Abejew Asrat Agalu, Wubetu Gizachew Yismaw, Fenta Teferi Gedif
Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Interact J Med Res. 2024 Oct 23;13:e57285. doi: 10.2196/57285.
Antibiotic resistance, fueled by irrational prescribing, is a global threat associated with health, social, and economic consequences. Understanding antibiotic prescribing behavior and associated factors is important to promote good prescribing practice.
This study aimed to determine the factors affecting antibiotic prescribing behaviors of physicians based on the theory of planned behavior in hospitals in northwest Ethiopia in 2022.
A cross-sectional study was conducted from September 2022 to October 2022. A total of 185 health professionals were included, and a self-administered questionnaire was used to collect data. A structural equation model based on the modified theory of planned behavior was used to determine factors affecting antibiotic prescribing behavior. The percentages of physicians' estimated prescriptions for patients with upper respiratory tract infections (URTIs) and during weekly outpatient visits were used to predict antibiotic prescribing behavior and finally linked with behavioral constructs. A P value <.05 was considered significant.
Physicians estimated that they prescribed antibiotics for 54.8% (9896/18,049) of weekly outpatient encounters, and 178 (96.2%) of the 185 physicians estimated they prescribed antibiotics for patients who presented with symptoms of a URTI. Physicians aged ≤30 years were less likely to prescribe antibiotics (48/100, 48%) for patients who presented with a URTI than physicians older than 30 years (51/100, 51%; P=.004), and general practitioners were less likely to prescribe antibiotics (47/100, 47%) for patients who presented with a URTI than residents (51/100, 51%; P=.03). Similarly, during outpatient visits, physicians ≤30 years old were less likely to prescribe antibiotics (54/100, 54%) than physicians older than 30 years (57/100, 57%; P<.001), male physicians were less likely to prescribe antibiotics (53/100, 53%) than female physicians (64/100, 64%; P=.03), and general practitioners were less likely to prescribe antibiotics (53/100, 53%) than residents (57/100, 57%; P=.02). Physicians with good knowledge were less affected by perceived social pressure (mean 4.4, SD 0.6) than those with poor knowledge (mean 4.0, SD 0.9; P<.001) and felt it was easy to make rational decisions (mean 4.1, SD 1.1) compared with those with poor knowledge (mean 3.8, SD 1; P<.001). However, intentions to reduce and prescribe antibiotics were not affected by attitudes, subjective norms, or perceived behavioral control, and perceived antibiotic prescribing behavior was not related to intentions to reduce or prescribe antibiotics.
Antibiotic prescribing behavior was not under the volitional control of physicians. This calls for a systematic approach to change antibiotic prescribing practices in hospital.
不合理用药导致的抗生素耐药性是一个全球性威胁，会带来健康、社会和经济后果。了解抗生素处方行为及相关因素对于促进良好的处方实践很重要。
本研究旨在基于计划行为理论，确定2022年埃塞俄比亚西北部医院医生抗生素处方行为的影响因素。
于2022年9月至10月进行了一项横断面研究。共纳入185名卫生专业人员，使用自填式问卷收集数据。基于修正的计划行为理论构建结构方程模型，以确定影响抗生素处方行为的因素。医生对每周门诊患者和上呼吸道感染（URTI）患者的估计处方比例用于预测抗生素处方行为，并最终与行为结构相关联。P值<.05被认为具有统计学意义。
医生估计他们在每周门诊中为54.8%（9896/18049）的患者开具了抗生素，185名医生中有178名（96.2%）估计他们为出现URTI症状的患者开具了抗生素。年龄≤30岁的医生为出现URTI症状的患者开具抗生素的可能性（48/100，48%）低于30岁以上的医生（51/100，51%；P = 0.004），全科医生为出现URTI症状的患者开具抗生素的可能性（47/100，47%）低于住院医生（51/100，51%；P = 0.03）。同样，在门诊期间，30岁及以下的医生开具抗生素的可能性（54/100，54%）低于30岁以上的医生（57/100，57%；P <.001），男性医生开具抗生素的可能性（53/100，53%）低于女性医生（64/100，64%；P = 0.03），全科医生开具抗生素的可能性（53/100，53%）低于住院医生（57/100，57%；P = 0.02）。知识水平良好的医生比知识水平较差的医生受感知社会压力的影响更小（平均4.4，标准差0.6）（平均4.0，标准差0.9；P <.001），并且与知识水平较差的医生相比，他们更容易做出合理决策（平均4.1，标准差1.1）（平均3.8，标准差1；P <.001）。然而，减少和开具抗生素的意图不受态度、主观规范或感知行为控制的影响，并且感知到的抗生素处方行为与减少或开具抗生素的意图无关。
抗生素处方行为不受医生意志控制。这需要一种系统的方法来改变医院的抗生素处方实践。
