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 Original Articles |
| Variations of Antimicrobial Prescription Patterns Among Some Hospitals |
| Young Soo Shin, Yong-Ik Kim, Young Seong Lee, Chang Yup Kim, Kang Won Choe, Hoan Jong Lee |
| Department of Health Policy and Management, College of Medicine, Seoul National University, Seoul, Korea, Department of Preventive Medicine, College of Medicine, Dankook University, Chunan, Korea, Infection Control Department, Seoul National University Hospital, Seoul, Korea |
Vol.24 Num.4 (p271~284)
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The purpose of this study is to probe the patterns of antibiotic prescriptions among the hospitals in Korea; such as drug cost, prescription rate, duration and appropriateness. Five clinical cases which are Cesarean section, appendectomy, cholecystectomy, cataract extraction, and pediatric pneumonia, were selected for this study. The selected clinical cases were sampled from the medical insurance claim bills (total 2,316 cases) and medical records (total 414 cases). The precribing variation of the hospitals (total 70) were analysed as the frame of hospital bed size (tertiary hospital, general hospital (A, B), hospital) and their ownership (public tertiary, private tertiary, public general, private general, private).
The results are as follows;
1) The consumption pattern, proportion of antibiotics in total drug cost, showed significant difference among hospital groups. For example, the proportion of antibiotic cost in pediatric pneumonia was highest in the general hospital group A (28.1%).
2) The prescription rate of general antibiotics ranged from 96.5% to 100%. For the reserved antibiotics, The rate was 74.7% in cataract extraction, 66.5% in Cesarean section, 62.6% in cholecystectomy, 51.6% in appendectomy and 42.0% in pediatric pneumonia. The rate also varied significantly among hospitals. The variation of inter-hospital groups was highest in pediatric pneumonia. The general hospital B and the private tertiary hospital groups priscribed the reserved antibiotics more frequently.
3) In all cases, the average duration of antibiotic administration was more than five days, which was differ little from average length of stay (ALOS) of each cases. For example, the mean durations of Cesarean section and cholecystectomy were 6.9 and 14.3 days respectively, while the ALOS of this cases were 8.8 and 15.7 days. Most of the prescribed antibiotics were not therapeutic, but prophylactic.
4) Considering the principles of prescribing prophylactic antibotics, these findings on the pattern of antibiotic prescription, especially on the aspects of prescription rate, duration, and its variation among the hospitals have particular significance for the quality of hospital care.
The results of this study imply a strong probability of antibiotic over-utilization, whicah lead to thefollowing perspectives. First, well designed further research on this topic should be followed, including analysis of behavioral factors affecting the drug prescription. Second, it is necessary to develop quality improvement programs such as drug utilization review for the proper and efficient use of antibiotics.
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