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


Autoři: Legese A. Mekuria aff001;  Tobias FR de Wit aff001;  Nicole Spieker aff004;  Ramona Koech aff004;  Robert Nyarango aff005;  Stanley Ndwiga aff005;  Christine J. Fenenga aff003;  Alice Ogink aff003;  Constance Schultsz aff001;  Anja van’t Hoog aff001
Působiště autorů: Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands aff001;  Amsterdam University Medical Centers, Location AMC, Meibergdreef, Amsterdam, The Netherlands aff002;  PharmAccess Foundation, Amsterdam, The Netherlands aff003;  PharmAccess Foundation, Nairobi, Kenya aff004;  Gertrude’s Children’s Hospital, Nairobi, Kenya aff005
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222651

Souhrn

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.

Klíčová slova:

Antibiotics – Drug therapy – Health economics – Kenya – Medical doctors – Primary care – Respiratory infections – Treatment guidelines


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