What contributes to inappropriate antibiotic dispensing among qualified and unqualified healthcare providers in Bangladesh? A qualitative study
What contributes to inappropriate antibiotic dispensing among qualified and unqualified healthcare providers in Bangladesh? A qualitative study
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DOI：
10.1186/s12913-020-05512-y
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发表时间：
2020-07-15
影响因子：
2.8
通讯作者：
Rousham, Emily K.
中科院分区：
文献类型：
--
作者：
Nahar, Papreen;Unicomb, Leanne;Rousham, Emily K.
抗生素的过度处方和不适当使用导致了抗菌素耐药性（AMR）的出现。在低收入和中等收入环境中，很少有研究采用定性方法来研究抗生素销售的驱动因素，并在整个医疗保健提供者（HCP）中分发。我们的目的是探索对抗生素的使用和功能的理解;对AMR的认识和感知的患者或客户需求以及孟加拉国人类和动物医学HCP的依从性。方法我们采用人种学方法进行面对面的，深入访谈46个社区卫生服务提供者在一个城市和一个农村地区（Gazipur和米尔扎布尔区分别）。我们有目的地从人类和兽医学的四类提供者中选择参与者：合格;半合格;辅助和不合格。采用扎根理论方法，采用框架方法进行专题分析。结果抗生素被认为是一种快速见效的强力药物，对几乎所有疾病都有效，包括病毒。抗生素的价格等同于力量，昂贵的抗生素被认为是最强大的药物。抗生素也被视为预防性药物。虽然一些供应商充分了解抗生素耐药性及其原因，但其他人完全不知道。许多供应商将抗生素耐药性误认为是抗生素的副作用，无论是在人类还是动物医学中。尽管知识各不相同，但提供者对抗生素耐药性表示担忧，但抗生素使用不当的责任被转移到患者和客户，包括牲畜和动物的主人。结论：误解和错误信息导致了不同类别的人类和动物医疗保健提供者对抗生素的广泛不当使用。医疗服务提供者对抗生素作用和抗生素耐药性的认识较低，特别是那些很少或没有接受过培训的人和农村地区的人。针对孟加拉国AMR的具体和有针对性的干预措施应包括关于合理使用抗生素及其工作原理的教育信息，针对所有类型的医疗保健提供者。虽然为供应商量身定制的培训可能会增加对抗生素作用的理解并改善实践，但需要进行更深远的结构性变革，以影响和增加所有HCP优化抗生素分配的责任。
Background Over-prescribing and inappropriate use of antibiotics contributes to the emergence of antimicrobial resistance (AMR). Few studies in low and middle-income settings have employed qualitative approaches to examine the drivers of antibiotic sale and dispensing across the full range of healthcare providers (HCPs). We aimed to explore understandings of the use and functions of antibiotics; awareness of AMR and perceived patient or customer demand and adherence among HCPs for human and animal medicine in Bangladesh. Methods We used an ethnographic approach to conduct face-to-face, in-depth interviews with 46 community HCPs in one urban and one rural area (Gazipur and Mirzapur districts respectively). We purposefully selected participants from four categories of provider in human and veterinary medicine: qualified; semi-qualified; auxiliary and unqualified. Using a grounded theory approach, thematic analysis was conducted using a framework method. Results Antibiotics were considered a medicine of power that gives quick results and works against almost all diseases, including viruses. The price of antibiotics was equated with power such that expensive antibiotics were considered the most powerful medicines. Antibiotics were also seen as preventative medicines. While some providers were well informed about antibiotic resistance and its causes, others were completely unaware. Many providers mistook antibiotic resistance as the side effects of antibiotics, both in human and animal medicine. Despite varied knowledge, providers showed concern about antibiotic resistance but responsibility for inappropriate antibiotic use was shifted to the patients and clients including owners of livestock and animals. Conclusions Misconceptions and misinformation led to a wide range of inappropriate uses of antibiotics across the different categories of human and animal healthcare providers. Low awareness of antibiotic action and antibiotic resistance were apparent among healthcare providers, particularly those with little or no training and those in rural areas. Specific and targeted interventions to address AMR in Bangladesh should include educational messages on the rational use of antibiotics and how they work, targeting all types of healthcare providers. While tailored training for providers may increase understanding of antibiotic action and improve practices, more far-reaching structural changes are required to influence and increase responsibility for optimising antibiotic dispensing among all HCPs.