Graduate School of Urban Public Health, University of Seoul, 163 Seoulsiripdae-ro, Dongdaemun-gu, Seoul, 02504, Republic of Korea.
College of Pharmacy, Yonsei Institute of Pharmaceutical Research, Yonsei University, 162-1 Songdo-dong, Yeonsu-gu, Incheon, 21983, Republic of Korea.
Soc Sci Med. 2022 Dec;314:115466. doi: 10.1016/j.socscimed.2022.115466. Epub 2022 Oct 19.
Inappropriate antibiotic use is a main driver in microbes' development of antibiotic resistance. This study explored the extent to which patient, provider, and other factors contribute to antibiotic prescriptions for acute upper respiratory tract infection. We exploited exogenous patients' temporary and permanent migration from their residential area to robustly separate patient-related, provider-related, and other factors in terms of their contributions to antibiotic use. We analyzed claims of 914,013 URI patients from the 2002-2019 Korean National Health Insurance Sample Cohort Database. The results showed that both patient- and provider-related factors affect antibiotic use for upper respiratory tract infection treatment, although providers' impact is stronger than that of patients. Further decomposition analysis confirmed that provider-related factors explain about 55% of the total variance in antibiotic use. The demand side contributes to approximately 33-34% of the variance. Providers' local market share and market competitiveness are associated with antibiotic prescription. The findings suggest that regulations to reduce antibiotic consumption in Korea should target both patients and providers with appropriate quantifiable penalties.
不适当的抗生素使用是微生物产生抗生素耐药性的主要驱动因素。本研究探讨了患者、提供者和其他因素在多大程度上导致急性上呼吸道感染的抗生素处方。我们利用患者从其居住地区的临时和永久性迁移，来稳健地区分与患者相关、与提供者相关以及其他因素，以了解它们对抗生素使用的贡献。我们分析了 2002-2019 年韩国国家健康保险样本队列数据库中 914013 例 URI 患者的索赔。结果表明，患者和提供者相关因素都会影响上呼吸道感染治疗中的抗生素使用，尽管提供者的影响比患者更强。进一步的分解分析证实，提供者相关因素解释了抗生素使用总方差的约 55%。需求方贡献了约 33-34%的方差。提供者的当地市场份额和市场竞争力与抗生素处方有关。研究结果表明，韩国减少抗生素使用的法规应针对患者和提供者，并制定适当的可量化处罚措施。
