Determinants of antibiotic prescribing behaviors of primary care physicians in Hubei of China: a structural equation model based on the theory of planned behavior
Determinants of antibiotic prescribing behaviors of primary care physicians in Hubei of China: a structural equation model based on the theory of planned behavior
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DOI：
10.1186/s13756-019-0478-6
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发表时间：
2019-01-30
影响因子：
5.5
通讯作者：
Zhang, Xinping
中科院分区：
文献类型：
--
作者：
Liu, Chenxi;Liu, Chaojie;Zhang, Xinping
背景抗生素的过度使用在世界范围内普遍存在，导致抗生素耐药性的产生。了解医生如何开抗生素的重要性越来越突出，以促进良好的实践。本研究以计划行为理论（TPB）为基础，探讨影响基层医疗机构医师抗生素处方行为的因素。方法收集湖北省65家基层医疗机构503名处方医师的数据，从态度、行为控制、行为控制和行为控制4个方面分析影响基层医疗机构医师抗生素处方的因素（处方者赞成使用抗生素的程度），主观规范（处方者在抗生素处方方面所承受的社会压力），对行为的感知控制（开药者对抗生素处方做出合理决定的容易程度）和意图（开药者愿意开抗生素的程度）。共审计了440，268张处方，以评估医生的抗生素处方实践。四个行为结构进一步与医生的实际使用抗生素使用结构方程模型（SEM）的基础上TPB.ResultsOn平均，40.54%（SD=20.82%）的门诊遇到导致处方的抗生素给予的参与者和9.81%（SD=10.18%）的患者被给予两种或更多种抗生素。对抗生素态度较好的被试开抗生素的意愿较高（= 0.226，p
BackgroundOver-prescription of antibiotics is prevalent all over the world, contributing to the development of antibiotic resistance. The importance of understanding how physicians prescribe antibiotics is increasingly highlighted for the purpose of promoting good practice. This study aimed to identify factors that shape the antibiotic prescribing behaviors of physicians in primary care based on the theory of planned behavior (TPB).MethodsData were collected from 503 prescribers within 65 primary care facilities in Hubei, tapping into four behavioral aspects leading to antibiotic prescribing based on TPB, namely, attitudes (the degree to which a prescriber is in favor of the use of antibiotics), subjective norms (perceived social pressure to which a prescriber is subject in relation to antibiotic prescriptions), perceived control of behaviors (how easy a prescriber feels in making a rational decision on antibiotic prescriptions) and intentions (the degree to which a prescriber is willing to prescribe antibiotics). A total of 440,268 prescriptions were audited to assess physician antibiotic prescribing practices. The four behavioral constructs were further linked with physician's actual use of antibiotics using structural equation modelling (SEM) based on TPB.ResultsOn average, 40.54% (SD=20.82%) of the outpatient encounters resulted in a prescription for an antibiotic given by the participants and 9.81% (SD=10.18%) of the patients were given two or more antibiotics. The participants showing a more favorable attitude toward antibiotics had a higher intention to prescribe antibiotics (=0.226, p