Center for Health Systems Research, National Institute of Public Health, Av, Universidad 655, Cuernavaca, Mor, Mexico.
BMC Public Health. 2012 Dec 6;12:1051. doi: 10.1186/1471-2458-12-1051.
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.
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.
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.
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.
限制抗生素销售仅限于有医疗处方的人群，是促进合理使用和遏制抗生素耐药性的核心策略；然而，许多低收入和中等收入国家尚未执行防止广泛自行使用抗生素的政策。2010 年，墨西哥政府宣布实施抗生素销售法规，该政策引起了媒体的关注。本研究分析了媒体对问题的报道、利益相关者的代表性以及在政策议程制定、起草和实施过程中采取的立场，以阐明促进合理使用抗生素的政策制定。
我们对 2009 年 1 月至 2010 年 12 月期间在 18 种全国性和地区性报纸上发表的 322 篇报纸文章进行了定量内容分析。此外，我们还进行了定性内容分析，以了解 9 个关键利益相关者所采取的立场和制定的策略。框架理论指导了分析。
卫生部主导了媒体报道，通过关注自我用药的风险，以及在较小程度上关注抗生素耐药性增加的危险，为执行该政策提供了依据。药房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，对药房及其客户产生了负面影响。协会制定了针对该法规的策略，例如试图延迟执行，并在药房内设立医生咨询处。虽然医学协会和学术机构呼吁制定全面的策略来对抗抗生素耐药性、提高处方质量并提高公众意识，但这些问题对媒体报道的影响很小。消费者团体和立法者几乎没有受到媒体的关注。
媒体报道的范围狭窄且两极分化——集中在自我用药问题和经济影响上——这是一个错失的机会，没有公开讨论并制定墨西哥抗生素使用的全面国家战略。它强调了在药品政策框架内讨论和制定干预措施的必要性。
