Factors influencing antibiotic prescribing in China: An exploratory analysis
Factors influencing antibiotic prescribing in China: An exploratory analysis
复制标题
DOI：
10.1016/j.healthpol.2008.09.002
复制
发表时间：
2009-04-01
期刊：
影响因子：
3.3
通讯作者：
McKee, Martin
中科院分区：
文献类型：
--
作者：
Reynolds, Lucy;McKee, Martin
目的：中国的抗生素耐药性非常高，医疗保健系统为过度处方提供了强大的激励。本文介绍了定性研究的结果，在中国南方的一个省，旨在评估知识，态度和做法，在有关使用抗生素。方法：半结构化访谈患者和卫生工作者在省，县，乡，村一级。访谈使用了四个探针（普通感冒，咳嗽，轻度腹泻和疲劳），其中抗生素没有指示，补充知识，态度和做法的问题。这些数据补充了两个焦点小组，医学生和药剂师，并与与会者在全国会议上讨论抗生素use.Results：咳嗽和腹泻几乎普遍用抗生素治疗，而感冒通常是用抗病毒药物治疗，而不是或以及。许多医生都知道，感冒通常是自我限制的，但相信他们可以加速恢复，他们正在回应病人的期望。大多数医生和许多患者都意识到抗生素耐药性的现象，尽管它通常被视为患者获得的属性，而不是微生物。医生开处方面临着经济激励，与药品供应商分享利润。销售利润是医院收入的主要部分。结论：抗生素的滥用具有相当大的风险。有效的行动将需要一个多方面的战略，包括基于对现有信念的理解的教育，用促进最佳做法的激励措施取代不正当的激励措施，以及对改善监督的投资。其中许多工作需要在国家一级采取行动。(C)2008爱思唯尔爱尔兰有限公司保留所有权利。
Objectives: China has very high rates of antibiotic resistance and a health care system that provides strong incentives for over-prescribing. This paper describes the findings of a qualitative study in a province of southern China that seeks to assess knowledge, attitudes, and practices in relation to the use of antibiotics.Methods: Semi-structured interviews with patients and health workers at provincial, county, township, and village level. Interviews used four probes (common cold, cough, mild diarrhoea and tiredness) where antibiotics were not indicated, supplemented by questions on knowledge, attitudes, and practices. These data were supplemented by two focus groups, with medical students and pharmacists, and discussions with participants at a national conference on antibiotic use.Results: Coughs and diarrhoea are almost universally treated with antibiotics, while the cold is normally treated with antivirals instead or as well. Many physicians are aware that the cold is usually self-limiting but believe that they can speed recovery and that they are responding to patient expectations. Most physicians and many patients are aware of the phenomenon of antibiotic resistance, although it is often seen as a property acquired by the patient and not the micro-organism. Physicians face financial incentives to prescribe, with profit splitting with pharmaceutical suppliers. Sales profits form a major part of a hospital's income. National guidance on use of antibiotics is fragmentary and incomplete.Conclusion: The misuse of antibiotics poses considerable risks. Effective action will require a multi-faceted strategy including education, based on an understanding of existing beliefs, the replacement of perverse incentives with those promoting best practice, and investment in improved surveillance. Much of this will require action at national level. (C) 2008 Elsevier Ireland Ltd. All rights reserved.