Antibiotic overuse for acute respiratory tract infections in Sri Lanka: a qualitative study of outpatients and their physicians.
Antibiotic overuse for acute respiratory tract infections in Sri Lanka: a qualitative study of outpatients and their physicians.
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DOI：
10.1186/s12875-017-0619-z
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发表时间：
2017-03-16
影响因子：
2.9
通讯作者：
Woods CW
中科院分区：
文献类型：
--
作者：
Tillekeratne LG;Bodinayake CK;Dabrera T;Nagahawatte A;Arachchi WK;Sooriyaarachchi A;Stewart K;Watt M;Østbye T;Woods CW
急性呼吸道感染(ARTIS)是全世界过度使用抗生素的常见原因。我们之前曾显示，在斯里兰卡的一家三级保健医院就诊的流感样疾病患者中，超过80%的人接受了抗生素处方，尽管后来几乎有一半人被证实患有流感。这项定性研究的目的是评估斯里兰卡患者和医生对ARTI诊断和治疗的态度。在斯里兰卡南部一家大型公立三级保健医院，对50名ARTIS患者和门诊部(OPD)的5名医生进行了半结构化访谈。访谈被录音、转录，并针对与ARTI诊断和治疗相关的主题进行分析。患者经常在公共部门寻求ARTI护理，因为接受了免费护理，并认为政府医院对患者的健康负有责任感。患者报告说，他们的疾病短期内多次就医，许多人表示，他们在医院期间因其他原因在门诊部寻求治疗。虽然患者通常希望在就诊时收到药物处方，但大多数患者并不是专门寻求抗生素处方。然而，超过70%的患者在门诊就诊时收到了抗生素处方。医生错误地认为患者需要抗生素或“胶囊”，这是一种在门诊环境中分发的抗生素的常见配方，并将患者需求列为抗生素过度使用的重要原因。医生还表示，高病人数量和对细菌重叠感染的恐惧推动了抗生素的过度使用。在这项研究中，患者正在为他们的Artis寻找药物处方，但医生错误地认为需要抗生素处方。高病人量和对细菌重叠感染的恐惧也是过度使用抗生素的重要因素。对医生进行关于指南一致性管理和处理诊断不确定性的培训，对患者进行关于ARTI病因学和管理的教育，以及系统地改变公共门诊护理结构，可能有助于减少这种情况下ARTIS不必要的抗生素处方。
Acute respiratory tract infections (ARTIs) are a common reason for antibiotic overuse worldwide. We previously showed that over 80% of outpatients presenting to a tertiary care hospital in Sri Lanka with influenza-like illness received antibiotic prescriptions, although almost half were later confirmed to have influenza. The purpose of this qualitative study was to assess Sri Lankan patients’ and physicians’ attitudes towards ARTI diagnosis and treatment. Semi-structured interviews were conducted with 50 outpatients with ARTIs and five physicians in the Outpatient Department (OPD) at a large, public tertiary care hospital in southern Sri Lanka. Interviews were audio-recorded, transcribed, and analyzed for themes related to ARTI diagnosis and treatment. Patients frequently sought ARTI care in the public sector due to the receipt of free care and the perception that government hospitals carried a sense of responsibility for patients’ health. Patients reported multiple medical visits for their illnesses of short duration and many indicated that they were seeking care in the OPD while at the hospital for another reason. While patients generally expected to receive medication prescriptions at their visit, most patients were not specifically seeking an antibiotic prescription. However, more than 70% of patients received antibiotic prescriptions at their OPD visit. Physicians incorrectly perceived that patients desired antibiotics or “capsules,” a common formulation of antibiotics dispensed in this outpatient setting, and cited patient demand as an important cause of antibiotic overuse. Physicians also indicated that high patient volume and fear of bacterial superinfection drove antibiotic overuse. Patients in this study were seeking medication prescriptions for their ARTIs, but physicians incorrectly perceived that antibiotic prescriptions were desired. High patient volume and fear of bacterial superinfection were also important factors in antibiotic overuse. Training of physicians regarding guideline-concordant management and dealing with diagnostic uncertainty, education of patients regarding ARTI etiology and management, and systematic changes in the public outpatient care structure may help decrease unnecessary antibiotic prescriptions for ARTIs in this setting.