Prescribing Antibiotics in Rural China: The Influence of Capital on Clinical Realities.
Prescribing Antibiotics in Rural China: The Influence of Capital on Clinical Realities.
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DOI：
10.3389/fsoc.2020.00066
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发表时间：
2020
影响因子：
2.5
通讯作者：
Lambert H
中科院分区：
文献类型：
--
作者：
Chen M;Kadetz P;Cabral C;Lambert H
中国农村地区的初级保健临床医生需要平衡他们对患者的直接护理责任与患者对抗生素的期望，财务压力以及他们对公共卫生的更广泛责任。我们样本中的临床医生似乎在管理即时临床风险和个人声誉方面做出了更大的努力，而不是考虑其行为的长期后果可能导致抗生素耐药性。本文采用布迪厄的资本理论来研究中国初级保健临床医生在中国安徽省农村低水平的卫生设施处方抗生素的观点和做法。我们研究了这些农村卫生设施的制度背景和临床现实，并确定这些如何影响临床医生在管理常见的上呼吸道感染中使用抗生素的方式。面对各种官方法规和机构的压力，以创造收入，举报人的愿望，以保持良好的关系与病人再加上他们对病人安全的关注，导致他们的专业知识之间的紧张关系的“合理”抗生素使用和他们的实际处方做法。告密者通常将抗菌药物管理的责任推给政府或医疗保健系统的上层，并利用强大的“人性”（人类素质）公共话语，使他们在想象的社会经济等级中自由开抗生素处方合法化。从业者和患者的社会、文化和经济资本形式的需求有助于解释中国农村卫生机构的抗生素处方模式。
Primary care clinicians in rural China are required to balance their immediate duty of care to their patients with patient expectations for antibiotics, financial pressures, and their wider responsibilities to public health. The clinicians in our sample appear to make greater efforts in managing immediate clinical risks and personal reputation than in considering the long-term consequences of their actions as potentially contributing to antimicrobial resistance. This paper employs Bourdieu's theory of capital to examine the perspectives and practices of Chinese primary care clinicians prescribing antibiotics at low-level health facilities in rural Anhui province, China. We examine the institutional context and clinical realities of these rural health facilities and identify how these influence the way clinicians utilize antibiotics in the management of common upper respiratory tract infections. Confronted with various official regulations and institutional pressures to generate revenues, informants' desire to maintain good relations with patients coupled with their concerns for patient safety result in tensions between their professional knowledge of “rational” antibiotic use and their actual prescribing practices. Informants often deferred responsibility for antimicrobial stewardship to the government or upper echelons of the healthcare system and drew on the powerful public discourse of “suzhi” (human quality) to legitimize their liberal prescribing of antibiotics in an imagined socioeconomic hierarchy. The demands of both practitioners' and patients' social, cultural, and economic forms of capital help to explain patterns of antibiotic prescribing in rural Chinese health facilities.
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