深圳市宝安区社康中心运行机制改革对抗生素处方比例的影响:基于间断时间序列比较组分析

Effects of Community Health Reform on Prescription of Antibiotics in the Community Health Center of Bao'an District of Shenzhen,through an Interrupted Time Series Design with a Comparison Group

目的评估深圳市宝安区社康中心运行机制改革对门诊抗生素处方比例的影响。方法深圳市宝安区观澜街道的社区健康中心从2009-06-01开始进行社康中心服务改革,为试点组;松岗街道社区健康中心作为比较组。利用从罡正社康信息系统导出比较组2008-06-01至2010-05-31的门诊电子数据,试点组2008-10-01至2010-05-31的门诊电子数据。采取间断时间序列比较组的评估设计进行分段回归分析。结果试点组抗生素处方比例在波动中呈下降趋势,改革前平均水平为77.00%,改革后平均水平为72.78%。比较组抗生素处方比例呈季节波动。控制时间趋势,分段回归分析结果显示,改革使得试点组抗生素处方比例每两周减少0.77(P=0.047)。结论深圳市宝安区社康中心运行机制改革有效控制了抗生素处方比例,有利于合理用药。

Objective To evaluate the effects of operation reform on the ratio of antibiotic prescriptions in outpatient clinics in the Community Health Center of Bao'an District in Shenzhen City.Methods The Community Health Center of Bao'an District started service and operation reform on 2009-06-01,and was considered the pilot group.The Community Health Center of the Songgang street community was used as a comparative group.The outpatient electronic data from the two health centers were extracted from the Conggangzheng Community Health Information System(from June 1,2008 to May 31,2010 for the pilot group,and from October 1,2008 to May 31,2010 for the comparative group).A piecewise regression analysis based on an interrupted time series design with a comparison group was used to compare the antibiotic usage between the two groups.Results The proportion of antibiotic prescriptions in the pilot group showed a decreasing trend in a fluctuating manner.The average level was 77.00%before the reform and 72.78%after the reform.The proportion of antibiotic prescriptions in the comparative group showed seasonal fluctuations.With controlling for a time trend,the results of the piecewise regression showed that the community health service reform in Shenzhen city led to a 0.77 reduction in the proportion of antibiotic prescriptions in the pilot group every 2 weeks(P=0.047).Conclusion The operation reform at the Community Health Center of Bao'an District of Shenzhen effectively controlled the use of antibiotics and improved the rational use of antibiotic drugs.