Determinants of self-medication with antibiotics in Europe: the impact of beliefs, country wealth and the healthcare system
Determinants of self-medication with antibiotics in Europe: the impact of beliefs, country wealth and the healthcare system
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DOI：
10.1093/jac/dkn054
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发表时间：
2008-05-01
影响因子：
5.2
通讯作者：
Haaijer-Ruskamp, Flora M.
中科院分区：
文献类型：
--
作者：
Grigoryan, Larissa;Burgerhof, Johannes G. M.;Haaijer-Ruskamp, Flora M.
背景：欧洲人群中存在自行服用抗生素的情况，特别是在南部和东部国家。我们研究了诱发因素（例如对抗生素使用和自我药疗的态度和知识）和促成因素（国家财富和医疗保健系统因素）对欧洲抗生素自我药疗的影响。方法：在之前欧洲调查的后续调查中，我们采访了 1101 名受访者的子样本。进行了两个级别（受访者和国家）的多级别分析。自我药疗使用者和非使用者之间统计上显着差异的变量被考虑纳入多水平回归分析中。结果：诱发因素包括个体水平特征。使用抗生素治疗支气管炎的自我药疗的高度认知适当性以及支持使用抗生素治疗小病的态度与自我药疗的可能性较高有关。促成因素包括个人和国家数据。在个人层面上，感知到无需处方即可获得抗生素与自我用药的可能性增加有关。在国家层面，较高的国内生产总值（财富）和药房准确配发处方药片数量与较低的自我药疗可能性独立相关。结论：旨在防止自我药疗的干预措施应包括公共教育、执行有关抗生素销售的法规以及实施药房准确配发处方药片数量的法律。通过包含的决定因素，我们解释了国家层面上的几乎所有差异，但无法解释个人层面上的差异。未来为了加深我们对抗生素自我药疗决定因素的理解，应重点关注个体层面的因素，例如医患关系和患者满意度。
Background: Self-medication with antibiotics occurs among the population in Europe, particularly in southern and eastern countries. We studied the impact of predisposing factors (e.g. attitudes and knowledge concerning antibiotic use and self-medication) and enabling factors (country wealth and healthcare system factors) on self-medication with antibiotics in Europe.Methods: In this follow-up of a previous European survey, we interviewed a subsample of 1101 respondents. A multilevel analysis with two levels (respondent and country) was performed. Variables that were statistically significantly different between users and non-users of self-medication were considered for inclusion into the multilevel regression analyses.Results: Predisposing factors included individual-level characteristics. High perceived appropriateness of self-medication with antibiotics for bronchitis and an attitude favouring antibiotic use for minor ailments were related to a higher likelihood of self-medication. Enabling factors included individual and country data. At the individual level, perceived availability of antibiotics without a prescription was related to increased probability of self-medication. At the country level, higher gross domestic product (wealth) and exact dispensation of prescribed tablet quantities by pharmacies were independently associated with lower likelihood of self-medication.Conclusions: Interventions aimed at preventing self-medication should include public education, enforcing regulations regarding the sale of antibiotics, and implementing laws for dispensing exact prescribed tablet quantities in pharmacies. With the included determinants, we explained almost all the variance at the country level, but not at the individual level. Future studies to increase our understanding of determinants of self-medication with antibiotics should focus on individual-level factors such as doctor-patient relationships and patient satisfaction.