Antibiotic use following a Korean national policy to prohibit medication dispensing by physicians
Open accessAbstract
This study investigated whether a Korean national policy prohibiting doctors from dispensing drugs as of 2000 selectively reduced inappropriate antibiotic prescribing in viral illness compared with bacterial illness. We assessed the proportions of episodes prescribed an antibiotic and the number of different antibiotics prescribed for patients with viral and bacterial illness episodes before and after the policy. The nationally representative sample consisted of 50,999 episodes (18,656 viral and 7758 bacterial pre-policy, 16,736 viral and 7849 bacterial post-policy) from 1372 primary care clinics. We used generalized estimating equations to investigate changes in antibiotic prescribing after the policy, and multiple linear regression to determine provider factors associated with reductions in inappropriate antibiotic prescribing for viral illness. After the dispensing restriction, antibiotic prescribing declined substantially for patients with viral illness (from 80.8 to 72.8%, relative risk (RR) = 0.89, [95% confidence interval: 0.86, 0.91], p<0.001), and only minimally for patients with bacterial illness (from 91.6 to 89.7%, RR = 0.98, [0.97, 0.99], p = 0.017). Reductions in antibiotic prescribing were significantly larger (RR = 0.90, [0.87, 0.93], p<0.001) for patients with viral illness. The number of different antibiotics prescribed per episode also decreased significantly after the policy, but there were no significant differences in these reductions between viral and bacterial illness. The dispensing restriction also reduced prescribing of non-antibiotic drugs, with no difference by diagnosis. Provider factors found to be associated with reduced inappropriate antibiotic prescribing were younger age and practice location in an urban area. Prohibiting doctors from dispensing drugs reduced prescribing overall, both of antibiotics and other drugs, and selectively reduced inappropriate antibiotic prescribing in viral illness.
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Studies in Zimbabwe, Chile, Colombia, Brazil, Mexico, Korea and Saudi Arabia found strict enforcement of existing laws to be effective in containing non-prescribed antibiotic provision.
“A number of studies conducted in Zimbabwe, Chile, Colombia, Brazil, Mexico and Korea in addition to a study completed in Saudi Arabia found strict enforcement of existing laws to be effective in containing the non-prescribed antibiotics provision [61–65].”
From No prescription? No problem: drivers of non-prescribed sale of antibiotics among community drug retail outlets in low and middle income countries: a systematic review of qualitative studies (2021) · cites this paper as [62]
The 'Policy effects on reducing drug prescribing' section reports that a new Korean policy prohibiting physicians from dispensing medicines reduced antibiotic prescribing. It does not study strict enforcement of existing laws or the provision of antibiotics without prescriptions; its measured outcome was physicians' prescribing. (LLM, conf=0.86)
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- Authors
- Park, S., Soumerai, S. B., Adams, A. S., Finkelstein, J. A., Jang, S., & Ross-Degnan, D.
- Affiliations
- Harvard University (US)
- Corresponding author
- Park, Sylvia
- Venue
- Health Policy and Planning
- Publisher
- Oxford University Press (OUP)
- Published
- 2005-07-06
- Volume
- 20
- Issue
- 5
- Pages
- 302-309
- ISSN
- 0268-1080 (ISSN-L)
- 1460-2237
- OpenAlex
- W2131383438
- Cited by
- 107
- References
- 28
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 6 · 2021: 12 · 2020: 8 · 2019: 8 · 2018: 6 · 2017: 4 · 2016: 6 · 2015: 4 · 2014: 10 · 2013: 3 · 2012: 7
- FWCI
- 2.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Health Policy and Planning (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Korea Health Industry Development Institute
- Agency for Healthcare Research and Quality (U18 HS 1039-01)
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- antibiotic prescribing, inappropriate antibiotic use, viral illness, primary care, prescribing policy, provider characteristics
- MeSH terms
- Adolescent, Adult, Aged, Anti-Bacterial Agents, Child, Child, Preschool, Female, Humans, Infant, Korea, Male, Middle Aged, Physicians, Policy Making, Drug Prescriptions
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