| BackgroundThe problem of bacterial resistance caused by irrational use of antibiotics is one of the important health issues worldwide.China is the hardest hit area for the unreasonable use of antibiotics.The irrational use of antibiotics not only threatens the health of the people,but also has a very large impact on the development and safety of the entire economy and society.The reason is that the behavior of health care providers and patients and their related policy systems have a great impact on the rational use of antibiotics.From the existing research,although a large number of researchers domestic and overseas have paid attention to the problem of irrational use of antibiotics,most of the research focuses on the disclosure of the problem of irrational use of antibiotics,and the lack of in-depth investigation of the use of antibiotics and the reasons.From the perspective of research,the existing research is mostly meso-level research,with medical institutions or regions as the main research objects,focusing on the analysis of the results of antibiotic prescriptions or medications.Lacking of individual behavior analysis and deep excavation of reasons.Based on this,this study uses the non-participant observation method in sociology to analyze the antibiotic use behavior of the supplier from the micro level to explore the deep-seated reasons for the unreasonable use of antibiotics.ObjectiveThe main purpose of this article is to use the non-participant observation method,starting from the prescription process of health service providers,to find out the characteristics and influential factors of antibiotic use behaviors of rural doctors in their actual work,and to provide evidence for promoting the rational use of antibiotics in China's rural areas.MethodsBased on the level of economic development,population size,and number and scale of township health centers,this study identified S and Y counties in Liaocheng,Shandong Province as research sites.The 1,377 village clinics in the two counties were classified according to different attributes.Representative clinics were selected from every category as the research objects,and 10 clinics in S and Y counties were selected.Village doctors in 10 clinics were observed by non-participant observation method for 5 days focused on collecting rural doctors' prescription behavior process from the three aspects of personal characteristics,social environment and regulation,and possible series of factors affecting the use of antibiotics.Data collection and information mining on the doubts encountered during the observation process were used by in-depth interviews.Based on the collected qualitative data,the mode of diagnosis and treatment of rural doctors was summarized by inducting the recorded data;quantitative data was used to analyze the characteristics of antibiotic prescriptions of rural doctors by statistical methods such as descriptive analysis and chi-square test;Factors affecting the use of antibiotics by rural doctors were analyzed by fuzzy set QCA.Results(1)The process of diagnosis and treatment of rural doctors is not standardized There is not a complete and standardized process from consultation to prescribing medicines,especially during the peak period of outpatients.The clinic environment is relatively busy.The various behavioral indicators such as consultation rate and physical examination rate of village doctors are relatively low;the social and economic levels of different village doctors are quite different,mainly reflected in medical income;rural doctors are subject to the regulatory management of higher-level township health centers mainly for public health performance evaluation,and in drug management and Prescription management is relatively free.Almost all clinics go to pharmaceutical companies to purchase medicines.The profit margin of medicines is between 10%and 30%.Most village doctors write poorly on prescriptions.(2)The average antibiotic prescription rate of outpatients of rural doctors is 39.8%.Among these 12 village doctors,the lowest antibiotic prescription rate is 31.3%and the highest is 58.9%.The antibiotic prescription rate among individual rural doctors varies widely.From the perspective of patient characteristics,the highest antibiotic prescription rate at different ages is in children which is 49.5%.Among different symptoms,the antibiotic use rate is higher in patients with suspected upper respiratory infection symptoms and in stomatology patients,respectively 61.4%and 65.2%.(3)The results of qualitative comparative analysis of fuzzy sets show that the unreasonable use of antibiotics by rural doctors is determined by three factors:personal characteristics,social environment and regulatory management.The combined effect of the personal characteristics of village doctors and the regulatory management is the main reason for the unreasonable use of antibiotics by village doctors.The combined effect of the two factors of the social environment and regulatory management of village doctors is the secondary cause of the unreasonable use of antibiotics by village doctors.Among them,the individual characteristic factor is long working life,the social environment factor is low medical income,and the regulatory management factor is poor prescription management and drug management.Conclusions and suggestionsIn general,the situation of antibiotic use by rural doctors in rural areas is grim and the antibiotic prescription rate remains high.The implementation of the relevant management policies at the village clinic level is inadequate,and there is still a model of "supporting doctors with medicine" in some areas.The diagnosis and treatment environment of rural doctors is complicated,and the procedure of patient visits is not standardized.Unreasonable and irregular operations during the medication process are common.Village doctors' antibiotic use behavior is affected by the interaction between different factors of personal characteristics,social environment and regulatory management,and different combinations of factors will lead to the result of unreasonable use of antibiotics.The main avenues found in this study are the combination of personal characteristics and regulatory management factors,as well as the unreasonable use of antibiotics by the combination of social environment and regulatory management factors.Based on the above research conclusions,this article proposes the following suggestions:(1)Rural areas are also the hardest hit areas for the unreasonable use of antibiotics,to control the abuse of antibiotics and prevent the development of antibiotic resistance,the level of village clinics is a key area for future intervention.During interventions with providers training is required on medications for children,suspected upper respiratory infection symptoms,and dental patients.(2)Strengthen the standardized construction of the process of seeing patients in village clinics,give full play to the functions of consultation rooms,observation rooms,treatment rooms and pharmacies,so that village doctors and patients have a good order of seeing and seeing doctors.Standardize the village doctor's diagnosis and treatment behavior,reduce unnecessary antibiotic use to reduce drug resistance.(3)Promote the rational use of antibiotics in rural areas.It is not enough to focus on only one factor.It needs to intervene from the personal characteristics,social environment,and regulatory management of rural doctors,and it is particularly necessary to pay attention to village doctors with long working years,as well as improving the reasonable medical income of village doctors,strengthening the management of village clinics by township health centers,breaking the "support doctors by medicine" system,and multi-pronged approaches can really effectively solve the problem of irrational use of antibiotics in rural areas in China. |
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