The Study On The Optimal Route Of Antimicrobials Use In Rural Areas Of Anhui Province

Objectives(1)To explore the process and link of antimicrobials unreasonable use.(2)To examine the accuracy and reliability of the existing monitoring and reporting system of antimicrobials use.(3)To explore the influencing factors of antimicrobials use among doctors and residents in rural Anhui,China.(4)To develop the measures and schemes for optimizing the antimicrobials use in rural Anhui,China.Methods(1)The household survey adopts the method of random cluster sampling to select the respondents,and carries out the questionnaire survey on the respondents meeting the inclusion criteria through the self-designed structured questionnaire;Observing the treatment process of all outpatients meeting the inclusion criteria,and fill in the observation form;Recording self-reported symptoms,course of disease,diagnosis and prescription,and so on.Collecting electronic medical records of all subjects at the end of each study site.Interviewing patients and doctors recruited at the observation site.(2)Descriptive analysis was conducted on the data of household survey,observation and electronic medical record using Microsoft Excel 2010.The interview data were coded using Nvivo11 qualitative analysis software,and finding the key conclusion,as the reason of the quantitative data analysis results complement.(4)According the above research results,To develop measures for optimizing the antimicrobials use in rural Anhui,China.Results(1)After respiratory infection,seeking help from clinics happened most frequently(56.4%)followed by getting antimicrobials from clinics(41.7%),buying medicine from shops(23.6%),getting antimicrobials from shops(16.4%),taking leftover medicine(13.5%)and taking leftover antimicrobials(9.9%).The key steps inantimicrobials use include obtaining antimicrobials from clinics,purchasing antimicrobials from shops and taking the remaining antimicrobials.(2)The Day of onset of specific symptoms curves deviate a step further from DSO curves,with 2-3peaks centered on days 3,5,10 and especially day 7.The time lag between symptom occurrence(ARSO)and recovery(ARSR)was longest for cough,followed by that of sore throat,shortness of breath,rhinorrhea headache/general discomfort and fever.(3)Over 60.5% of healthcare-seeking happened between two days before and one day after symptoms peaked.The timing of healthcare-seeking showed varied extent of clustering on different symptom peaks,being most narrowly centered for Fever followed by Headache/General discomfort and Rhinorrhea without pus.(4)Taking leftover medicine and antimicrobials happened the earliest: but seeking help from clinics and getting antimicrobials at clinics,the latest.(5)Through direct observation in clinics we have demonstrated very high prescription rates for antibiotics in outpatient facilities in rural Anhui province.Antimicrobials were prescribed in 917(89%)of consultations;of these prescriptions 391(42.6%)were for more than one antimicrobials.(6)E-record coverage was particularly varied at the level of village clinics: site 2 lacked the Information Technology(IT)infrastructure to support any routine use of e-records,whereas in site 1 e-records were created for 98.7% of observed consultations.(7)The antimicrobials names and doses were accurately recorded in 82.8% and 68.4% of e-records,and the diagnostic accuracy was 45.5%,as compared with presenting symptoms only 1.1% of observed symptoms were accurately recorded.(8)On e-record,only 38 different antimicrobials types were recorded although in clinic consultations a total of 51 types of antimicrobials were prescribed.(9)Residents are relatively lack of knowledge about antimicrobials,and most residents have a larger misunderstanding of antimicrobials;Residents will not go to the hospital for diagnosis and treatment immediately after infection,and will only go to the hospital for treatment after feeling severe symptoms.The reason forresidents to use or ask doctors to prescribe antimicrobials by themselves is mainly the habit cognition cultivated by grassroots doctors themselves and pharmacy personnel.(10)Doctors' knowledge of antimicrobials is relatively weak,and they prefer to use antimicrobials empirically and prophylactically.Doctors may prescribe antimicrobials because of the patient's stress.(11)The preliminary intervention measures include:setting procedures and procedures,providing reference principles and evidence,implementing quality and effect supervision and feedback,displaying action commitment and slogan,using take-away information and prescription,pushing instant reminder and guidance.Conclusion(1)The key steps in antimicrobials use include obtaining antimicrobials from clinics,purchasing antimicrobials from shops and taking the remaining antimicrobials.The time of seeking help from clinics are associated with peak symptoms.(2)The prescription rates for antimicrobials is very high in outpatient facilities in rural Anhui province.E-records are designed to claim reimbursement from state insurance for investigations and treatments.The accuracy and reliability of using electronic medical record to monitor the prescription of antimicrobials is low.(3)The residents have a low level of knowledge about infection and antimicrobials in rural Anhui,China.Doctors they prefer to use antimicrobials empirically and prophylactically.The doctor's prescribing behavior can be influenced by the patient's stress.(4)The study develops a comprehensive intervention programme,to help promote and improve the use of antimicrobials,to reduce the emergence and harm of infection and bacterial resistance.