Infusion madness: patients in Nanchang hospitals consuming gallons of IV antibiotics

by Michael Woodhead
Health experts in Nanchang, Jiangxi have admitted that their city's hospitals are some of the worst offenders in China when it comes to the practice of allowing patients to unnecessary IV infusions. 
In a country where the average person consumes eight bottles of IV infusion fluid per year, Nanchang is above the national average. Dr Yuan Zhaokang, head of the Nanchang University department of public health, says 90% of people are not aware of the risks and harms of IV infusions and yet between 60-70% of people in outpatient departments are given them. Of these patients, 75% don't need the infusions and could be given oral medicines instead. Dr Yuan says China's rate of IV antibiotic use is10 times higher than the international average, meaning that most intravenous antibiotics given in China are unnecessary.
In theory, the public are told that they should not have an injection when an oral medicine will suffice, but in practice in China this order has been turned on its head, Dr Yuan says.
A Sichuan emergency medicine director, Dr Zhen Tao says he opposes routine use of IV drips for people with colds, but it is hard to change the public mindset.
"People believe that IV infusions are more effective and work faster than oral medicine - but they are wrong," he says. Given a choice, patients always demand "infusion first", and few are aware that this directly contradicts the WHO advice for "never give an IV infusion when an IM injection will suffice, and never given an injection when oral medicine will be sufficient".
While this message is slowly getting across to more educated adults, the situation for children is getting worse, says Dr Zhen. Whenever the weather gets cold or the season changes, the hospital's infusion room is crowded with children who have colds who are attached to IV infusion bottles.
A common cold is a minor viral illness - so why do all Chinese insist on having unnecessary antibiotics by intravenous infusion? Dr Zhen says one reason is the pressure from parents with 'inflexible' thinking and attitudes. Another reason is that hospitals make money from infusions.
"Families want a quick cure-all and hospitals want a quick profit. When these two factors come together the result is bad medicine," says Dr Zhen.
The craze for children to have infusions especially worries Dr Zhen because he says it can weaken their health. Antibiotics not only kill pathogens, they also kill the 'good' bacteria that children need for developing an immune system and digestive health, he says. This is especially so for children who have repeated infusions, which become a vicious circle, where more treatments are requested because the child gets sicker and more prone to infections.
As well as increasing antibiotic resistance, IV infusions of antibiotics often cause many other serious health problems, including life-threatening anaphylaxis and other allergic reactions, phlebitis and injection site reactions, circulatory overload and heart failure as well as pyrexia (high fever), Dr Zhen warns.
The only people who really need IV infusions are those who have swallowing disorders, gastric malabsorption problems and the acutely  critically ill patient, he said.

Shenzhen clinics show over-prescribing of antibiotics can be curbed by removing financial incentives for doctors

by Michael Woodhead
Antibiotic prescribing fell significantly when Shenzhen community clinics severed their ties with hospitals and dropped the financial incentives to prescribe them, a study has shown.
Published in the journal Family Practice, the study by Dr Liang Xiaoyun and colleagues at Beijing Normal University shows that prescribing of antibiotics fell by about 10% when the governance model of community  clinics in Shenzhen's Baoan district was changed by government in 2009. Under the new independent model, doctors no longer received financial incentives for prescribing. After the reform, the number of young children receiving antibiotics decreased by 9%. The costs of antibiotic prescriptions also fell because doctors tended to prescribe cheaper first generation antibiotics instead of more expensive newer drugs. The study authors said their findings showed that "changes in governance structure model can have positive effects on the antibiotic prescribing behaviour of providers. This short-term effect might have an important
implication for community health reform in China."

China needs to act on overuse of intravenous infusions - BMJ

[Pic: www.news.cn]

Action is needed to reduce China’s massive overuse of intravenous infusions for inappropriate indications, according to an article in the BMJ this week.
The timid steps taken so far by the Chinese government have done little to dent the widespread misuse of IV infusions, with as many as ten billion courses – or eight per person per year – being given, says Yuan Sanying of the West China Hospital, Sichuan University, Chengdu.
She says the government has recognised the problem and has acted to reduce financial incentives for prescribing infusions. However, there is still enormous pressure on doctors to set up IV infusions and the practice continues in most hospitals. Many hospitals even have dedicated infusion rooms, she notes.
Ms Yuan, who works as a nurse in the Department of Liver Surgery, says hospitals look like ‘infusion forests’ during cold weather spells as patients are treated with infusions for common respiratory ailments. And yet doctors acknowledge that most patients don’t need IV medication and could be better treated with oral remedies and rest.
The use of infusions is a major burden on hospital staff, with nurses reporting being overworked and diverted from other tasks as they spend half their working day setting up IV infusions. The Ministry of health has responded by monitoring the number of infusions and by banning some hospitals and doctors from earning commissions from the use of infusions. However, inappropriate is still driven by pressure from patients who believe that they will recover faster if they have an infusion. Doctors and nurses who refuse to provide infusions face getting into disputes with patients and their families, she says. Yuan Sanying says financial restrictions should be extended to all hospitals. She also recommends a public education campaign, similar to the ones that have discouraged the public from using antibiotics for viral illnesses.

Shanghai residents now use antibiotics appropriately

City campaign persuaded residents and doctors not to misuse antibiotics

A recent health survey found that 90 percent of respondents were using antibiotics properly last year following a local government education campaign to curb overuse of the drugs, Shanghai's health promotion authority has announced.
The survey's results show that the local government's education efforts are paying off, said Gu Xiping, a press officer from the Shanghai Municipal Health Promotion Committee.
"Fewer residents are taking antibiotics as a panacea, or asking doctors to prescribe them when they aren't needed," Gu told the Global Times. "Doctors are reducing the amount of antibiotics they prescribe to patients due to both the campaign and a regulation issued last year that capped the amount and types of antibiotics that each doctor can prescribe."
The Shanghai Municipal Health Promotion Committee interviewed 3,375 residents this year about how they use antibiotics. About 80 percent said they understand the importance of restricting their use of antibiotics, a 28 percent increase from 2010, according to a committee press release. The proportion of respondents found to be using antibiotics properly had increased from 75 percent in 2010.
The average amount of antibiotics used for each patient in Shanghai's public hospitals fell by 20 percent from 2010 following the campaign, according to the press release.
Still, patients in Shanghai continued to receive antibiotics at a far higher rate than the world average. About 60 percent of patients treated at local hospitals, including outpatients, were given antibiotics in 2011, according to a study by local health authorities that was published on the news website Eastday.com.
Only 10 percent of patients around the world are treated with antibiotics on average, Du Wenmin, vice director of the Shanghai Clinical Center for Drug Adverse Reactions, told China Radio International.
A major reason for the overuse in China comes from patients, who often insist that doctors proscribe them antibiotics regardless of whether the proscription is necessary, said Zhen Jianying, a doctor from a community health center.
The problem not only wastes medical resources but can also seriously damage a patient's health, said Xu Wensheng, director of the Infectious Disease Department from Changzheng Hospital. "Overusing antibiotics can cause patients to grow resistant to the drugs, which can become a big problem for them in the future," Xu told the Global Times. "It can lead to liver and kidney damage. It is also a waste of money for patients if they are given unnecessary and expensive antibiotics."
The committee has sent educational brochures to more than 621,000 residents detailing the problems of overusing antibiotics.
Source: Global Times.