Healthcare Providers’ Accounts of Influences of Antibiotic-Related Reforms on their Behavior with Respect to the Use of Antibiotics for Children: A Qualitative Study in China

Purpose: High and inappropriate pediatric use of antibiotics by healthcare providers is a key driver of antibiotic resistance in China. The Chinese government initiated a programme of antibiotic-related reforms in 2011 after a wider healthcare reform in 2009. However, very few studies shed light on the influence of these reforms on providers' antibiotic-related behavior; only one qualitative study of providers' perspectives and experiences has been undertaken. Therefore, our qualitative study aims to explore the influence of the 2009 and 2011 reforms on providers' pediatric antibiotic use. Methods: Qualitative interviews were conducted with 26 providers in Taiyuan city, a typical Chinese city in central China in 2016. Interviews were transcribed verbatim, translated from Chinese to English, and analyzed using framework analysis. Results: Healthcare providers described how their behavior was influenced by the availability of diagnostic testing. They also pointed to financial considerations and pressures, as well as other healthcare institutions within China's healthcare system that influence their antibiotic-related behavior. Conclusions: As far as we are aware, this is the first city-based qualitative study in China providing evidence of the influences of the 2009 and 2011 reforms on providers' antibiotic-related behavior. It points to issues around the enforcement of antibiotic-related reforms in community health institutions and retail pharmacies, and highlights the importance of understanding the reforms' influences on provider behavior within China's healthcare system as a whole.