Prescribing, care and resistance: antibiotic use in urban South Africa
Prescribing, care and resistance: antibiotic use in urban South Africa
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DOI：
10.1057/s41599-020-00564-1
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发表时间：
2020-09-01
影响因子：
--
通讯作者：
Manderson, Lenore
中科院分区：
文献类型：
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作者：
Manderson, Lenore
在南非，病人和提供者对保健服务交易的期望集中在急性呼吸道感染的咨询和抗生素处方上。为了探索这一点，在南非大都市的四个地区的社区卫生中心和私人全科诊所进行了一项定性研究，有目的地选择，以允许患者人群的社会经济地位和种族/种族方面的广泛差异。在获得许可的情况下，观察了诊所候诊室和患者/提供者的协商，并与患者或父母或监护人进行了65次深入访谈。除了这些访谈之外，还与保健提供者（26人）和关键举报人（12人）进行了访谈。所有访谈都被记录、转录并输入NVivo 12进行管理。数据是开放编码的，通过个体访谈和观察数据进行比较和对比，以突出对护理、抗生素制备和使用的理解和实践。在这篇文章中，我说明了如何在初级保健环境中的患者和提供者的互动影响治疗的社会背景。社区保健中心和诊所过去（现在也是）资源紧张，病人要等很长时间才能得到诊治;咨询时间很短，关于咳嗽和感冒管理的口头交流相对较少。提供者的治疗决定是根据临床评估、对细菌感染风险的关注以及对患者寻求进一步护理和建议的能力的看法--临床和社会考虑的混合。虽然患者并不总是要求使用抗生素，并且愿意讨论如何在没有抗生素的情况下管理急性疾病，但私人执业的医生仍然经常提供处方，有时会推迟日期以阻止使用，但如果需要，可以选择药物。在公共部门，提供处方也反映了临床医生对经济制约和脆弱性的认识。如上所述，与其他药物相比，患者了解抗生素的适当使用和储存原则，并且他们在很大程度上愿意与他们的供应商讨论是否使用抗生素。然而，他们自己和他们的处方提供者对抗生素耐药性的机制有不同的理解，因此需要抗生素管理。
In South Africa, patients' and providers' expectations of transactions in health services converge in consultations for acute respiratory tract infections with the prescription of antibiotics. To explore this, a qualitative study was undertaken at community health centres and private general practice surgeries in four areas of metropolitan South Africa, selected purposively to allow for wide variability in terms of socioeconomic status and ethnicities/race of patient populations. With permission, clinic waiting rooms and patient/provider consultations were observed, and 65 in-depth interviews were undertaken with patients or parents or guardians presenting with children. These interviews were complemented by interviews with health providers (26) and key informants (12). All interviews were recorded, transcribed and imported into NVivo 12 for management. Data were open coded, with individual interviews and observational data compared and contrasted to highlight understandings and practices of care, antibiotic precription and use. In this article, I illustrate how the social context of patient and provider interactions in primary care settings influenced treatment. Community health centres and clinics were (and are) stretched for resources, and there were long wait times before patients can be seen; consultations were brief, with relatively little verbal exchange on the management of coughs and colds. Providers' decisions of treatment were informed by clinical assessment, concern about the risks of bacterial infection, and perceptions of patient ability to seek further care and advice-a mix of clinical and social considerations. While patients did not always request antibiotics and were willing to discuss how to manage acute conditions without them, doctors in private practice still often provided a prescription, sometimes post-dated to discourage use but with the option for medication if needed. In the public sector, the provision of a prescription also reflected clinicans' appreciation of economic constraint and vulnerability. As described, patients understood principles of the appropriate use and storage of antibiotics, in contrast to other medications, and they were largely open to discussions with their providers about whether or not to use an antibiotic. However, their own and their prescribing providers had varied understandings of the mechanisms of resistance to antibiotics and so the need for antibiotic stewardship.