Antibiotic prescription patterns of South African general medical practitioners for treatment of acute bronchitis

Background: Antibiotic resistance is a significant public health problem. Prudent use of antibiotics is crucial in reducing this resistance. Acute bronchitis is a common reason for consultations with general medical practitioners, and antibiotics are often prescribed even though guidelines recommend not prescribing them for uncomplicated acute bronchitis. Objective: To analyse the antibiotic prescription patterns of South African (SA) general medical practitioners in the treatment of acute bronchitis. Methods: The 2013 claims for members of 11 health insurance schemes were analysed to assess antibiotic prescription patterns for patients diagnosed with acute bronchitis. The patterns were assessed by type of bronchitis, chronic health status of the patients, sex and age group. The types of antibiotic prescribed were also analysed. Results: Of 166 821 events analysed, an antibiotic was prescribed in more than half (52.9%). There were significant differences by type of bronchitis and chronic health status. Patients with viral bronchitis were more likely to be prescribed an antibiotic than those with bacterial bronchitis (odds ratio (OR) 1.17, 95% confidence interval (CI) 1.08 - 1.26). Patients with a chronic illness were less likely to be prescribed an antibiotic than those without (OR 0.58, 95% CI 0.57 - 0.60). More than 70% of the antibiotics prescribed were cephalosporins, penicillins and other beta-lactams. Conclusions: Prescription rates of antibiotics for acute bronchitis by SA general medical practitioners are high. There is an urgent need to follow the guidelines for antibiotic use for acute bronchitis to reduce the likelihood of increasing resistance to available antibiotics.IS

Professionally applied topical fluoride and fissure sealants: matching insurance claims with evidence.

OBJECTIVE: The purpose of this study was to assess the extent to which medical aid schemes are funding evidence-based dental care, specifically assessing claims patterns for professionally applied topical fluoride and fissure sealant treatments to the beneficiaries of a large South African medical aid scheme. The rising costs of dental care provide the impetus to review spending patterns to assess whether resources are being utilised optimally. The emergence of evidence-based dentistry offers an important tool in this regard. METHODOLOGY: The 2005 membership and claims data of a large South African medical scheme were analysed for the period 1 January 2005 to 31 December 2005. The claim patterns for two dental caries preventive interventions with different levels of evidence were assessed and compared for two age groups: under 20 years of age and 20 and above. RESULTS: About 30% received a topical fluoride application, equally provided to both age categories. Less than 3% of all who visited the dentists received at least one sealant. Of those under 20 years of age, only 10% received this proven preventive intervention. CONCLUSIONS: This study highlights the need to substantially increase the provision of fissure sealants to children with erupting first (5-7 year olds) and second (11-13 year olds) permanent molar teeth and decrease the provision of professionally applied fluoride applications to those outside of specifically identified caries-risk groups. This study further illustrates the potential of applying evidence-based dentistry research findings to assessing the appropriateness of claim patterns as well as the funding thereof

Support for social health insurance in South Africa

A national cross-sectional survey was carried out in South Africa to gain an understanding of the perceptions and priorities of the likely members of a future social health insurance (SHI). More than 1,000 employees were interviewed in a variety of employment sectors, including state and parastatal organisations, formal and informal private sectors. This article reports on respondents’ level of support for a compulsory contribution towards a hospital insurance scheme funding care at public sector hospitals in South Africa. The results showed that only 11 per cent of employees supported an SHI scheme if public hospitals remain as they are. Support increased to 53 per cent if preferential access to treatment was offered to those contributing to the scheme. Support was almost unanimous (87 per cent) if public hospitals were improved. The levels of support differed by current type of health insurance. Thus, support for a compulsory SHI tax to fund care in public hospitals was conditional upon either improving the hospitals or providing differential treatment to contributing members. If one or both of these conditions are not met, its long-term success will be compromised.M.J. Smith, G.C. Solanki, R. Lalloo, N.G. Myburgh and J.E. Cornel

Support for social health insurance in South Africa

A national cross-sectional survey was carried out in South Africa to gain an understanding of the perceptions and priorities of the likely members of a future social health insurance (SHI). More than 1,000 employees were interviewed in a variety of employment sectors, including state and parastatal organisations, formal and informal private sectors. This article reports on respondents’ level of support for a compulsory contribution towards a hospital insurance scheme funding care at public sector hospitals in South Africa. The results showed that only 11 per cent of employees supported an SHI scheme if public hospitals remain as they are. Support increased to 53 per cent if preferential access to treatment was offered to those contributing to the scheme. Support was almost unanimous (87 per cent) if public hospitals were improved. The levels of support differed by current type of health insurance. Thus, support for a compulsory SHI tax to fund care in public hospitals was conditional upon either improving the hospitals or providing differential treatment to contributing members. If one or both of these conditions are not met, its long-term success will be compromised