Wagner Zachary, Mohanan Manoj, Mukherji Arnab, Zutshi Rushil, Patil Sumeet, Krishnappa Jagadish, Banerjee Somalee, Sood Neeraj
Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA.
Department of Economics, University of Southern California, Los Angeles, CA, USA.
Sci Adv. 2025 Sep 12;11(37):eady9868. doi: 10.1126/sciadv.ady9868. Epub 2025 Sep 10.
Antimicrobial resistance is largely driven by overuse of antibiotics, which is particularly common in low- and middle-income countries. We combine provider knowledge assessments and over 2000 anonymous standardized patient visits to providers in India to examine why they overprescribe antibiotics for pediatric diarrhea and figure out how to reduce overprescribing. Seventy percent of providers prescribed antibiotics without indication of bacterial infection. Knowledge gaps explain little: 62% of providers who knew antibiotics were inappropriate still prescribed them. Closing this "know-do gap" would reduce prescribing by 30 percentage points, versus only 6 points if all providers had perfect knowledge. Using randomized experiments, we revealed that the know-do gap stems from providers' beliefs that patients want antibiotics, not from profit motives or lack of alternative treatments. Yet, a discrete choice experiment suggests patients do not prefer providers who give antibiotics. Our findings indicate that addressing provider misperceptions about patient preferences may be more effective than standard information-based interventions in reducing antibiotic overuse.
抗生素耐药性在很大程度上是由抗生素的过度使用所驱动的，这在低收入和中等收入国家尤为常见。我们结合对医疗服务提供者的知识评估以及对印度医疗服务提供者进行的2000多次匿名标准化患者问诊，来探究他们为何对小儿腹泻过度开具抗生素处方，并找出减少过度开药的方法。70%的医疗服务提供者在没有细菌感染迹象的情况下就开具了抗生素。知识差距并不能很好地解释这一现象：62%知道抗生素不适用的医疗服务提供者仍然开具了这些药物。消除这种“知行差距”将使开药率降低30个百分点，而如果所有医疗服务提供者都具备完善的知识，开药率仅会降低6个百分点。通过随机试验，我们发现知行差距源于医疗服务提供者认为患者想要使用抗生素，而非出于盈利动机或缺乏替代治疗方法。然而，一项离散选择实验表明，患者并不偏爱开具抗生素的医疗服务提供者。我们的研究结果表明，在减少抗生素过度使用方面，解决医疗服务提供者对患者偏好的误解可能比基于信息的标准干预措施更有效。
