Analyzing data from the digital healthcare exchange platform for surveillance of antibiotic prescriptions in primary care in urban Kenya: A mixed-methods study

Background
Knowledge of antibiotic prescription practices in low- and middle-income countries is limited due to a lack of adequate surveillance systems.
Objective
To assess the prescription of antibiotics for the treatment of acute respiratory tract infections (ARIs) in primary care.
Method
An explanatory sequential mixed-methods study was conducted in 4 private not-for-profit outreach clinics located in slum areas in Nairobi, Kenya. Claims data of patients who received healthcare between April 1 and December 27, 2016 were collected in real-time through a mobile telephone-based healthcare data and payment exchange platform (branded as M-TIBA). These data were used to calculate the percentage of ARIs for which antibiotics were prescribed. In-depth interviews were conducted among 12 clinicians and 17 patients to explain the quantitative results.
Results
A total of 49,098 individuals were registered onto the platform, which allowed them to access healthcare at the study clinics through M-TIBA. For 36,210 clinic visits by 21,913 patients, 45,706 diagnoses and 85,484 medication prescriptions were recorded. ARIs were the most common diagnoses (17,739; 38.8%), and antibiotics were the most frequently prescribed medications (21,870; 25.6%). For 78.5% (95% CI: 77.9%, 79.1%) of ARI diagnoses, antibiotics were prescribed, most commonly amoxicillin (45%; 95% CI: 44.1%, 45.8%). These relatively high levels of prescription were explained by high patient load, clinician and patient perceptions that clinicians should prescribe, lack of access to laboratory tests, offloading near-expiry drugs, absence of policy and surveillance, and the use of treatment guidelines that are not up-to-date. Clinicians in contrast reported to strictly follow the Kenyan treatment guidelines.
Conclusion
This study showed successful quantification of antibiotic prescription and the prescribing pattern using real-world data collected through M-TIBA in private not-for-profit clinics in Nairobi.

研究背景
由于缺乏完善的监测体系，低收入和中等收入国家的抗生素处方实践相关认知仍较为有限。

研究目的
评估基层医疗（Primary Care）中用于治疗急性呼吸道感染（Acute Respiratory Tract Infections, ARIs）的抗生素处方情况。

研究方法
本研究在肯尼亚内罗毕贫民窟区域的4家私立非营利性外展门诊开展，采用解释性序贯混合方法研究设计。于2016年4月1日至12月27日期间，通过基于移动电话的医疗数据与支付交换平台（品牌名为M-TIBA）实时采集在此类门诊接受医疗服务的患者就诊明细数据；利用该数据计算开具抗生素的急性呼吸道感染病例占比。此外，对12名临床医师与17名患者开展深度访谈，以阐释定量研究结果。

研究结果
共计49098名个体注册至该平台，可通过M-TIBA在本研究涉及的门诊接受医疗服务。21913名患者共计完成36210人次门诊就诊，累计记录45706条诊断记录与85484张药物处方。急性呼吸道感染为最常见的诊断类别（共17739例，占比38.8%），抗生素则为最常开具的药物（共21870张处方，占比25.6%）。在78.5%（95%置信区间（Confidence Interval, CI）：77.9%~79.1%）的急性呼吸道感染诊断中均开具了抗生素，其中最常用的为阿莫西林（占比45%；95%置信区间：44.1%~45.8%）。此类较高的抗生素处方率可归因于以下因素：门诊负荷过重、临床医师与患者均认为医师应当开具抗生素、无法开展实验室检测、处置临期药品、缺乏相关政策与监测体系，以及使用了过时的诊疗指南。与之相反，临床医师称其严格遵循肯尼亚国内的诊疗指南。

研究结论
本研究利用内罗毕地区私立非营利性门诊通过M-TIBA平台采集的真实世界数据（Real-World Data, RWD），成功实现了抗生素处方情况与处方模式的量化分析。