Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, China.
Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA, 02118, USA.
Soc Sci Med. 2020 Jul;256:113035. doi: 10.1016/j.socscimed.2020.113035. Epub 2020 May 15.
Although non-prescription antibiotic dispensing (NPAD) has been officially forbidden by the Chinese government since 2004, it is still a common practice throughout the country. In this study, we use China as an example to explore the determinants of NPAD within the framework of its health system from a socio-ecological perspective. A mixed-method combining the simulated client method (SCM) and key informant interviews conducted in Zhejiang, Hubei, and Sichuan provinces was adopted. 73.3% of the SCM interactions engendered NPAD (91.7% through antibiotic requests vs. 55% through consultation) in Chinese community pharmacies; a much higher rate than the global average. At the intrapersonal level, NPAD was found to be driven by profits from selling non-prescription antibiotics and traditional Chinese medicine. At the interpersonal level, NPAD was driven by fierce competition in the community pharmacy market and by customers' unreasonable expectations. At the institutional level, it is easy for community pharmacies to evade the Food and Drug Administration's (FDA) supervision by obtaining unsupervised and fake prescriptions, refusing to give customers sale receipts, and hiding their antibiotic supplies and sale records. At the policy level, the low cost of violating the prescription-only antibiotic sale regulation and poor FDA supervision facilitated NPAD. The Chinese health system has thus failed to establish and regulate a diverse network of pharmacies for patients to fill their prescriptions; few antibiotic prescriptions are transferred from hospitals to community pharmacies. Education campaigns to increase awareness about the risks of self-medication with antibiotics among the general public, recognizable standardize prescriptions for customers to fill their prescriptions in community pharmacies, regulations on Internet and private clinic doctors' antibiotic prescribing behaviors, electronic tracking and tracing system to purchases and sales data of antibiotics and other prescription drugs, increasing cost of violating the prescription-only regulations for antibiotics sales are expected interventions to reduce NPAD.
尽管中国政府自 2004 年起已正式禁止非处方抗生素配药（NPAD），但在全国范围内，这仍然是一种常见做法。在本研究中，我们以中国为例，从社会生态学的角度探讨了其卫生系统内 NPAD 的决定因素。采用了一种混合方法，结合模拟客户法（SCM）和在浙江省、湖北省和四川省进行的关键知情人访谈。SCM 互动中有 73.3%导致了中国社区药店的 NPAD（91.7%通过抗生素请求，55%通过咨询）；这一比例远高于全球平均水平。在个人层面上，发现 NPAD 是由销售非处方抗生素和中药的利润驱动的。在人际层面上，社区药店市场的激烈竞争和顾客不合理的期望推动了 NPAD。在制度层面上，社区药店很容易通过获得无人监督和假处方、拒绝给顾客销售收据以及隐藏抗生素供应和销售记录来逃避食品药品监督管理局（FDA）的监督。在政策层面上，违反凭处方销售抗生素的规定的成本低和 FDA 监督不力，助长了 NPAD。中国卫生系统未能建立和规范多元化的药店网络，以满足患者的处方需求；很少有抗生素处方从医院转到社区药店。提高公众对自行使用抗生素风险的认识的教育活动、为顾客在社区药店填写处方制定可识别的标准化处方、规范互联网和私人诊所医生开具抗生素处方的行为、购买和销售抗生素和其他处方药的数据的电子跟踪和追溯系统、增加违反凭处方销售抗生素的规定的成本，预计这些干预措施将减少 NPAD。
