Community pharmacies, drug stores, and antibiotic dispensing in Indonesia: a qualitative study.
Community pharmacies, drug stores, and antibiotic dispensing in Indonesia: a qualitative study.
复制标题
印度尼西亚的社区药房，药店和抗生素配药：定性研究。
DOI：
10.1186/s12889-021-11885-4
复制
发表时间：
2021-10-07
影响因子：
4.5
通讯作者：
Probandari A
中科院分区：
文献类型：
--
作者：
Ferdiana A;Liverani M;Khan M;Wulandari LPL;Mashuri YA;Batura N;Wibawa T;Yeung S;Day R;Jan S;Wiseman V;Probandari A
社区药房不适当地分配抗生素是导致抗菌素耐药性(AMR)的一个重要驱动因素，特别是在低收入和中等收入国家。因此，更好地了解配药实践对于了解国家、地区和全球对AMR的反应至关重要。这需要仔细检查供应商和客户之间的交互，并对这些交互发生的上下文敏感。2019年，我们进行了一项定性研究，以检查印度尼西亚的抗生素配药做法和相关驱动因素，在那里，在社区药店和药店购买的抗生素自我给药很普遍。数据收集涉及对药房和药店的工作人员(n = 31人)及其客户(n = 28人)进行的59次深入访谈，这些访谈在城市(贝卡西)和半农村(塔巴隆)进行，以了解不同的市场和不同的获得药品的情况。访谈记录采用主题内容分析法进行分析。一种常见的配药模式是客户直接要求抗生素，他们走进药店或药店，在没有处方的情况下要求提供抗生素，要么是通过他们的仿制/品牌名称，要么是通过出示一个空的包装或样品。一种不太常见的模式是，在患者出现症状后，供应商建议使用抗生素。不恰当的抗生素处方的驱动因素包括：对抗生素和AMR缺乏了解；在竞争日益激烈的市场上为最大化药品销售而采取的经济激励措施；让所有人免费获得抗生素和其他基本药物的医疗政策改革产生的意外影响；以及监管执法不力。在社区药房和药店不适当地配发抗生素是供应商和客户之间复杂互动的结果，受到更广泛和不断变化的社会经济进程的影响。在印度尼西亚，与许多其他拥有庞大和非正式私营部门的低收入国家一样，应采取协调一致的行动，让这些提供者参与减少AMR的计划。这将有助于避免市场竞争的意外影响和不利的政策结果，正如本研究所观察到的那样。
Inappropriate dispensing of antibiotics at community pharmacies is an important driver of antimicrobial resistance (AMR), particularly in low- and middle-income countries. Thus, a better understanding of dispensing practices is crucial to inform national, regional, and global responses to AMR. This requires careful examination of the interactions between vendors and clients, sensitive to the context in which these interactions take place. In 2019, we conducted a qualitative study to examine antibiotic dispensing practices and associated drivers in Indonesia, where self-medication with antibiotics purchased at community pharmacies and drug stores is widespread. Data collection involved 59 in-depth interviews with staff at pharmacies and drug stores (n = 31) and their clients (n = 28), conducted in an urban (Bekasi) and a semi-rural location (Tabalong) to capture different markets and different contexts of access to medicines. Interview transcripts were analysed using thematic content analysis. A common dispensing pattern was the direct request of antibiotics by clients, who walked into pharmacies or drug stores and asked for antibiotics without prescription, either by their generic/brand name or by showing an empty package or sample. A less common pattern was recommendation to use antibiotics by the vendor after the patient presented with symptoms. Drivers of inappropriate antibiotic dispensing included poor knowledge of antibiotics and AMR, financial incentives to maximise medicine sales in an increasingly competitive market, the unintended effects of health policy reforms to make antibiotics and other essential medicines freely available to all, and weak regulatory enforcement. Inappropriate dispensing of antibiotics in community pharmacies and drug stores is the outcome of complex interactions between vendors and clients, shaped by wider and changing socio-economic processes. In Indonesia, as in many other LMICs with large and informal private sectors, concerted action should be taken to engage such providers in plans to reduce AMR. This would help avert unintended effects of market competition and adverse policy outcomes, as observed in this study.
登录
查看更多内容
影响因子：
--
作者：
Ekawati FM;Claramita M;Hort K;Furler J;Licqurish S;Gunn J
通讯作者：
Gunn J
影响因子：
3.2
作者：
Cuevas C;Batura N;Wulandari LPL;Khan M;Wiseman V
通讯作者：
Wiseman V
影响因子：
4
作者：
Chandler, Clare I. R.
通讯作者：
Chandler, Clare I. R.
影响因子：
4.5
作者：
Hong Hanh Nguyen;Dang Phuc Ho;Wertheim, Heiman
通讯作者：
Wertheim, Heiman
影响因子：
3.7
作者：
Farida H;Severin JA;Gasem MH;Keuter M;Wahyono H;van den Broek P;Hermans PW;Verbrugh HA
通讯作者：
Verbrugh HA