Patients without records and records without patients: Review of patient records in primary care and implications for surveillance of antibiotic prescribing in rural China

Rachel Kwiatkowska*, Xingrong Shen, Manman Lu, Jing Cheng, Matthew Hickman, Helen Lambert, Debin Wang, Isabel Oliver

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Background: We need to monitor patterns of antibiotic prescribing in order to develop and evaluate antibiotic stewardship interventions in rural China. As part of a multidisciplinary study of antibiotic use in Anhui Province we assessed the validity of electronic records (e-records) as a source of surveillance data. Methods: One township healthcare centre and one village clinic were selected in each of three different counties. Patients with symptoms of Upper Respiratory Tract Infection (URTI), exacerbation of Chronic Obstructive Pulmonary Disease (COPD) or Urinary Tract Infection (UTI) were recruited consecutively. Researchers observed and documented clinic consultations and interviewed each of the study participants. E-records were compared to clinic observations and patient interviews. Results: A total of 1030 patients were observed in clinic. Antibiotics were prescribed in 917 (89%) of consultations. E-records were created only for individuals with health insurance, with considerable between-site variation in completeness (0 to 98.7% of clinic consultations) and in the timing of documentation (within-consultation up to weeks afterwards). E-record accuracy was better in relation to antibiotics (82.8% of e-records accurately recorded what was prescribed in clinic) than for diagnosis and symptoms (45.0 and 1.1% accuracy). Only 31 participants (3.0%) presented with UTI symptoms. Conclusions: We have confirmed very high rates of outpatient antibiotic prescribing in rural Anhui province. E-records could provide useful information to inform stewardship interventions, however they may be inaccurate and/or biased. Public Health authorities should focus on improving technical infrastructure and record-keeping culture in outpatient settings. Further research is needed into community treatment of UTIs.

Original languageEnglish
Article number564
JournalBMC Health Services Research
Issue number1
Publication statusPublished - 22 Jun 2020

Bibliographical note

Funding Information:
We acknowledge the support of the Newton Fund (UK Research and Innovation (UKRI) and the National Natural Science Foundation of China (NSFC)) under the UK-China AMR Partnership Initiative, grant number MR/P00756/1. Funding was awarded through a competitive peer review selection process and the role of funders consisted in provision of financial resources. The research findings reported in this paper and their interpretation constitute independent academic work. RK, MH and IO all acknowledge support from the NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol.

Publisher Copyright:
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License.


  • Antibiotics
  • Antimicrobial resistance
  • China
  • Medical records
  • Mixed methods
  • Outpatients


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