Regulation of antibiotic sales in Mexico: an analysis of printed media coverage and stakeholder participation
Regulation of antibiotic sales in Mexico: an analysis of printed media coverage and stakeholder participation
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DOI：
10.1186/1471-2458-12-1051
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发表时间：
2012-12-06
影响因子：
4.5
通讯作者：
Wirtz, Veronika J.
中科院分区：
文献类型：
--
作者：
Dreser, Anahi;Vazquez-Velez, Edna;Wirtz, Veronika J.
背景：仅向有医疗处方的人销售抗生素是促进适当使用和遏制抗生素耐药性的一项核心战略；然而，许多低收入和中等收入国家没有执行防止广泛使用抗生素自我用药的政策。2010年，墨西哥政府宣布实施抗生素销售法规，这一政策引起了媒体的关注。本研究分析了媒体对问题的报道、利益相关者的代表以及在政策议程制定、起草和实施过程中所采取的立场，以阐明促进抗生素适当使用的政策制定。方法：对2009年1月至2010年12月18家全国性和区域性报纸发表的322篇报纸文章进行定量内容分析。此外，我们还进行了定性内容分析，以了解九个关键利益相关者所采取的立场和制定的战略。框架理论指导了分析。结果：卫生部主导媒体报道，通过关注自我用药的风险来证明执行政策的合理性，并在较小程度上增加抗生素耐药性的危险。药店协会似乎是主要的反对者，他们认为该政策造成了后勤困难和腐败，并对药店及其客户产生了负面的经济影响。这些协会制定了反对该规定的战略，例如试图推迟实施和在药房内设立医生咨询办公室。虽然医学协会和学术机构呼吁制定一项全面战略，以对抗抗生素耐药性，提高处方质量，并提高公众意识，但这些问题对媒体报道几乎没有影响。消费者团体和立法者很少得到媒体的报道。结论：媒体报道聚焦于自我药疗问题和经济影响，范围狭窄，两极分化，错失了公开讨论和制定墨西哥抗生素使用综合国家战略的机会。它突出了在药物政策框架内讨论和制定干预措施的必要性。
Background: Restricting antibiotics sales to those with medical prescriptions only is a central strategy for promoting appropriate use and containing antibiotic resistance; however, many low and middle income countries have not enforced policies that prevent widespread self-medication with antibiotics. In 2010, the Mexican government announced the enforcement of antibiotic sales regulations, a policy that gained media prominence. This study analyzes media coverage of issues, stakeholder representation, and positions taken during policy agenda setting, drafting, and implementation to shed light on policy making to promote appropriate antibiotic utilization.Methods: We carried out a quantitative content analysis of 322 newspaper articles published between January 2009 and December 2010 in 18 national and regional newspapers. Additionally, we conducted a qualitative content analysis to understand the positions adopted and strategies developed by nine key stakeholders. Framing theory guided the analysis.Results: The Ministry of Health dominated media coverage, justifying the enforcement policy by focusing on risks of self-medication, and to a lesser degree dangers of increasing antibiotic resistance. Pharmacy associations appeared to be the leading opponents, arguing that the policy created logistical difficulties and corruption, and had negative economic impact for pharmacies and their clients. The associations developed strategies against the regulation such as attempting to delay implementation and installing physicians' consultation offices within pharmacies. While medical associations and academic institutions called for a comprehensive strategy to combat antibiotic resistance, improve prescription quality, and create public awareness, these issues had little impact on media coverage. Consumer groups and legislators received very little media coverage.Conclusions: The narrowly-focused and polarized media coverage - centred on problems of self-medication and economic impact - was a missed opportunity to publicly discuss and to develop a comprehensive national strategy on antibiotic use in Mexico. It highlights the need for discussing and developing interventions within the framework of a pharmaceutical policy.