Wattles Bethany A, Brothers Kyle B, Rich Carla A, Ryan Lesa, Smith Michael J
Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Norton Children's Research Institute affiliated with the University of Louisville School of Medicine, Louisville, Kentucky, USA.
J Eval Clin Pract. 2025 Feb;31(1):e14108. doi: 10.1111/jep.14108. Epub 2024 Jul 29.
Understanding drivers of antibiotic use is key to limiting the development of antimicrobial resistance. Outpatient antibiotic prescribing rates vary substantially across and within states. Kentucky is one of the highest prescribing states, and the southeastern region has rates that are drastically higher than the national average and urban areas of the state. We sought to examine provider perceptions of antibiotic use in this rural area to more effectively guide future interventions and policy.
This study utilized Medicaid prescription claims to identify providers who frequently prescribe antibiotics to children in southeastern Kentucky. Semistructured qualitative interviews were conducted to elicit provider perspectives on antibiotic overuse.
Individual, in-person interviews were conducted with 25 providers from a variety of practices and training backgrounds (private, nonprofit, retail, physician, advanced practice registered nurses, etc.). The following themes emerged as issues that prescribers consider to contribute to antibiotic overuse: (1) caregiver pressure, especially from grandparents or families who desire a 'quick fix'; (2) business concerns and competition and (3) cultural factors related to poverty and rural locations. Interviewed providers were supportive of public education and had mixed views on the effectiveness of delayed fill or provider feedback initiatives.
This study highlights unique challenges associated with antibiotic prescribing in rural areas. Findings will guide future interventions through adaptation of existing strategies to better serve this vulnerable population.
了解抗生素使用的驱动因素是限制抗菌药物耐药性发展的关键。门诊抗生素处方率在各州之间以及州内差异很大。肯塔基州是处方率最高的州之一，东南部地区的处方率大幅高于全国平均水平以及该州的城市地区。我们试图调查该农村地区医疗服务提供者对抗生素使用的看法，以便更有效地指导未来的干预措施和政策。
本研究利用医疗补助处方索赔记录来确定肯塔基州东南部经常给儿童开抗生素的医疗服务提供者。通过半结构化定性访谈来了解医疗服务提供者对抗生素过度使用的看法。
对来自不同执业类型和培训背景（私人诊所、非营利机构、零售药店、医生、高级执业注册护士等）的25名医疗服务提供者进行了个人面对面访谈。以下主题被认为是开处方者认为导致抗生素过度使用的问题：（1）护理人员的压力，特别是来自希望“快速解决问题”的祖父母或家庭；（2）商业顾虑和竞争；（3）与贫困和农村地区相关的文化因素。接受访谈的医疗服务提供者支持公众教育，对延迟取药或向医疗服务提供者反馈措施的有效性看法不一。
本研究突出了农村地区抗生素处方方面的独特挑战。研究结果将通过调整现有策略来指导未来的干预措施，以更好地服务于这一弱势群体。
