Pattern of antibiotic prescribing and factors associated with it in eight village clinics in rural Shandong Province, China: a descriptive study

2019 ◽  
Vol 113 (11) ◽  
pp. 714-721 ◽  
Author(s):  
Jia Yin ◽  
Oliver James Dyar ◽  
Peng Yang ◽  
Ding Yang ◽  
Gaetano Marrone ◽  
...  
Keyword(s):  
Rural China ◽  
Village Doctor ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Structured Interviews ◽  
Antibiotic Overuse ◽  
Factors Associated ◽  
Village Doctors ◽  
Level Of Knowledge ◽  
Tract Infections

Abstract Background This study describes the patterns of antibiotic prescribing in eight village clinics in rural China and evaluates factors associated with antibiotic prescribing using quantitative and qualitative methods. Methods From January 2015 to July 2017, 60 prescriptions were collected monthly from selected village clinics in Shandong, China. Village clinic doctors completed a questionnaire regarding their knowledge of antibiotic prescribing. Semi-structured interviews were conducted with 15 village doctors and 1 deputy director from the township hospital. Results Of the 14 526 prescriptions collected, 5851 (40.3%) contained at least one antibiotic, among which 18.4% had two or more antibiotics and 24.3% had parenteral antibiotics. The antibiotic prescribing rate (β=−0.007 [95% confidence interval −0.009 to −0.004]) showed a declining trend (1.7% per month). Higher antibiotic prescribing rates were observed for patients <45 y of age and those diagnosed with upper respiratory tract infections and among village doctors who had less working experience and a lower level of knowledge on antibiotic prescribing. Qualitative analyses suggested that antibiotic prescribing was influenced by the patients’ symptoms, patients’ requests, policies restraining the overuse of antibiotics, subsidies for referral and routine village doctor training. Conclusions Antibiotic prescribing has declined in the included village clinics, which may be due to the policy of reducing antibiotic overuse in primary health care centres in China.

scholarly journals Systematic Review of Factors Associated with Antibiotic Prescribing for Respiratory Tract Infections

2016 ◽  
Vol 60 (7) ◽  
pp. 4106-4118 ◽  
Author(s):  
Rachel McKay ◽  
Allison Mah ◽  
Michael R. Law ◽  
Kimberlyn McGrail ◽  
David M. Patrick
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Multivariable Analysis ◽  
Signs And Symptoms ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Medical Subject Headings ◽  
Factors Associated ◽  
Tract Infections

ABSTRACTAntibiotic use is a modifiable driver of antibiotic resistance. In many circumstances, antibiotic use is overly broad or unnecessary. We systematically assessed factors associated with antibiotic prescribing for respiratory tract infections (RTI). Studies were included if they used actual (not self-reported or intended) prescribing data, assessed factors associated with antibiotic prescribing for RTIs, and performed multivariable analysis of associations. We searched Medline, Embase, and International Pharmaceutical Abstracts using keyword and MeSH (medical subject headings) search terms. Two authors reviewed each abstract and independently appraised all included texts. Data on factors affecting antibiotic prescribing were extracted. Our searches retrieved a total of 2,848 abstracts, with 97 included in full-text review and 28 meeting full inclusion criteria. Compared to other factors, diagnosis of acute bronchitis was associated with increased antibiotic prescribing (range of adjusted odds ratios [aOR], 1.56 to 15.9). Features on physical exam, such as fever, purulent sputum, abnormal respiratory exam, and tonsillar exudate, were also associated with higher odds of antibiotic prescribing. Patient desire for an antibiotic was not associated or was modestly associated with prescription (range of aORs, 0.61 to 9.87), in contrast to physician perception of patient desire for antibiotics, which showed a stronger association (range of aORs, 2.11 to 23.3). Physician's perception of patient desire for antibiotics was strongly associated with antibiotic prescribing. Antimicrobial stewardship programs should continue to expand in the outpatient setting and should emphasize clear and direct communication between patients and physicians, as well as signs and symptoms that do and do not predict bacterial etiology of upper respiratory tract infections.

scholarly journals Low Prevalence of Antibiotic Resistance and High Level of Antibiotic Consumption in Rural China: Interdisciplinary Study

2021 ◽  
Author(s):  
Debin Wang ◽  
Xinrong Shen ◽  
Jing Chai ◽  
Jing Cheng ◽  
Rui Feng ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Rural China ◽  
Bacterial Pathogens ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Electronic Patient Records ◽  
Structured Interviews ◽  
Self Medication ◽  
Diagnostic Uncertainty ◽  
Tract Infections

Abstract Background: We tested the feasibility of determining the prevalence and epidemiology of antibiotic resistance in rural China and investigated patterns and drivers of antibiotic use for common respiratory and urinary tract infections (RTI/UTI). Methods: (i) Observations and exit interviews in eight village clinics and township health centres and 15 retail pharmacies; (ii) Urine, throat swab and sputum samples from patients to identify potential pathogens and test susceptibility; (iii) 103 semi-structured interviews with doctors, patients, pharmacy workers and antibiotic-purchasing customers; (iv) Assessment of completeness and accuracy of electronic patient records through comparison with observational data. Results: 87.9% of 1123 recruited patients were prescribed antibiotics, most of whom had RTIs. Antibiotic prescribing for RTIs was not associated with presence of bacterial pathogens but with longer duration of infection (OR=3.33) and presence of sore throat (OR=1.64). Fever strongly predicted prescription of intravenous antibiotics (OR=2.87). Resistance rates in bacterial pathogens isolated were low compared with national data. 25.8% of patients reported antibiotics use pre-clinic visit. Only 56.2% of clinic patients and 53% of pharmacy customers could confirm their prescription included antibiotics. Diagnostic uncertainty, economic need, understanding of antibiotics as anti-inflammatory and limited doctor-patient communication were identified as drivers of antibiotic use. Completion and accuracy of e-records was variable. Conclusions: Despite high levels of antibiotic prescribing and self-medication, prevalence of antibiotic resistance in this rural population is currently relatively low. More systematic use of e-records could improve antibiotic surveillance in rural facilities.

scholarly journals Variations in antibiotic prescribing among village doctors in a rural region of Shandong province, China: a cross-sectional analysis of prescriptions

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e036703
Author(s):  
Oliver James Dyar ◽  
Ding Yang ◽  
Jia Yin ◽  
Qiang Sun ◽  
Cecilia Stålsby Lundborg
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Shandong Province ◽  
Upper Respiratory Tract Infections ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Parenteral Antibiotic ◽  
Village Doctors ◽  
Upper Respiratory ◽  
Tract Infections

ObjectivesTo assess variation in antibiotic prescribing practices among village doctors in a rural region of Shandong province, China.Design, setting and participantsAlmost all outpatient encounters at village clinics result in a prescription being issued. Prescriptions were collected over a 2.5-year period from 8 primary care village clinics staffed by 24 doctors located around a town in rural Shandong province. A target of 60 prescriptions per clinic per month was sampled from an average total of around 300. Prescriptions were analysed at both aggregate and individual-prescriber levels, with a focus on diagnoses of likely viral acute upper respiratory tract infections (AURIs), defined as International Classification of Diseases, 10th Revision codes J00 and J06.9.Main outcome measuresProportions of prescriptions for AURIs containing (1) at least one antibiotic, (2) multiple antibiotics, (3) at least one parenteral antibiotic; classes and agents of antibiotics prescribed.ResultsIn total, 14 471 prescriptions from 23 prescribers were ultimately included, of which 5833 (40.3%) contained at least 1 antibiotic. Nearly two-thirds 62.5% (3237/5177) of likely viral AURI prescriptions contained an antibiotic, accounting for 55.5% (3237/5833) of all antibiotic-containing prescriptions. For AURIs, there was wide variation at the individual level in antibiotic prescribing rates (33.1%–88.0%), as well multiple antibiotic prescribing rates (1.3%–60.2%) and parenteral antibiotic prescribing rates (3.2%–62.1%). Each village doctor prescribed between 11 and 21 unique agents for AURIs, including many broad-spectrum antibiotics. Doctors in the highest quartile for antibiotic prescribing rates for AURI also had higher antibiotic prescribing rates than doctors in the lowest quartile for potentially bacterial upper respiratory tract infections (pharyngitis, tonsillitis, laryngopharyngitis; 89.1% vs 72.4%, p=0.002).ConclusionsAll village doctors overused antibiotics for respiratory tract infections. Variations in individual prescriber practices are significant even in a small homogenous setting and should be accounted for when developing targets and interventions to improve antibiotic use.

scholarly journals Factors Associated with Prescribing Broad-Spectrum Antibiotics for Children with Upper Respiratory Tract Infections in Ambulatory Care Settings

2018 ◽  
Vol 12 ◽  
pp. 117955651878430 ◽  
Author(s):  
Mohammad S Alzahrani ◽  
Mary K Maneno ◽  
Monika N Daftary ◽  
La’Marcus Wingate ◽  
Earl B Ettienne
Keyword(s):  
Broad Spectrum ◽  
Respiratory Tract Infections ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Factors Associated ◽  
Broad Spectrum Antibiotics ◽  
Care Survey ◽  
Upper Respiratory ◽  
Tract Infections ◽  
Ambulatory Medical Care

Objectives: Broad-spectrum antibiotics are frequently prescribed for children with upper respiratory tract infections (URI). Excessive use of broad-spectrum antibiotics leads to the emergence of resistant bacteria. This study aimed to identify factors associated with prescribing broad-spectrum antibiotics among children younger than 18 years presenting with URI in outpatient settings. Methods: We conducted a cross-sectional analysis of the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey-Outpatient Departments (NHAMCS-OPD) between 2006 and 2010. Descriptive statistics of visits from children with URI were estimated. Simple and multiple logistic regression analyses were used to identify socio-demographic and clinical characteristics associated with broad-spectrum antibiotic prescribing. We also completed a stratified analysis by age (⩽2 vs >2). Results: A total of 4013 outpatient visits for children with URI from both NAMCS and NHAMCS-0PD data were examined. Broad-spectrum antibiotics were prescribed in 39% of the visits, accounting for an estimated 6.8 million visits annually. Multivariable analysis showed that visits in the South region (odds ratio [OR] = 2.38; 95% confidence interval [CI]: 1.38-4.10) compared with the West region and visits with diagnoses of acute sinusitis (OR = 2.77; 95% CI: 1.65-4.63) and acute otitis media (OR = 1.90; 95% CI: 1.32-2.74) compared with those with acute pharyngitis were associated with greater odds of broad-spectrum antibiotic prescribing. Conclusions: The prescribing of broad-spectrum antibiotics is common for children with URI in ambulatory care settings. Diagnosis and management of URI remain a critical area for awareness campaigns promoting judicious use of antibiotics.

scholarly journals The Construction of Patient Understandings of Antibiotic use for Upper Respiratorytract Infections in Rural China.

2021 ◽  
Author(s):  
Jing Cheng ◽  
Paul I. Kadetz ◽  
Jing Chai ◽  
Xingrong Shen ◽  
Christie Cabral ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Rural China ◽  
Antibiotic Use ◽  
Upper Respiratory Tract ◽  
Structured Interviews ◽  
Inappropriate Use ◽  
Related Information ◽  
Upper Respiratory ◽  
Tract Infections

Abstract Background: This paper seeks to identify the lay understandings concerning “anti-inflammatories”, their relation to antibiotics, and their utilization in treating upper respiratory tract infections (RTIs) among patients in rural Anhui Province, China. Methods: In-depth semi-structured interviews were carried out with 30 patients from rural clinics who presented with RTI symptoms between December 2017 and May 2018. These patient-informants were purposively sampled for follow-up interviews from an original sample of 1,030 patients who completed preliminary structured interviews. All informants were over 18 years old and had consulted a doctor at village- or township-level government health facilities for symptoms of RTIs within two weeks preceding follow-up interviews. Data was collected until saturation was achieved. Responses were audiotaped, transcribed, and analyzed using a thematic framework via NVivo 12.0 software. Results: A majority of informants reported that antibiotics such as cephalosporin, known colloquially as “anti-inflammation medicine”, are the preferred treatment for upper respiratory tract symptoms. These are commonly prescribed by township and village doctors, who are an important source of antibiotic-related information for patients. Approximately 87% (n=26) of patient informants reported that doctors neither revealed the name nor classification of their diagnosis. Only 13% (n=4) were specifically told they had an upper respiratory tract infection. However, all patients in this sample were treated with antibiotics regardless of diagnosis or pathogenic etiology. Conclusion: The findings of the present study may provide important insights for designing future interventions to promote public health awareness concerning unnecessary and inappropriate use of antibiotics in China.

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