Background
Methods
Study settings
Sr. no. | Characteristics | RHCsa(16) | BHUsb(16) | All PHCCsc(32) |
---|---|---|---|---|
1 | Number of beds | 9 (6–11) | 4.5 (3–7) | 6 (3–11) |
2 | Outpatients visit last year | 36,658 (25,390 − 67,760) | 21,312 (16,410 − 36,256) | 29,297 (16,410 − 67,760) |
3 | Inpatients visit last year | 1056 (783–1371) | 413 (309–591) | 756 (309–1371) |
4 | Prescribers/Medical officers | 3.5 (3–5) | 1.5 (1–3) | 3 (1–5) |
5 | Nurses | 6 (5–9) | 3 (2–5) | 4.5 (2–9) |
6 | Pharmacists/Dispensers | 1.5 (1–3) | 1 (1–2) | 1 (1–3) |
7 | AM groups available | 7 (5–9) | 3 .5 (3–6) | 5 (3–9) |
8 | AM agents available | 11 (9–15) | 7 (5–11) | 10 (5–15) |
Study design and outcome variables
Study inclusion / exclusion criteria
Sampling and data collection
Data analysis
Results
Hospital indicators
Sr. No. | Indicator | RHCsg(n = 16) | BHUs h(n = 16) | All PHCCsi(n = 32) |
p-value
|
---|---|---|---|---|---|
1 | Existence of DTCb, % | 100 | 100 | 100 | -------a |
2 | Availability of STGsc for infectious diseases, % | 0.0 | 0.0 | 0.0 | -------a |
3 | Availability of FL/EMLd, % | 100 | 100 | 100 | -------a |
4 | Number of AMs on the FL/EML | 15 | 15 | 15 | -------a |
5 | Medicines identified by INNe, % | 100 | 100 | 100 | -------a |
6 | Key AMs in stock, % | 73.8 (60–100) | 47.9 (33.3–73.3) | 60.8 (33.3–100) | < 0.001 |
7 | No. of days/month that a set of key AMs is out of stock, mean (range) | 7.4 (3.1–9.7) | 15.4 (8.7–19.2) | 12.1 (3.1–19.2) | < 0.001 |
8 | Total number of patients discharged per PHCC during the last calendar year | 1056 (783–1371) | 413 (309–591) | 756 (309–1371) | < 0.001 |
9 | Surgeries performed during the last calendar year | Major = 47.5 (29–93) | Major = 17.5 (11–33) | Major = 29.5 (11–93) | < 0.001 |
Minor = 219 (165–303) | Minor = 134.5 (104–207) | Minor = 189 (104–303) | |||
10 | Expenditure on AMsf per total PHCC medicine costs, % | 23.2 (17.1–29.5) | 31.3 (21.4–39.0) | 26.2 (17.1–39.0) | < 0.001 |
Prescribing indicators
Sr. No. | Indicator | RHCse(n = 16) | BHUsf(n = 16) | All PHCCsg(n = 32) |
p-value
|
---|---|---|---|---|---|
1 | Prescriptions with one or more AMsb, % (range) | 79.3 (68.9–86.2) | 83.8 (71.4–89.1) | 81.5 (68.9–89.1) | < 0.001 |
2 | AMs prescribed per prescription, mean (range) | 1.3 (1.1–1.5) | 1.5 (1.2–1.7) | 1.4 (1.1–1.7) | < 0.001 |
3 | AMs prescribed from FL/EMLh, % | 100 | 100 | 100 | -------a |
4 | Cost (USDc) of AMs prescribed per prescription, mean (range) | 1.5 (0.6–4.3) | 0.9 (0.6–3.7) | 1.3 (0.6–4.3) | < 0.001 |
5 | Duration of prescribed AMs (days), mean (range) | 5.2 (3.3–6.4) | 4.9 (3.7–5.8) | 5.1 (3.3–6.4) | < 0.001 |
6 | Pneumonia patients who received AMs, % | 100 | 100 | 100 | -------a |
7 | Patients who received AMs for Pneumonia in accordance with clinical guidelinesi, % | 0.0 | 0.0 | 0.0 | -------a |
8 | AMs prescribed by INNd, % | 100 | 100 | 100 | -------a |
Antimicrobial use in outpatients and inpatients
Indicator | RHCsb (n = 3600) | BHUsc (n = 3600) | All PHCCs (n = 7200) |
---|---|---|---|
Outpatients (n = 6400) | |||
1. Prescriptions with one or more AMsa, % | 76.7 | 81.8 | 79.2 |
2. AMs prescribed per prescription, mean (SD) | 1.0 (0.23) | 1.3 (0.41) | 1.2 (0.31) |
3. % of prescriptions with injected AMs | 31.6 | 42.7 | 36.8 |
4. Proper AMs use, % | 22.1 | 11.9 | 16.4 |
Inpatients all (n = 800) | |||
1. Prescriptions with one or more AMsa, % | 100 | 100 | 100 |
2. AMs prescribed per prescription, mean (SD) | 2.9 (0.11) | 3.1 (0.13) | 3.0 (0.12) |
3. % of prescriptions with injected AMs | 40.9 | 44.7 | 43.6 |
4. Proper AMs use, % | 14.3 | 11.6 | 12.1 |
A. Surgical (n = 436) | |||
1. Prescriptions with one or more AMsa, % | 100 | 100 | 100 |
2. AMs prescribed per prescription, mean (SD) | 2.9 (0.11) | 3.1 (0.13) | 3.0 (0.12) |
3. Proper AMs use, % | 13.1 | 11.7 | 11.9 |
B. Nonsurgical (n = 364) | |||
1. Prescriptions with one or more AMsa, % | 100 | 100 | 100 |
2. AMs prescribed per prescription, mean (SD) | 2.9 (0.11) | 3.1 (0.13) | 3.0 (0.12) |
3. Proper AMs use, % | 15.1 | 11.3 | 12.9 |
Prescribing patterns of antimicrobials
Sr. No. | ATCa Code | Antimicrobial name | RHCs b(n = 3711) | BHUs c(n = 4525) | Outpatients (n = 5853) | Inpatients (n = 2383) | All (N = 8236) |
---|---|---|---|---|---|---|---|
1 | J01AA02 | Doxycycline | 131 (3.5) | 97 (2.1) | 228 (3.9) | – | 228 (2.8) |
2 | J01CA01 | Ampicillin | 304 (8.2) | 464 (10.3) | 768 (13.1) | – | 768 (9.3) |
3 | J01CR02 | Amoxiclav | 497 (13.4) | 679 (15.0) | 863 (14.7) | 313 (13.1) | 1176 (14.3) |
4 | J01DB09 | Cephradine | 207 (5.6) | 109 (2.4) | 297 (5.1) | 19 (0.8) | 316 (3.8) |
5 | J01DD01 | Cefotaxime | 134 (3.6) | 77 (1.7) | 89 (1.5) | 122 (5.1) | 211 (2.6) |
6 | J01DD04 | Ceftriaxone | 488 (13.2) | 643 (14.2) | 522 (8.9) | 609 (25.6) | 1131 (13.7) |
7 | J01EE01 | Cotrimoxazole | 53 (1.4) | 31 (0.7) | 69 (1.2) | 15 (0.6) | 84 (1.0) |
8 | J01FA09 | Clarithromycin | 219 (5.9) | 242 (5.3) | 418 (7.1) | 43 (1.8) | 461 (5.6) |
9 | J01FF01 | Clindamycin | 123 (3.3) | 91 (2.0) | 214 (3.7) | – | 214 (2.6) |
10 | J01FF02 | Lincomycin | 212 (5.7) | 197 (4.4) | 409 (7.0) | – | 409 (5.0) |
11 | J01GB03 | Gentamicin | 79 (2.1) | 42 (0.9) | – | 121 (5.1) | 121 (1.5) |
12 | J01GB06 | Amikacin | 29 (0.8) | 14 (0.3) | 25 (0.4) | 18 (0.8) | 43 (0.5) |
13 | J01MA02 | Ciprofloxacin | 451 (12.2) | 906 (20.0) | 1163 (19.9) | 194 (8.1) | 1357 (16.5) |
14 | J01MA14 | Moxifloxacin | 113 (3.0) | 124 (2.7) | 108 (1.8) | 129 (5.4) | 237 (2.9) |
15 | J01XD01 | Metronidazole | 671 (18.1) | 809 (17.9) | 680 (11.6) | 800 (33.6) | 1480 (18.0) |