The Impact of the Health Transformation Plan on Injectable Antibiotic Prescription Patterns:
A Case Study of Bu-Ali Hospital
-
Mohammad Mahdi Raeis zadeh
,
Fatemeh Soleymani
,
Anahita Bineshian
,
Daryush Talei
,
Maryam Shiehmorteza
Abstract
Background: Health systems must continuously adapt and undergo reforms in both structure and function to effectively meet the evolving needs of society and respond to changing conditions. Due to the importance of the role of drug studies in rationalizing the pattern of drug use, the current study was based on the anatomical therapeutic chemical (ATC) classification system and the defined daily dose (DDD) developed by World Health Organization (WHO). Methods: This study is a retrospective, cross-sectional, descriptive-analytical analysis of injectable antibiotic prescriptions at Bu-Ali Hospital from 2012 to 2017. Data were extracted from the Hospital Information System (HIS), focusing on injectable antibiotics administered and consumed during hospital stays. The Kolmogorov-Smirnov test was used to assess data normality, and the paired t-test was applied to compare the periods before and after the implementation of the HTP. The Wilcoxon signed-rank test was also used for paired group comparisons. Results: Following the implementation of the HTP, all investigated indicators include total number, DDD and cost showed a significant increase compared to the pre-HTP period. Only the cost per capita (p-value=0.712) and amount per capita (p-value =0.182) of total injectable antibiotics decreased post-HTP, though this change was not statistically significant. Conclusion: The HTP in Iran significantly influenced antibiotic prescription patterns at Bu-Ali Hospital, leading to increased usage of injectable antibiotics and DDD. These changes improved access to potent antibiotics, but continued monitoring is necessary to ensure responsible usage and prevent antimicrobial resistance.
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[19] OECD. Stemming the Superbug Tide [Internet]. OECD; 2018. 220 p. (OECD Health Policy Studies; vol. 2015). Available from: http://www.oecd.org/health/health-systems/Stemming-the-Superbug-Tide-Executive-Summary-English.pdf%0Ahttps://www.oecd-ilibrary.org/social-issues-migration-health/stemming-the-superbug-tide_9789264307599-en%0Ahttps://www.oecd-ilibrary.org/social-issues-mig
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[21] Rogers Van Katwyk S, Grimshaw JM, Nkangu M, Nagi R, Mendelson M, Taljaard M, et al. Government policy interventions to reduce human antimicrobial use: A systematic review and evidence map. Banach D, editor. PLOS Med [Internet]. 2019 Jun 11;16(6):e1002819. Available from: https://dx.plos.org/10.1371/journal.pmed.1002819
[22] Rogers Van Katwyk S, Grimshaw JM, Mendelson M, Taljaard M, Hoffman SJ. Government policy interventions to reduce human antimicrobial use: protocol for a systematic review and meta-analysis. Syst Rev [Internet]. 2017 Dec 13;6(1):256. Available from: https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-017-0640-2
[23] World Health Organization [Internet]. [cited 2024 Jun 10]. Defined Daily Dose (DDD). Available from: https://www.who.int/tools/atc-ddd-toolkit/about-ddd
[2] Kuhlmann E, Annandale E. Researching transformations in healthcare services and policy in international perspective: An introduction. Curr Sociol [Internet]. 2012 Jul 22;60(4):401–14. Available from: http://journals.sagepub.com/doi/10.1177/0011392112438325
[3] BEST A, GREENHALGH T, LEWIS S, SAUL JE, CARROLL S, BITZ J. Large‐System Transformation in Health Care: A Realist Review. Milbank Q [Internet]. 2012 Sep 18;90(3):421–56. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1468-0009.2012.00670.x
[4] Halfon N, Long P, Chang DI, Hester J, Inkelas M, Rodgers A. Applying A 3.0 Transformation Framework To Guide Large-Scale Health System Reform. Health Aff [Internet]. 2014 Nov;33(11):2003–11. Available from: http://www.healthaffairs.org/doi/10.1377/hlthaff.2014.0485
[5] Lukas CV, Holmes SK, Cohen AB, Restuccia J, Cramer IE, Shwartz M, et al. Transformational change in health care systems. Health Care Manage Rev [Internet]. 2007 Oct;32(4):309–20. Available from: https://journals.lww.com/00004010-200710000-00003
[6] Riley WJ, Parsons HM, Duffy GL, Moran JW, Henry B. Realizing Transformational Change Through Quality Improvement in Public Health. J Public Heal Manag Pract [Internet]. 2010 Jan;16(1):72–8. Available from: https://journals.lww.com/00124784-201001000-00015
[7] Swanson RC, Cattaneo A, Bradley E, Chunharas S, Atun R, Abbas KM, et al. Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change. Health Policy Plan [Internet]. 2012 Oct 1;27(suppl 4):iv54–61. Available from: https://academic.oup.com/heapol/article-lookup/doi/10.1093/heapol/czs090
[8] Moradi-Lakeh M, Vosoogh-Moghaddam A. Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns. Int J Heal Policy Manag [Internet]. 2015 Aug 31;4(10):637–40. Available from: http://ijhpm.com/article_3089_616.html
[9] Esmailzadeh H, Rajabi F, Rostamigooran N, Majdzadeh R. Iran health system reform plan methodology. Iran J Public Health. 2013;42(1 SUPPL 1):13–7.
[10] Ghasemyani S, Raoofi S, Hamidi H, Khodayari-Zarnaq R. Iran’s Health Transformation Plan; Main Issues and Opportuni-ties for Improvement: A Systematic Review. Iran J Public Health [Internet]. 2022 Sep 11; Available from: https://publish.kne-publishing.com/index.php/ijph/article/view/10552
[11] Jahani MA, Naghshineh A, Naghavian M, Semnani H. Safety indicators in the hospitals affiliated to Babol University of medical sciences, Iran; 2010. J Babol Univ Med Sci. 2013;15(2):95–101.
[12] Naghavian M, Naghshine A, Abdi M, Jahani MA. The evaluation of performance indicators in the health care centers of Babol university of medical sciences by the Pabon Lasso model (2011-2014). J Babol Univ Med Sci. 2015;17(3):76–82.
[13] Tadesse TY, Molla M, Yimer YS, Tarekegn BS, Kefale B. Evaluation of antibiotic prescribing patterns among inpatients using World Health Organization indicators: A cross-sectional study. SAGE Open Med [Internet]. 2022 Jan 14;10:205031212210966. Available from: http://journals.sagepub.com/doi/10.1177/20503121221096608
[14] Sulis G, Adam P, Nafade V, Gore G, Daniels B, Daftary A, et al. Antibiotic prescription practices in primary care in low- and middle-income countries: A systematic review and meta-analysis. Kruk ME, editor. PLOS Med [Internet]. 2020 Jun 16;17(6):e1003139. Available from: https://dx.plos.org/10.1371/journal.pmed.1003139
[15] Machowska A, Stålsby Lundborg C. Drivers of Irrational Use of Antibiotics in Europe. Int J Environ Res Public Health [Internet]. 2018 Dec 23;16(1):27. Available from: http://www.mdpi.com/1660-4601/16/1/27
[16] Debela GA, Tesfaye BT, Yizengaw MA. Risk Factors for Inappropriate Antimicrobial Therapy Among Patients with Hospital-Acquired Infection at Jimma Medical Center: A Prospective Observational Study. Infect Drug Resist [Internet]. 2022 Mar;Volume 15:837–50. Available from: https://www.dovepress.com/risk-factors-for-inappropriate-antimicrobial-therapy-among-patients-wi-peer-reviewed-fulltext-article-IDR
[17] Nazer MR, Darvishi M. Prescribe and use of antibiotics and its role in microbial resistance and its effects on resistance economy. Yafteh. 2017;19(3):49–62.
[18] Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet [Internet]. 2022 Feb;399(10325):629–55. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673621027240
[19] OECD. Stemming the Superbug Tide [Internet]. OECD; 2018. 220 p. (OECD Health Policy Studies; vol. 2015). Available from: http://www.oecd.org/health/health-systems/Stemming-the-Superbug-Tide-Executive-Summary-English.pdf%0Ahttps://www.oecd-ilibrary.org/social-issues-migration-health/stemming-the-superbug-tide_9789264307599-en%0Ahttps://www.oecd-ilibrary.org/social-issues-mig
[20] The Review on Antimicrobial Resistance (Chaired by Jim O’Neill). Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. 2016;(May):1–80.
[21] Rogers Van Katwyk S, Grimshaw JM, Nkangu M, Nagi R, Mendelson M, Taljaard M, et al. Government policy interventions to reduce human antimicrobial use: A systematic review and evidence map. Banach D, editor. PLOS Med [Internet]. 2019 Jun 11;16(6):e1002819. Available from: https://dx.plos.org/10.1371/journal.pmed.1002819
[22] Rogers Van Katwyk S, Grimshaw JM, Mendelson M, Taljaard M, Hoffman SJ. Government policy interventions to reduce human antimicrobial use: protocol for a systematic review and meta-analysis. Syst Rev [Internet]. 2017 Dec 13;6(1):256. Available from: https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-017-0640-2
[23] World Health Organization [Internet]. [cited 2024 Jun 10]. Defined Daily Dose (DDD). Available from: https://www.who.int/tools/atc-ddd-toolkit/about-ddd
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| Issue | Vol 11 No 1 (2025) | |
| Section | Case Report(s) | |
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| Healthcare policy Out-of-pocket payments Healthcare reform Resource allocation | ||
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How to Cite
1.
Raeis zadeh MM, Soleymani F, Bineshian A, Talei D, Shiehmorteza M. The Impact of the Health Transformation Plan on Injectable Antibiotic Prescription Patterns:. JPPM. 2025;11(1):45-56.
