To improve access to health care services, an intervention was implemented in Burkina Faso granting full exemption from user fees. Two further components, staff training and supervision, were added to support the intervention. Our aim in this study was to examine how this tripartite intervention affected the quality of drug prescriptions. Using a mixed methodology, we first conducted an interrupted time series over 24 months. Nine health centres were studied that had previously undergone a process analysis. A total of 14 956 prescriptions for children 0-4 years old were selected by interval sampling from the visit registries from 1 year before to 1 year after the intervention's launch. We then interviewed 14 prescribers. We used three World Health Organization (WHO) indicators to assess drug prescription quality. Analysis was carried out using linear regression and logistic regression. The prescribers' statements underwent content analysis, to understand their perceptions and changes in their practice since the subsidy's introduction. One effect of the intervention was a reduced use of injections (odd ratio (OR) = 0.28 [0.17; 0.46]) in cases of acute lower respiratory tract infections (ALRTI) without comorbidity. Another was a reduction in the inappropriate use of antibiotics in malaria without comorbidity (OR = 0.48 [0.33; 0.70]). The average number of drugs prescribed also decreased (coefficient = -0.14 [-0.20; -0.08]) in cases of ALRTI without comorbidity. The prescribers reported that their practices were either maintained or improved. The user fees exemption programme, combined with health staff training and supervision, did not lead to any deterioration in the quality of drug prescriptions.

译文

:为了改善获得医疗保健服务的机会,在布基纳法索实施了一项干预措施,准予完全免除使用费。添加了两个其他部分,即员工培训和监督,以支持干预措施。我们在这项研究中的目的是检验这种三方干预如何影响药物处方的质量。使用混合方法,我们首先进行了24个月的中断时间序列。研究了九个以前进行过过程分析的卫生中心。从干预开始前1年到开始1年间,从访视登记处定期抽取14 956张0-4岁儿童的处方。然后,我们采访了14位处方者。我们使用了三个世界卫生组织(WHO)指标来评估药物处方质量。使用线性回归和逻辑回归进行分析。开具处方后,对处方者的陈述进行了内容分析,以了解他们对补贴实施以来的看法和做法的变化。干预的效果之一是在无合并症的急性下呼吸道感染(ALRTI)病例中减少了注射剂量的使用(比值比(OR)= 0.28 [0.17; 0.46])。另一个是减少无合并症的疟疾中抗生素的不当使用(OR = 0.48 [0.33; 0.70])。在没有合并症的ALRTI情况下,开出的平均处方药数量也减少了(系数= -0.14 [-0.20; -0.08])。开处方者报告说他们的做法得以维持或得到改善。豁免使用费的计划,加上卫生人员的培训和监督,并未导致药物处方质量的任何下降。

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