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Overuse of antibiotics for the common cold - attitudes and behaviors among doctors in rural areas of Shandong Province, China.

Sun Q, Dyar OJ, Zhao L, Tomson G, Nilsson LE, Grape M, Song Y, Yan L, Lundborg CS - BMC Pharmacol Toxicol (2015)

Bottom Line: Over half (55%, 869/1590) of them included an antibiotic.Prescriptions from village clinics were more likely to contain an antibiotic than those from other healthcare institutions (71% vs. 44% [township] vs. 47% [county], p < 0.001).Exploring and addressing gaps between knowledge and practice is critical to improving antibiotic use in rural China.

View Article: PubMed Central - PubMed

Affiliation: Center for Health Management and Policy, Key Lab of Health Economics and Policy Research of Ministry of Health, Shandong University, 250012, Jinan, Shandong, China. qiangs@sdu.edu.cn.

ABSTRACT

Background: Irrational antibiotic use is common in rural areas of China, despite the growing recognition of the importance of appropriate prescribing to contain antibiotic resistance. The aim of this study was to analyze doctors' attitudes and prescribing practices related to antibiotics in rural areas of Shandong province, focusing on patients with the common cold.

Methods: A survey was conducted with doctors working at thirty health facilities (village clinics, township health centers and county general hospitals) in three counties within Shandong province. Questions were included on knowledge and attitudes towards antibiotic prescribing. Separately, a random selection of prescriptions for patients with the common cold was collected from the healthcare institutions at which the doctors worked, to investigate actual prescribing behaviors.

Results: A total of 188 doctors completed the survey. Most doctors (83%, 149/180) had attended training on antibiotic use since the beginning of their medical practice as a doctor, irrespective of the academic level of their undergraduate training. Of those that had training, most had attended it within the past three years (97%, 112/116). Very few doctors (2%, 3/187) said they would give antibiotics to a patient with symptoms of a common cold, and the majority (87%, 156/179) would refuse to prescribe an antibiotic even if patients were insistent on getting them. Doctors who had attended training were less likely to give antibiotics in this circumstance (29% vs. 14%, p < 0.001). A diagnosis of common cold was the only diagnosis reported on 1590 out of 8400 prescriptions. Over half (55%, 869/1590) of them included an antibiotic. Prescriptions from village clinics were more likely to contain an antibiotic than those from other healthcare institutions (71% vs. 44% [township] vs. 47% [county], p < 0.001).

Conclusions: Most doctors have recently attended training on antibiotic use and report they would not prescribe antibiotics for patients with a common cold, even when placed under pressure by patients. However, more than half of the prescriptions from these healthcare institutions for patients with the common cold included an antibiotic. Exploring and addressing gaps between knowledge and practice is critical to improving antibiotic use in rural China.

No MeSH data available.


Related in: MedlinePlus

The selection of study sites and healthcare facilities.
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Fig1: The selection of study sites and healthcare facilities.

Mentions: The study was conducted in 2012 in Shandong Province, located in the eastern part of China. A total of 3 county general hospitals, 9 township health centers and 18 village clinics were selected as study sites using a multistage sampling based on the vertical administrative structure in rural China (see FigureĀ 1). First, three counties (JN, NY and YG) were purposely selected out of a total of 91 counties in Shandong Province, based on geographic location and feasibility of the study. These three counties had around 2.47 million inhabitants in 2012. Secondly, three administrative units were randomly selected in each county. Each administrative unit consists of a town and its surrounding villages. Thirdly, two villages were randomly selected from within each administrative unit. The only county general hospital in each county was included in the study, alongside the only township health centers in each participating administrative unit, and the village clinic within each village.Figure 1


Overuse of antibiotics for the common cold - attitudes and behaviors among doctors in rural areas of Shandong Province, China.

Sun Q, Dyar OJ, Zhao L, Tomson G, Nilsson LE, Grape M, Song Y, Yan L, Lundborg CS - BMC Pharmacol Toxicol (2015)

The selection of study sites and healthcare facilities.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4389968&req=5

Fig1: The selection of study sites and healthcare facilities.
Mentions: The study was conducted in 2012 in Shandong Province, located in the eastern part of China. A total of 3 county general hospitals, 9 township health centers and 18 village clinics were selected as study sites using a multistage sampling based on the vertical administrative structure in rural China (see FigureĀ 1). First, three counties (JN, NY and YG) were purposely selected out of a total of 91 counties in Shandong Province, based on geographic location and feasibility of the study. These three counties had around 2.47 million inhabitants in 2012. Secondly, three administrative units were randomly selected in each county. Each administrative unit consists of a town and its surrounding villages. Thirdly, two villages were randomly selected from within each administrative unit. The only county general hospital in each county was included in the study, alongside the only township health centers in each participating administrative unit, and the village clinic within each village.Figure 1

Bottom Line: Over half (55%, 869/1590) of them included an antibiotic.Prescriptions from village clinics were more likely to contain an antibiotic than those from other healthcare institutions (71% vs. 44% [township] vs. 47% [county], p < 0.001).Exploring and addressing gaps between knowledge and practice is critical to improving antibiotic use in rural China.

View Article: PubMed Central - PubMed

Affiliation: Center for Health Management and Policy, Key Lab of Health Economics and Policy Research of Ministry of Health, Shandong University, 250012, Jinan, Shandong, China. qiangs@sdu.edu.cn.

ABSTRACT

Background: Irrational antibiotic use is common in rural areas of China, despite the growing recognition of the importance of appropriate prescribing to contain antibiotic resistance. The aim of this study was to analyze doctors' attitudes and prescribing practices related to antibiotics in rural areas of Shandong province, focusing on patients with the common cold.

Methods: A survey was conducted with doctors working at thirty health facilities (village clinics, township health centers and county general hospitals) in three counties within Shandong province. Questions were included on knowledge and attitudes towards antibiotic prescribing. Separately, a random selection of prescriptions for patients with the common cold was collected from the healthcare institutions at which the doctors worked, to investigate actual prescribing behaviors.

Results: A total of 188 doctors completed the survey. Most doctors (83%, 149/180) had attended training on antibiotic use since the beginning of their medical practice as a doctor, irrespective of the academic level of their undergraduate training. Of those that had training, most had attended it within the past three years (97%, 112/116). Very few doctors (2%, 3/187) said they would give antibiotics to a patient with symptoms of a common cold, and the majority (87%, 156/179) would refuse to prescribe an antibiotic even if patients were insistent on getting them. Doctors who had attended training were less likely to give antibiotics in this circumstance (29% vs. 14%, p < 0.001). A diagnosis of common cold was the only diagnosis reported on 1590 out of 8400 prescriptions. Over half (55%, 869/1590) of them included an antibiotic. Prescriptions from village clinics were more likely to contain an antibiotic than those from other healthcare institutions (71% vs. 44% [township] vs. 47% [county], p < 0.001).

Conclusions: Most doctors have recently attended training on antibiotic use and report they would not prescribe antibiotics for patients with a common cold, even when placed under pressure by patients. However, more than half of the prescriptions from these healthcare institutions for patients with the common cold included an antibiotic. Exploring and addressing gaps between knowledge and practice is critical to improving antibiotic use in rural China.

No MeSH data available.


Related in: MedlinePlus