The Strategies for Improving Antibiotic Usage under the Diagnoses of Upper Respiratory Infections and Its Impact in the Ambulatory Clinics in One Medical Centre in Taiwan

The Bureau of National Health Insurance (NHI) in Taiwan has provided quality indicators to all medical care providers each quarter to assure and evaluate the quality of medical service. This system highlighted a higher rate of antimicrobial usage in treating upper respiratory tract infections (URIs) in our ambulatory clinics than that in other tertiary medical care providers. Therefore, we aimed at developing effective strategies to reduce irrational antimicrobial usage in patients with URIs. Clinical practice guidelines were applied in a series of educational discussion meetings from October 2004 to September 2005. The principle of writing correct diagnoses was explained using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) codes, and educational materials were provided for patients during the ambulatory clinics. Data submitted to NHI were analysed by the Department of Pharmacy of Cathay General Hospital. Antimicrobial usage by patients with URIs decreased dramatically after the program had been implemented, i.e., from 28.6% in the third quarter of 2004 to 13.9% in the third quarter of 2005. It is noteworthy that even after the end of the study, the rates remained persistently low, i.e., 9.7%-12.1% from the fourth quarter of 2005 through the second quarter of 2006. The result of this study demonstrated the effectiveness of the strategies for promoting appropriate antimicrobial usage.