Evaluation of More Than One Billion Outpatient Prescriptions and Eight‐Year Trend Showing a Remarkable Reduction in Antibiotic Prescription in Turkey: A Success Model of Governmental Interventions at National Level

Author(s):  
Mesil Aksoy ◽  
Fatma Isli ◽  
Esma Kadi ◽  
Didem Varimli ◽  
Hakki Gursoz ◽  
...  
2020 ◽  
Vol 5 ◽  
pp. 194
Author(s):  
Benjamin Jeffrey ◽  
David M. Aanensen ◽  
Nicholas J. Croucher ◽  
Samir Bhatt

Background: Increasing antibiotic resistance in a location may be mitigated by changes in treatment policy, or interventions to limit transmission of resistant bacteria. Therefore, accurate forecasting of the distribution of antibiotic resistance could be advantageous. Two previously published studies addressed this, but neither study compared alternative forecasting algorithms or considered spatial patterns of resistance spread. Methods: We analysed data describing the annual prevalence of antibiotic resistance per country in Europe from 2012 – 2016, and the quarterly prevalence of antibiotic resistance per clinical commissioning group in England from 2015 – 2018. We combined these with data on rates of possible covariates of resistance. These data were used to compare the previously published forecasting models, with other commonly used forecasting models, including one geospatial model. Covariates were incorporated into the geospatial model to assess their relationship with antibiotic resistance. Results: For the European data, which was recorded on a coarse spatiotemporal scale, a naïve forecasting model was consistently the most accurate of any of the forecasting models tested. The geospatial model did not improve on this accuracy. However, it did provide some evidence that antibiotic consumption can partially explain the distribution of resistance. The English data were aggregated at a finer scale, and expected-trend-seasonal (ETS) forecasts were the most accurate. The geospatial model did not significantly improve upon the median accuracy of the ETS model, but it appeared to be less sensitive to noise in the data, and provided evidence that rates of antibiotic prescription and bacteraemia are correlated with resistance. Conclusion: Annual, national-level surveillance data appears to be insufficient for fitting accurate antibiotic resistance forecasting models, but there is evidence that data collected at a finer spatiotemporal scale could be used to improve forecast accuracy. Additionally, incorporating antibiotic prescription or consumption data into the model could improve the predictive accuracy.


Author(s):  
Nehad J. Ahmed

Aim: The aim of this study was to describe the seasonal variations in dispensing antibiotic prescriptions in the outpatient setting of a public hospital in Alkharj. Methodology: A retrospective cross-sectional study was conducted. The outpatient prescriptions in 2017 and 2018 were collected from medical records in a public hospital in Alkharj. The data include the number of prescribed antibiotics in general, the number of prescribed antibiotics in different months and seasons in the outpatient setting. Results: In the outpatient setting in 2017 and 2018, antibiotics were prescribed excessively in most of the months. About 27.84 %of the prescriptions in 2017 were in spring season and about 26.64% of the prescriptions in 2018 were in autumn. Total number of antibiotics prescriptions in 2017 and 2018 were 5348 in spring followed by 5097 in autumn. Conclusion: The results of the present study showed the widespread use of antibiotics by practitioners that was associated with season of prescribing. In general, there are excess use of antibiotics in all months. It is important to understand how the prescribing of antibiotic varies throughout the year to design an appropriate intervention to decrease incorrect antibiotic use.


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S750-S750
Author(s):  
Shinya Tsuzuki ◽  
Yuki Kimura ◽  
Masahiro Ishikane ◽  
Yoshiki Kusama ◽  
Norio Ohmagari

Abstract Background Antibiotics are often inappropriately prescribed for treating upper respiratory infection (URI) patients in ambulatory care settings. In Japan, a previous study estimated physicians prescribed antibiotics in about 30% of URI cases. However, trends of prescription behavior and additional costs of inappropriate antibiotic use in URI cases are still not clear in Japan. The present study’s main objective was to clarify the amount of additional cost owing to inappropriate antibiotic prescription for URI, and the recent trend. Methods We conducted a retrospective observational survey using longitudinal claims data spanning 2013–2016, obtained from the Japan Medical Data Center Co., Ltd. (JMDC) Claims Database, which contains anonymous claim data on 5.1 million (for 2013–2016) corporate employees covered by the employees’ health insurance plan (Social insurance), and their family members <65 years old. Six physicians specialized in infectious disease assessed the appropriateness of antibiotic prescription based on the ICD-10 code in the database. The total additional cost of antibiotic prescription for URI at the national level was estimated by weighting corresponds to the age-structured population data, from the healthcare payer perspective. Costs of treatment for adverse events and of antimicrobial resistance caused by inappropriate antibiotic prescription were not taken into consideration. Results The total annual cost of antibiotic prescription for URI was estimated at US$423.6 (95% confidence interval: 416.8–430.5) million in 2013, $340.9 (335.7–346.2) million in 2014, $349.9 (344.5–355.3) million in 2015, and $297.1 (292.4–301.9) million in 2016. Conclusion Although a decreasing trend was observed, the annual cost of antibiotic prescription for URI potentially imposes a substantial economic burden in Japan. Disclosures All authors: No reported disclosures.


Author(s):  
Priyastiwi Priyastiwi

The purpose of this article is to provide the basic model of Hofstede and Grays’ cultural values that relates the Hofstede’s cultural dimensions and Gray‘s accounting value. This article reviews some studies that prove the model and develop the research in the future. There are some evidences that link the Hofstede’s cultural values studies with the auditor’s judgment and decisions by developing a framework that categorizes the auditor’s judgments and decisions are most likely influenced by cross-cultural differences. The categories include risk assessment, risk decisions and ethical judgments. Understanding the impact of cultural factors on the practice of accounting and financial disclosure is important to achieve the harmonization of international accounting. Deep understanding about how the local values may affect the accounting practices and their impacts on the financial disclosure are important to ensure the international comparability of financial reporting. Gray’s framework (1988) expects how the culture may affect accounting practices at the national level. One area of the future studies will examine the impact of cultural dimensions to the values of accounting, auditing and decision making. Key word : Motivation, leadership style, job satisfaction, performance


2018 ◽  
Vol 13 (1) ◽  
Author(s):  
Reza Hendriyantore

The effort to put good governance in development in Indonesia is basically not new. Since the Reformation, the transformation of closed government into an open government (inclusive) has begun to be pursued. Highlighting the conflicts in the land sector that tend to strengthen lately, there are some issues that have intensified conflicts in the field, such as the lack of guaranteed land rights in various legal and policy products. In this paper, a descriptive method is considered important in identifying the applicable issue and methodological framework for addressing governance issues in Indonesia. To reduce such agrarian conflicts between farmers and the government, and as an effort to increase farmers' income, all farmers are incorporated into agricultural cooperatives. Agricultural cooperatives are structured down to the National Level. Thus, farmers participate in good access to the marketing of agricultural produce.Keywords:good governance, agrarian conflict, agricultural cooperative


2019 ◽  
pp. 20-45

This article examines how the global climate change discourse influences the implementation of national science policy in the area of energy technology, with a focus on industry and science collaborations and networks. We develop a set of theoretical propositions about how the issues in the global discourse are likely to influence research agendas and networks, the nature of industry-science linkages and the direction of innovation. The plausibility of these propositions is examined, using Estonia as a case study. We find that the global climate discourse has indeed led to the diversification of research agendas and networks, but the shifts in research strategies often tend to be rhetorical and opportunistic. The ambiguity of the global climate change discourse has also facilitated incremental innovation towards energy efficiency and the potentially sub-optimal lock-in of technologies. In sum, the Estonian case illustrates how the introduction of policy narratives from the global climate change discourse to the national level can shape the actual policy practices and also networks of actors in a complex and non-linear fashion, with unintended effects.


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