMC Health Services Research | Issue 1/2020

Abstract

Background

In 2018, the Japanese medical reimbursement system was revised to introduce a fee for the implementation of an antimicrobial stewardship (AS) fee for pediatric patients. The purpose of this study was to evaluate physicians’ prescription behavior following this revision.

Methods

We conducted a retrospective observational study from January 1, 2017 to September 30, 2018 of pediatric (< 15 years) outpatients with upper respiratory tract infections (URIs). To assess the pattern of antibiotic prescription for the treatment of pediatric URIs before and after the introduction of the AS fee, we extracted data on pediatric URIs, diagnosed during the study period. Patients were divided based on whether medical facilities claimed AS fees. We defined antibiotic use as the number of antibiotics prescribed, and evaluated the proportion of each class to the total number of antibiotics prescribed. We also recorded the number of medical facilities that each patient visited during the study period.

Results

The frequency of antibiotic prescription decreased after AS fee implementation, regardless of whether the facility claimed the AS fee, but tended to be lower in facilities that claimed the fee. Additionally, the frequency of antibiotic prescription decreased in all age groups. Despite the reduced frequency of antibiotic prescription, consultation behavior did not change.

Conclusions

The AS fee system, which compensates physicians for limiting antibiotic prescriptions, helped to reduce unnecessary antibiotic prescription and is thus a potentially effective measure against antimicrobial resistance.

World Health Organization. Global action plan on antimicrobial resistance: World Health Organization; 2015. Available from http://www.who.int/iris/handle/10665/193736. Accessed 8 March 2019.

Hofer U. The cost of antimicrobial resistance. Nat Rev Microbiol. 2019;17:3. https://doi.org/10.1038/s41579-018-0125-x.CrossRefPubMed

Founou RC, Founou LL, Essack SY. Clinical and economic impact of antibiotic resistance in developing countries: A systematic review and meta-analysis. PLoS One. 2017;21(12):e0189621. https://doi.org/10.1371/journal.pone.0189621.CrossRef

The Government of Japan. National action plan on antimicrobial resistance (AMR) 2016–2020. Available from: https://www.mhlw.go.jp/file/06-Seisakujouhou-10900000-Kenkoukyoku/0000138942.pdf. Accessed 8 March 2019.

Kronman MP, Zhou C, Mangione-Smith R. Bacterial prevalence and antimicrobial prescribing trends for acute respiratory tract infections. Pediatrics. 2014;134:e956–65. https://doi.org/10.1542/peds.2014-0605.CrossRefPubMed

Meropol SB, Localio AR, Metlay JP. Risks and benefits associated with antibiotic use for acute respiratory infections: a cohort study. Ann Fam Med. 2013;11:165–72. https://doi.org/10.1370/afm.1449.CrossRefPubMedPubMedCentral

Hashimoto H, Matsui H, Sasabuchi Y, Yasunaga H, Kotani K, Nagai R, et al. Antibiotic prescription among outpatients in a prefecture of Japan, 2012-2013: a retrospective claims database study. BMJ Open. 2019;9:e026251. https://doi.org/10.1136/bmjopen-2018-026251.CrossRefPubMedPubMedCentral

Muraki Y, Yagi T, Tsuji Y, Nishimura N, Tanabe M, Niwa T, et al. Japanese antimicrobial consumption surveillance: first report on oral and parenteral antimicrobial consumption in Japan (2009–2013). J Glob Antimicrob Resist. 2016;7:19–23. https://doi.org/10.1016/j.jgar.2016.07.002.CrossRefPubMed

Yamasaki D, Tanabe M, Muraki Y, Kato G, Ohmagari N, Yagi T. The first report of Japanese antimicrobial use measured by national database based on health insurance claims data (2011-2013): comparison with sales data, and trend analysis stratified by antimicrobial category and age group. Infection. 2018;46:207–14. https://doi.org/10.1007/s15010-017-1097-x.CrossRefPubMed

10.

Kinoshita N, Morisaki N, Uda K, Kasai M, Horikoshi Y, Miyairi I. Nationwide study of outpatient oral antimicrobial utilization patterns for children in Japan (2013-2016). J Infect Chemother. 2019;25:22–7. https://doi.org/10.1016/j.jac.2018.10.002.CrossRefPubMed

11.

van der Velden AW, Kuyvenhoven MM, Verheij TJ. Improving antibiotic prescribing quality by an intervention embedded in the primary care practice accreditation: the ARTI4 randomized trial. J Antimicrob Chemother. 2016;71:257–63. https://doi.org/10.1093/jac/dkv328.CrossRefPubMed

12.

Wei X, Zhang Z, Hicks JP, Walley JD, King R, Newell JN, et al. Long-term outcomes of an educational intervention to reduce antibiotic prescribing for childhood upper respiratory tract infections in rural China: follow-up of a cluster-randomised controlled trial. PLoS Med. 2019;16:e1002733. https://doi.org/10.1371/journal.pmed.1002733.CrossRefPubMedPubMedCentral

13.

Jacobs TG, Robertson J, van den Ham HA, Iwamoto K, Bak Pedersen H, Mantel-Teeuwisse AK. Assessing the impact of law enforcement to reduce over-the-counter (OTC) sales of antibiotics in low- and middle-income countries; a systematic literature review. BMC Health Serv Res. 2019;19:536. https://doi.org/10.1186/s12913-019-4359-8.CrossRefPubMedPubMedCentral

14.

Infectious Diseases Control Division. Health Service Bureau, Ministry of Health, Labour and Welfare. Manual of Antimicrobial Stewardship. 1st ed; 2017. Available from http://www.mhlw.go.jp/file/06-Seisakujouhou-10900000-Kenkoukyoku/0000193504.pdf. Accessed 8 March 2019.

15.

Ministry of Health, Labour and Welfare, Japan. The fiscal year 2018 Revision of Reimbursement of Medical Fees. Available from: https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000188411.html. Accessed 8 March 2019.

16.

AMR Clinical Reference Center, Japan. Antibiotic awareness survey 2018. Available from http://amr.ncgm.go.jp/infographics/008.html. Accessed 8 March 2019.

17.

Ministry of Health, Labour and Welfare. Ethical guidelines for medical and health research involving human Subjects. 2014 (Partly revised in 2017). Available from http://www.mhlw.go.jp/file/06-Seisakujouhou-10600000-Daijinkanboukouseikagakuka/0000153339.pdf. Accessed 8 March 2019.

18.

Hallsworth M, Chadborn T, Sallis A, Sanders M, Berry D, Greaves F, et al. Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial. Lancet. 2016;387:1743–1752. doi: https://doi.org/10.1016/S0140-6736(16)00215-4.

19.

AMR Clinical Reference Center, Japan. Japan Surveillance for Infection Prevention and Healthcare Epidemiology: J-SIPHE Available from https://j-siphe.ncgm.go.jp/home. Accessed 8 March 2019.

20.

AMR Clinical Reference Center, Japan. Surveillance of antimicrobial use Available from http://amrcrc.ncgm.go.jp/surveillance/010/20181128172333.html. Accessed 8 March 2019.

21.

Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European economic area in 2015: a population-level modelling analysis. Lancet Infect Dis. 2019;19:56–66. https://doi.org/10.1016/S1473-3099(18)30605-4.CrossRefPubMedPubMedCentral

22.

Ministry of Health, Labor and Welfare. Patient survey. https://www.mhlw.go.jp/toukei/saikin/hw/kanja/17/dl/01.pdf. Accessed 16 December 2019.

23.

Islam J, Ashiru-Oredope D, Budd E, Howard P, Walker AS, Hopkins S, et al. A national quality incentive scheme to reduce antibiotic overuse in hospitals: evaluation of perceptions and impact. J Antimicrob Chemother. 2018;73:1708–13. https://doi.org/10.1093/jac/dky041.CrossRefPubMed

24.

Wise J. Hospitals and GPs are offered incentives to reduce antibiotic prescribing. BMJ. 2016;352:i1499 https://doi.org/0.1136/bmj.i1499.CrossRef

25.

Mölstad S, Löfmark S, Carlin K, Erntell M, Aspevall O, Blad L, et al. Lessons learnt during 20 years of the Swedish strategic programme against antibiotic resistance. Bull World Health Organ. 2017;95:764–73. https://doi.org/10.2471/BLT.16.184374.CrossRefPubMedPubMedCentral

Title: Impact of antimicrobial stewardship fee on prescribing for Japanese pediatric patients with upper respiratory infections
Authors: Yuichi Muraki
Yoshiki Kusama
Masaki Tanabe
Kayoko Hayakawa
Yoshiaki Gu
Masahiro Ishikane
Daisuke Yamasaki
Tetsuya Yagi
Norio Ohmagari
Publication date: 01-12-2020
Publisher: BioMed Central
Keyword: Antibiotic
Published in: BMC Health Services Research / Issue 1/2020
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-020-05288-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Impact of antimicrobial stewardship fee on prescribing for Japanese pediatric patients with upper respiratory infections

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2020

Cost-effectiveness of pain management services for chronic low back pain: a systematic review of published studies

Levels, trends and determinants of technical efficiency of general hospitals in Uganda: data envelopment analysis and Tobit regression analysis

Cost–related unmet need for healthcare services in Kenya

Estimating the costs of genomic sequencing in cancer control

Integrating care: the work of diabetes care technicians in an integrated care initiative

The societal economic burden of autosomal dominant polycystic kidney disease in the United States