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Reducing antibiotic use in ambulatory patients with upper respiratory tract infections under Taiwan's National Health Insurance: An intervention analysis

Chia-Nien Liu, National Open University, Taiwan, No.172, Chung-Cheng Rd, Lu Chow, Taipei County, Taiwan, 886-2-22829355 ext. 3101, christin@nou.edu.tw

Background: Antibiotic use is associated with increased rates of antibiotic-resistant bacteria. Previous studies had identified antibiotic uses in ambulatory patients with upper respiratory infections (URIs) as an important source of antibiotic abuse. This study is to assess the restricting effects of a new reimbursement rule enforced by the Bureau of National Health Insurance (BNHI) on outpatient antibiotic use for patients with URIs in Taiwan. Methods: We conducted an intervention time series analysis to examine the effects of the BNHI new rule on monthly antibiotic use rates for outpatient visits on two groups- 1) URIs diagnoses as the target group and 2) the other respiratory tract infections diagnoses as the comparison group. The subject pool was composed by systematic sampling every 500th outpatient visit from the National Health Insurance Research Database, for the period between January 1, 2000 and December 31, 2002, with an intervention in February 2001. Results: Both groups reduced the monthly antibiotic use rates between the pre-intervention and post-intervention periods, as the announcement of BNHI new rule raised physicians' alert to use antibiotic more carefully for respiratory tract infections. The intervention-attributable decreases in antibiotic use rates were 12.3% (95% confidence interval, 8.8%-15.7%; P<0.005) for the target group of the primarily viral infections URIs, and 5.1% (95% CI. 3.0-7.0%) for the comparison group. Physicians did not change their coding of illness to justify antibiotic use after the intervention. Conclusions: This intervention of the National Health Insurance demonstrates prominent reductions in antibiotic use for patients with URIs.

Learning Objectives:

  • The learner will be able to

    Keywords: Health Insurance, Quality

    Presenting author's disclosure statement:

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    Advances in Health Systems Research: Posters

    The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA