Application of propensity scores to explore the effect of public reporting of medicine use information on rational drug use in China: a quasi-experimental design

BACKGROUND Transparency has become a hottest topic and a growing movement in the health care system worldwide. This study used a quasi-experimental design method to explore whether public reporting of medicine use information can improve rational drug use. METHODS 20 township hospitals and 274 doctors of City Y in Hubei Province, China were divided into the intervention and control groups on the basis of their characteristics. In the intervention group, the values and rankings of the average expenditure per prescription, percentage of prescriptions requiring antibiotics and percentage of prescriptions requiring injections of each hospital and doctor were publicly released to patients and doctors in an appropriate format monthly. Data were gathered both four months before and after the intervention. Propensity score matching (PSM) was used to minimize the observed covariate (gender, age, experience, education level, title, and monthly income) differences in the doctors' characteristics. 108 pairs of doctors were obtained after PSM. Chi-square test and t-test were employed to explore the effect of public reporting of medicine use information on rational drug use. The study was approved by the Committee of Tongji Medical College, Hua Zhong University of Science and Technology (IORG No: IORG0003571). RESULTS In baseline, the average expenditure per prescription of the 274 doctors was 42.82 RMB yuan (USD 6.97), the percentage of prescriptions requiring antibiotics was 63.00%, and the percentage of prescriptions requiring injections was 70.79%, all higher than the average of Hubei Province and the standard recommended by WHO. Before the intervention all the three indicators were all comparable (p > 0.05), whereas after the intervention, a significant difference (p < 0.05) was found for the percentage of prescriptions requiring injections between the intervention (64.66%) and control groups (70.52%). CONCLUSIONS Irrational drug use remains a policy issue in township hospitals in the study area. We demonstrated that publicly reporting medicine use information could decrease the percentage of prescriptions requiring injections in township hospitals in China, but this effect was not observed on prescription costs and antibiotics use. Analyses of the mechanism and long-term effect of public reporting of medicine use information are recommended for further studies.