The Study Of Patient's Expectation To The Doctor's Antibiotic Prescription In Wuhan

PurposeThe abuse of antibiotics is a misleading and serious phenomenon which has received great attentions. It is affected by three interacting forces including the shared value of the society, the group of doctors and the group of patients. The patient's expectation to antibiotic is vital to doctor's prescriptions. The purpose of the research is to find out the actual expectation of patients towards antibiotic at current, the influencing factors and the degree that patient's expectation influence doctor's prescribing behavior with antibiotics. After theoretical and practical study, feasible and valid suggestion aiming at lessening, even ceasing the phenomenon of antibiotic abuse and promoting the rational use of antibiotic are contributed.MethodsBy literature study and questionnaire survey, we had collected the data as follows: (1) the demographic characteristics of the investigated group in 2 levels of medical service organizations in Wuhan; (2) the actuality of knowledge, attitude, usage toward antibiotics of the investigated group in Wuhan; (3) the current patient's expectation to doctor's prescriptions with antibiotics and its influence on doctor's prescribing behavior of the investigated group in Wuhan.Results1. Three factors collected from the comparative group between a 3A hospital and a community health service center were proved to have statistic significance. They were patient's age(Z=4.74,p=0.000), education level (Z=4.74,p=0.000). On the other hand, the difference in gender, income, having the member about the medical background or not, the habit of the drug storage or not and the medical care insurance system were found to have no statistic significance.2. The antibiotic knowledge of the patients from the two hospitals in Wuhan was lacking. There were irrational antibiotic use by both the patients themselves and the doctors.3. The status quo of the patient's expectation to doctor's antibiotic prescription behavior: 34 patients out of 144 had expectation of antibiotic prescription. Within the 34 patients, 23 patients were from a 3A hospital or 28.75% of the total investigated group; 11 patients were from community healthcare center or 17.19% of the total investigated group. The patient's expectation to antibiotic from two levels of health service organizations had no statistic significance(χ2=2.636,p=0.104).4. There were three requirements for the influence from the patient's expectation to the antibiotic prescription: patient's expectation for antibiotic, the spread way and the infectious doctors. In our research there were three spread ways: patients asked doctors for antibiotics explicitly, patients asked doctors for antibiotics implicitly, doctors prescribed antibiotics to their patients without being asked. 10 of the investigated patients asked explicitly for antibiotic, 4 of them were from the 3A hospital, 17.39% of the total number of patients who had antibiotic expectation, while 6 of them were from the community health care center, 54.55% of the total number of patients who were expecting antibiotics. The patients from the community health service center asked for the antibiotic expectation explicitly more than the three-class hospital(χ2=4.948,p=0.045).Further more, we could conclude that patients who were expecting antibiotics but hadn't asked for them had the largest bite, 61.76% of the total number of patients. Followed was the group of patients asking explicitly for antibiotic, they occupied 29.41%. The group of patients asking implicitly for antibiotics was rare with only 8.83% occupation rate.5. The status quo of the doctor's compliance to the antibiotic patient's expectation was that all of 10 patients who asked the antibiotics explicitly obtained them, representing a high degree of doctor's compliance to the antibiotic expectation. 4 patients in the 3A hospital argued that their request had no influence to doctor's prescription behavior. 5 out of 6 patients in the community health service center thought that their asking for antibiotics had no impact at all to doctor's prescription behavior. Only 1 out of them experienced the reluctance to prescribe antibiotic medicine. For the view of patients, their behavior of asking antibiotics had substantial impact on doctor's prescription behavior to some extent.6. From the analysis of logistic regression of patient's expectation to doctor's antibiotic prescription behavior and demographic data (inc gender, age, education, income, having the member about the medical background or not, the habit of drug storage or not and having healthcare insurance or not) we could see that patient's income was the only dangerous factor(p=0.015,OR=1.985). Also, from the analysis of logistic regression, we found that knowledge of antibiotics attitude and behavior had no relation to patient's expectation.7. Patient's knowledge and their education background had a positive relation.(P=0.019,r=0.198).The Patient's attitudes had negative relation with their age(P=0.021,r=-0.194), education background(P=0.000,r=0.315), income(P=0.001,r=0.267), too. Also we found that the antibiotic behavior and the age of the patients(P=0.003,r=0.245), their education background(P=0.00,r=0.34)and their behavior of storing antibiotics(Z=2.769,P=0.006 )correlated positively. At the same time, there was relation between antibiotic knowledge and attitude while behavior had no relation between knowledge and attitude.Conclusions1. The patient's antibiotic expectation to doctor's prescription behavior in medical service organizations of two levels had no statistic significance, which was lower than that of relative researches aboard. In Wuhan, the patient's expectation was only related to demographic characteristics, not related to antibiotic knowledge, the attitude and the behavior. The expectation, to some degree, is a blind behavior. The motivations of the antibiotic expectation are the severity of the illness, the demand for quick recovery, the attempt to avoid deteriorating of illness, especially for kids and the experience to use drug accumulated before.2. The status quo that the patient asking for the antibiotic explicitly from the two hospitals has statistical significance. The first reason is the different medical model, the second one is different recognition about the medical environment, and last one is the different demographic characteristics. 3. The influencing factors to doctor's antibiotic prescription are various. This research shows that, from the view of patient, patient's expectation has influenced the doctor's antibiotic prescription. The relative foreign researches studied from the doctor suggest that the patient expectation has substantial influence on the antibiotic prescription by the doctor. However, we reckon that the doctors have overestimated the effect of patient expectation. Although it has substantial influence on the antibiotic prescription by the doctor, the doctors still play the determinant role in prescribing.4. Relations exist among the demographical characteristics, the antibiotic knowledge, attitudes and use of antibiotic drugs. While educating patients, it is important to carry out different education plans for individuals with various backgrounds.Therefore, to lessen the patient's expectation about antibiotic, a comprehensive scheme for health education should be started and participant doctor-patient model formed. At the same time, doctors should better their medical skills to use their antibiotic guideline more effectively. Also they should obtain necessary skills to deal with patient's irrational antibiotic expectation. InnovationThis research qualitatively and quantitatively analyzes the patient's expectation to the doctor's antibiotic prescription from theory and practice in our country.