Vol.68 No.2 March 2020
Obstacles to antimicrobial use surveillance using claims data in elderly care facilities in Japan
1)AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
2)Department of Emerging and Reemerging Infectious Diseases, Tohoku University School of Medicine
3)Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences
4)Disease Control and Prevention Center, National Center for Global Health and Medicine
Abstract
Antimicrobial use (AMU) is positively correlated with the occurrence of antimicrobial resistance (AMR). Inappropriate use of antimicrobials in elderly care facilities may promote and spread AMR to surrounding communities through intercommunication between these facilities and hospitals. Therefore, AMU surveillance in elderly care facilities is important. The Ministry of Health, Labour, and Welfare of Japan developed the National Insurance Claims Database (NDB), and this database is open to any researchers who pass its qualification exam. Although the NDB was previously used to estimate the state of national and prefectural AMU surveillance, it is unknown to what extent it can be used for AMU surveillance in elderly care facilities. Therefore, we evaluated the usefulness of the NDB for AMU surveillance in elderly care facilities. For us to be able to extract their AMU data from the NDB, elderly care facilities needed to meet both the following conditions: (1) they needed to have specified that their data could be extracted from the NDB; and (2) the medical fees of their patients were paid by medical insurance, not nursing insurance. Only two of the four kinds of elderly care facilities, namely, beds for long-term care in hospitals and intensive care home for elderly patients, met these conditions. However, AMU in beds for long-term care in hospitals could not be estimated using the NDB, because the detailed treatment information is unavailable in this database due to their comprehensive medicine system, in which all medical costs are paid as admission fees. The only situation in which AMU could be estimated using the NDB was in the case where the drugs were prescribed in intensive care home for elderly patients by visiting doctors; prescriptions could not be extracted from the NDB when they were prescribed in clinics or hospitals. In conclusion, AMU surveillance in elderly care facilities using the NDB is possible only for a very limited set of elderly care facilities at present. However, introduction of a system of mandatory reporting of detailed treatment information in long-term care hospitals, and/or of combining medical insurance and nursing insurance data, is currently planned. Therefore, the situation could change in the near future. An AMU surveillance system may also be widely applicable to the surveillance of other drugs. As society faces challenges from the rapidly aging population, we should continue to develop drug use surveillance systems for elderly care facilities using the NDB to solve issues related to polypharmacy or inappropriate drug use, including the use of antibiotics.
Key word
antimicrobial use, elderly facility, claim data, national database
Received
August 5, 2019
Accepted
October 21, 2019
Jpn. J. Chemother. 68 (2): 210-215, 2020
