Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA.
Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds, UK.
Res Social Adm Pharm. 2023 Jul;19(7):1007-1017. doi: 10.1016/j.sapharm.2023.03.009. Epub 2023 Mar 21.
Decreasing the prevalence of antibiotic self-medication among the public requires proper understanding of the risk factors involved. However, the determinants of antibiotic self-medication are not well defined.
To identify patient and health system-related determinants of antibiotic self-medication among the public.
A systematic review of quantitative observational studies and qualitative studies was undertaken. PubMed, Embase, and Web of Science were searched to identify studies on determinants of antibiotic self-medication. The data were analyzed using meta-analysis, descriptive analysis, and thematic analysis.
Sixty-eight studies were included in the review. From meta-analyses, male sex (pooled odds ratio [POR]: 1.52, 95% confidence interval [CI]: 1.19-1.75), lack of satisfaction with healthcare services/physicians (POR: 3.53, 95% CI: 2.26-4.75) were associated with antibiotic self-medication. In subgroup analysis, lower age was directly associated with self-medication in high-income countries (POR: 1.61, 95% CI: 1.10-2.36). In low- and middle-income countries, people with greater knowledge of antibiotics were less likely to self-medicate (POR: 0.2, 95% CI: 0.08-0.47). Patient-related determinants identified from descriptive and qualitative studies included previous experience with antibiotics and similar symptoms, perceived low severity of disease, intention to save time and get better quickly, cultural beliefs about curative power of antibiotics, advice from family/friends, and having home stock of antibiotics. Health system-related determinants included high cost of consulting physicians and low cost of self-medication, lack of access to physician/medical care, lack of trust/confidence in physicians, greater trust in pharmacists, long distance of physicians/healthcare facilities, long waiting time at healthcare facilities, easy access to antibiotics from pharmacies, and convenience associated with self-medication.
Patient and health system-related determinants are associated with antibiotic self-medication. Interventions to decrease antibiotic self-medication should incorporate community programs along with appropriate policies and healthcare reforms targeting these determinants with specific attention to population at high risk of self-medication.
要降低公众中抗生素自行用药的流行率，需要正确了解相关的风险因素。然而，抗生素自行用药的决定因素尚未明确定义。
确定与公众中抗生素自行用药相关的患者和卫生系统相关决定因素。
对定量观察性研究和定性研究进行系统回顾。检索 PubMed、Embase 和 Web of Science，以确定有关抗生素自行用药决定因素的研究。使用荟萃分析、描述性分析和主题分析对数据进行分析。
共纳入 68 项研究。荟萃分析显示，男性（汇总优势比 [POR]：1.52，95%置信区间 [CI]：1.19-1.75）、对医疗保健服务/医生不满意（POR：3.53，95% CI：2.26-4.75）与抗生素自行用药有关。在亚组分析中，在高收入国家，较低的年龄与自行用药直接相关（POR：1.61，95% CI：1.10-2.36）。在中低收入国家，对抗生素了解较多的人不太可能自行用药（POR：0.2，95% CI：0.08-0.47）。从描述性和定性研究中确定的患者相关决定因素包括以前使用过抗生素和类似症状、认为疾病严重程度较低、意图节省时间并尽快好转、对抗生素疗效的文化信念、来自家人/朋友的建议以及家中储备抗生素。卫生系统相关决定因素包括咨询医生的费用高和自行用药的费用低、难以获得医生/医疗服务、对医生缺乏信任/信心、对药剂师的信任度更高、医生/医疗设施的距离较远、在医疗设施的等待时间长、从药房轻松获得抗生素以及与自行用药相关的便利性。
患者和卫生系统相关的决定因素与抗生素自行用药有关。减少抗生素自行用药的干预措施应结合社区计划，并针对这些决定因素制定适当的政策和医疗改革，特别关注自行用药风险较高的人群。
