| BackgroundThe abuse of antibiotics not only threatens life and health of the human,but also imposes a heavy medical burden on patients and society.Now China suffers from the problem of the irrational use of antibiotics.The average annual per capita antibacterial drugs use is 10 times that of the United States,and the problem is more serious in rural areas.At present,most of the researches on the abuse of antibiotics in primary health facilities in China are cross-sectional survey,and the content of research is relatively highly homogeneous.Few articles can be based on prescription panel data on the trend of changes in the use of antimicrobial drugs and its influencing factors to conduct in-depth research.In view of the importance of rural health facilities providing medical services to rural residents,the research on the use of antibacterial drugs in village clinics is more practical.Thus,this study analyzes the panel data information of outpatient prescriptions in village clinics,sums up the regular pattern of antibiotic use,and analyzes the reasons for the formation of the rules in combination with questionnaires and interviews to provide intervention strategy and policy implication for promoting the rational use of antimicrobial agents in rural areas.ObjectiveThis study analyzes the trends in the use of antimicrobials by outpatient prescriptions in village clinics,summarizes the use rules of antimicrobials in rural areas,and explores the causes of changes in usage trends,and proposes the accurate intervention strategies and policy recommendations of antibiotic use in village clinics.MethodsThe data were derived from the project of National Natural Science Foundation"Sino-Swedish Integrated Multisectorial Partnership for Antibiotic resistance Containment(IMPACT)".The project selected 12 villages in H township of Z City as the investigation site based on the number of population,medical conditions,the number and scale of large-scale farms,and the distance from the reservoir.This study focuses on the analysis of the supply side,so survey sites were identified as H township hospitals and 8 village clinics.The project conducted questionnaire surveys and key informant interviews with all village doctors.At the same time,this study sampled outpatient prescriptions from the hospital information system of township hospital.The prescription time span is from January 2015 to July 2017.Outpatient prescriptions and survey data were entered in software such as Access 2007,Excel 2013.Descriptive and inferential statistical analysis was performed in software named SPSS.The method of linear regression and time series analysis of antibacterial drugs in prescriptions were usd to analyze the change of regular patterns and trend in the future.The single factor chi-square test was used to analyze the changes of village doctors' knowledge,attitude,and practice concerning antibiotic use.Then,the interview audio was transcribed into words in Word,and the main result of the interviews was summed up in Nvivo 10 for explaining the reason of a quantitative data analysis result.Results(1)The use rate of antimicrobial agents in out-patient prescriptions in village clinics was 40.31%,showing a significant downward trend during the survey period(?=-0.006,P<0.001).And there are seasonal features,illustrating peak of antimicrobial use in January or February of each year.The forecast results showed that there was no significant trend in August 2017 to July 2018(?=-0.005,P=0.138).(2)The percentage of prescriptions requiring antibiotics by age group and gender group showed a significant downward trend with time.The average use rates of antibiotics in the juvenile,young,middle-aged,and elderly groups were 57%,49%,42%,and 34%,respectively,showing a pattern of decreasing with age.The lowest proportion of antibacterial drugs in the 8 village clinics was 29.68%,and the highest was 49.98%,Among them,the usage rate of antimicrobial drugs in seven village clinics showed a significant downward trend.(3)About 40%(5573/14526)of the prescriptions were diagnosed as upper respiratory tract infections,and the proportion of prescriptions containing antibiotics was 63.29%(3527/5573).There was a marked decline in the period from January 2015 to July 2017(?=-0.007,P<0.001).However,the forecast results indicate that there will be a significant upward trend in the next year(?=0.006,P=0.025).(4)The use of broad-spectrum antibiotics is very common in village clinics.The most commonly used category is cephalosporins(JO1D).The most commonly used drug in all prescriptions and upper respiratory tract infections was amoxicillin(J01CA04),with a utilization rate of 10.31%and 19.34%,respectively,which also showed a declining trend during the survey period.(5)During the baseline survey,57.89%of village doctors stated that they would prescribe antibiotics for patients with upper respiratory tract infections.During the final survey,the proportion dropped to 14.29%.The difference was statistically significant(?=8.338,P=0.004).However,actual prescription data show that 63.29%of upper respiratory infections contain antibiotics.(6)The results of the interview show that the overall level of practice of village doctors is low,and the diagnosis in treatment process sometimes suffers from the expectation of patients and loses their professional judgment.Due to the low level of remuneration package,some doctors are driven by interests,and there are splitting of prescriptions and other self-interested behavior.Most doctors expressed support for health education interventions for villagers,but considered that the interventions did not work.Conclusion and suggestions:In the past three years,the use of antibiotics in rural areas has improved significantly in the village clinics.The percentage of prescriptions requiring antibiotics and combined use of antibiotics have been gradually reduced,but the problem of the abuse of antibiotics has not been completely resolved.The use rate of antibacterial drug injections has not yet improved.Although there is a downward trend in the proportion of patients taking antibiotics for upper respiratory tract infections,unreasonable use is still widespread.Village doctors have significantly improved their knowledge of antibiotics and their attitudes to use,but they still prefer to prescribe antibiotics in actual prescriptions.The study found that individual differences in rural doctors have a large impact on the use of antibiotics,such as sensitivity to incentives and penalties,and the degree to which cognitive attitudes affect behavior.It is recommended that precise intervention about the use of antibiotics for key diseases and key populations should be taken in rural area.A series of special lectures concerning how to use antibiotics rationaly should be hold for the village doctors in the peak period of the use of antibiotics,focusing on the training rational drug use about upper respiratory tract infections and young people.A prescription review system was implemented to focus on monitoring the diagnosis of upper respiratory tract infections,patients younger than 15 years old,containing antibacterial injections,prescriptions containing antibacterial drugs such as cephalosporins and amoxicillin,and publicizing the results of the reviews of village doctors.Establish a scientific and effective assessment and incentive mechanism for the use of antibacterial drugs,use rural doctors' sensitivity to incentives and penalties to reduce the use of antibiotics in the short term,and implement a reform of the regulatory system to prevent village doctors from exploiting loopholes in the pursuit of private interests.Combining training lectures with village doctors and implementing compulsory regulations can further improve the unreasonable behavior of doctors and mitigate the harm caused by the abuse of antibiotics. |
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