Antibiotics Prescription Rates for Upper Respiratory Tract Infections in Thai NaNational Health Insurance Systems (อัตราการใช้ยาปฏิชีวนะเพื่อรักษาโรคติดเชื้อทางเดินหายใจส่วนบน ในระบบประกันสุขภาพของประเทศไทย)

The objectives of the study were to assess the uses of antibiotics in treating non-specificupper respiratory infections in medical services under the national health insurance system.The rates of antibioticus prescription were compared between different types of health insurance.A review of medical records in eight provinces covering thirty community hospitals, fourgeneral hospitals, two regional hospitals, one university hospital and three private hospitals.Data were collected from medical records of adults and pediatric patients attending out-patientdepartments, primary care units located either inside or outside the hospitals. The total numbersof patients were 7,054. Fifty percent of them had been covered free of charge by the gold cardinsurance; 15 percent had gold card insurance with 30 baht fee for each visit. Civil servantmedical benefit scheme and social security scheme covered 8.4 and 4 percent of the patients.Seventeen percent of the patients had no health insurance and paid for the services. The resultsshowed that antibiotic prescription rates for non-specific upper respiratory infection (URI,rhinitis, common cold and flu) were different between the groups. The lowest rate of antibioticprescription was in the group of the patients who held the gold card insurance with fee exemption.The prescription rates in the group of gold card with 30 baht fee per visit, no insurance,government official and social health insurance were 54.4, 54.9, 50.0 and 51.1 percent respectively.Regarding patients with pharyngitis and laryngitis, there were no differrences betweenthe groups; and the prescription rate of pharyngitis was more than 80 percent. There weresignificant associations between the antibiotic prescription rates and the types of health insuranceafter controlling age, diseases diagnosed, and types of services. Patients holding gold cardwith fee exemption were prescribed less antibiotics than those who paid for service (adjustedodds ratio 0.56, 95%CI 0.49, 0.65). In conclusion, the study revealed that antibiotics prescriptionin non-specific upper respiratory tract infections might be redundant and subjective. Inhospitals with high rate of antibiotic prescriptions, the practice guidelines should be reviewed,and based on updated evidence. The follow-up and monitoring system should be in place inorder to decrease the over-use of antibiotics. Key words : antibiotics, upper respiratory tract infection, health insurance system, universal health care coverage