Reducing Use of Antibiotics without a Prescription among Outpatients in a Safety Net Healthcare System

非处方抗生素的使用是一个未得到充分研究的问题，在一些低收入社区很普遍。这 实践包括在没有处方的情况下获得和服用抗生素（例如，从民族商店或跳蚤 市场），服用另一个人的抗生素，或服用自己储存的抗生素用于除 抗生素最初被规定的用途。在我们对低收入初级保健患者的调查中， 在大城市地区，公立诊所的受访者比私立诊所的受访者更有可能 报告打算在没有处方的情况下使用抗生素。这项调查引起了新闻界的极大兴趣，因为 这个问题在美国几乎没有被描述过，但我们没有探讨为什么非处方药 使用正在发生。非处方使用增加了抗生素耐药性发展的风险， 药物反应、微生物组损伤和其他危害。迫切需要确定预测因素 非处方药的使用，这将指导在低- 收入人群，因为这些人群发展耐药性感染的风险更高。 拟议项目的总体目标是确定非处方抗生素使用的预测因素， 多样化，主要是没有保险的病人的安全网诊所，并奠定了基础， 干预我们将使用混合方法和基尔本等人（2006）的概念框架来推进 健康差异研究，以确定非处方药使用的预测因素。在目标1（定量阶段）中，我们 将用西班牙语和英语进行调查，以评估患者（例如，卫生知识）、卫生保健系统 (e.g.,获得护理）和临床遭遇因素（患者-提供者沟通）与非 低收入患者的处方抗生素使用。在目标2（定性阶段）中，使用深度访谈，我们 将探讨患者的观点和经验与非处方药使用之间的种族/民族多样化 报告在没有处方的情况下使用抗生素的调查受访者的子样本。在目标3（发展 我们将把定量和定性的结果整合到一个沟通工具中， 在诊所使用，以引导患者使用更安全的抗生素和医疗保健选择。我们的团队包括一个 流行病学家，传染病医生，健康差异研究员，健康通讯 专家和医学人类学家。这个多学科小组将与社区咨询委员会合作， 由参与计划的诊所的病人代表组成。我们的工作将由一个 来自疾病控制和预防中心的代表和两名健康知识顾问，其中一名是 他是双语的。拟议的研究是创新的，因为它将提供全面的了解 在低收入人群中不安全使用抗生素的预测因素。这项研究意义重大， 因为它将有助于了解抗生素使用的差异和未来干预措施的发展 以减少与非处方使用相关的危害，例如耐药性细菌的传播。

Non-prescription antibiotic use is an understudied problem, prevalent in some low-income communities. This practice includes obtaining and taking antibiotics without a prescription (e.g., from ethnic stores or flea markets), taking another person's antibiotics, or taking one's own stored antibiotics for an indication other than that for which the antibiotic was originally prescribed. In our survey of low-income primary care patients in a large urban area, respondents from public clinics were more likely than respondents from private clinics to report intention to use antibiotics without a prescription. This survey generated considerable press interest, as the problem has barely been described in the United States, but we did not explore why the non-prescription use was occurring. Non-prescription use increases the risk of development of antibiotic resistance, adverse drug reactions, damage to the microbiome, and other harms. There is a critical need to identify the predictors of non-prescription use that will guide development of effective antimicrobial stewardship interventions in low- income populations, given that these populations are at higher risk of developing antibiotic-resistant infections. The overall objectives of the proposed project are to identify the predictors of non-prescription antibiotic use in diverse, predominantly uninsured patients of safety net clinics and lay the foundation for a subsequent intervention. We will use mixed methods and the Kilbourne et al. (2006) conceptual framework for advancing health disparities research to identify the predictors of non-prescription use. In Aim 1 (quantitative phase), we will administer a survey in Spanish and English to assess how patient (e.g., health literacy), health care system (e.g., access to care), and clinical encounter factors (patient-provider communication) are associated with non- prescription antibiotic use in low-income patients. In Aim 2 (qualitative phase), using in-depth interviews, we will explore patient perspectives and experiences with non-prescription use among a racially/ethnically diverse subsample of survey respondents who reported using antibiotics without a prescription. In Aim 3 (development of a communication tool), we will integrate quantitative and qualitative results into a communication tool to be used in the clinics to steer patients toward safer antibiotic use and healthcare options. Our team includes an epidemiologist, an infectious diseases physician, a health disparities researcher, health communications experts, and a medical anthropologist. This multidisciplinary team will work with a Community Advisory Board comprised of patient representatives from participating clinics. Our work will be guided by input from a representative from the Centers for Disease Control and Prevention and two health literacy consultants, one of whom is bilingual. The proposed research is innovative, because it will provide comprehensive understanding of the predictors of this unsafe use of antibiotics in a low-income population. The research is significant, because it will inform understanding of disparities in use of antibiotics and future development of interventions to reduce harms associated with non-prescription use, such as the spread of antibiotic-resistant bacteria.