Wang Dan, Liu Chaojie, Zhang Xinping, Liu Chenxi
School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China.
School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.
Front Pharmacol. 2020 Nov 11;11:591709. doi: 10.3389/fphar.2020.591709. eCollection 2020.
: Overuse of antibiotics significantly fuels the development of Antimicrobial resistance, which threating the global population health. Great variations existed in antibiotic prescribing practices among physicians, indicating improvement potential for rational use of antibiotics. This study aims to identify antibiotic prescribing patterns of primary care physicians and potential determinants. : A cross-sectional survey was conducted on 551 physicians from 67 primary care facilities in Hubei selected through random cluster sampling, tapping into their knowledge, attitudes and prescribing practices toward antibiotics. Prescriptions ( = 501,072) made by the participants from 1 January to March 31, 2018 were extracted from the medical records system. Seven indicators were calculated for each prescriber: average number of medicines per prescription, average number of antibiotics per prescription, percentage of prescriptions containing antibiotics, percentage of antibiotic prescriptions containing broad-spectrum antibiotics, percentage of antibiotic prescriptions containing parenteral administered antibiotics, percentage of antibiotic prescriptions containing restricted antibiotics, and percentage of antibiotic prescriptions containing antibiotics included in the WHO "Watch and Reserve" list. Two-level latent profile analyses were performed to identify the antibiotic prescribing patterns of physicians based on those indicators. Multi-nominal logistic regression models were established to identify determinants with the antibiotic prescribing patterns. : On average, each primary care physician issued 909 (ranging from 100 to 11,941 with a median of 474) prescriptions over the study period. The mean percentage of prescriptions containing antibiotics issued by the physicians reached 52.19% (SD = 17.20%). Of those antibiotic prescriptions, an average of 82.29% (SD = 15.83%) contained broad-spectrum antibiotics; 71.92% (SD = 21.42%) contained parenteral administered antibiotics; 23.52% (SD = 19.12%) contained antibiotics restricted by the regional government; and 67.74% (SD = 20.98%) contained antibiotics listed in the WHO "Watch and Reserve" list. About 28.49% of the prescribers were identified as low antibiotic users, compared with 51.18% medium users and 20.33% high users. Higher use of antibiotics was associated with insufficient knowledge, indifference to changes, complacency with satisfied patients, low household income and rural location of the prescribers. : Great variation in antibiotic prescribing patterns exists among primary care physicians in Hubei of China. High use of antibiotics is not only associated with knowledge shortfalls but also low socioeconomic status of prescribers.
抗生素的过度使用显著助长了抗菌药物耐药性的发展，这对全球人口健康构成威胁。医生的抗生素处方行为存在很大差异，这表明抗生素合理使用方面有改进的潜力。本研究旨在确定基层医疗医生的抗生素处方模式及潜在决定因素。
一项横断面调查对通过随机整群抽样从湖北67家基层医疗机构选取的551名医生进行，了解他们对抗生素的知识、态度和处方行为。从医疗记录系统中提取了参与者在2018年1月1日至3月31日开出的处方（n = 501,072）。为每位开处方者计算了七个指标：每张处方的平均用药数量、每张处方的平均抗生素数量、含抗生素处方的百分比、含广谱抗生素的抗生素处方百分比、含胃肠外给药抗生素的抗生素处方百分比、含受限抗生素的抗生素处方百分比以及含世界卫生组织“观察与储备”清单中所列抗生素的抗生素处方百分比。基于这些指标进行了二级潜在类别分析，以确定医生的抗生素处方模式。建立了多项逻辑回归模型来确定与抗生素处方模式相关的决定因素。
在研究期间，每位基层医疗医生平均开出909张处方（范围为100至11,941张，中位数为474张）。医生开出的含抗生素处方的平均百分比达到52.19%（标准差 = 17.20%）。在那些抗生素处方中，平均82.29%（标准差 = 15.83%）含有广谱抗生素；71.92%（标准差 = 21.42%）含有胃肠外给药抗生素；23.52%（标准差 = 19.12%）含有受地区政府限制的抗生素；67.74%（标准差 = 20.98%）含有世界卫生组织“观察与储备”清单中所列的抗生素。约28.49%的开处方者被确定为低抗生素使用者，相比之下，中等使用者占51.18%，高使用者占20.33%。抗生素使用量较高与知识不足、对变化漠不关心、对患者满意感到自满、家庭收入低以及开处方者所在农村地区有关。
中国湖北的基层医疗医生的抗生素处方模式存在很大差异。抗生素的高使用量不仅与知识不足有关，还与开处方者的社会经济地位低有关。
