| Objective: Primary health care facilities are the largest source of inappropriate use of antimicrobial agents,with acute respiratory infection(ARI)being the most common disease seen in primary health care facilities.In this study,we investigated the use of antibiotics in rural areas of Guangdong province and analyzed the driving factors of doctors’ unreasonable use of antibiotics.We will develop a pilot study to evaluate the effectiveness of a comprehensive antibiotic stewardship program in China’s primary care hospitals to reduce inappropriate prescribing of antibiotics for acute respiratory infections among all ages.Methods: Prescriptions of 35 township hospitals in shaoguan city,guangdong province diagnosed as acute respiratory infection in outpatient clinics were collected from November 2017 to October 2018.We analyzed the Average Antibiotic Prescription Rate(APR),antimicrobial category and Combination.We used the questionnaire to find out the motivation of doctors for prescription behavior of acute respiratory tract infection.According to the results of the previous investigation,a series of multiple intervention kits were developed.Before the pilot study initiates,two township hospitals(1 intervention: 1 control)were randomly selected as the pre-experimental research sites.A six-month intervention study was conducted from June to November 2019.During the intervention,relevant prescription information was collected and doctors in the intervention group were interviewed face to face.Result: A total of 164051 prescriptions with complete information were collected.The utilization rate of antimicrobial agents in primary medical institutions was 83%,that of broad-spectrum antimicrobial agents was 49%,that of combined two or more antimicrobial agents was 32%,and that of injection antimicrobial agents was 42%.It was found that the use of antimicrobials was the most influential in the age group of patients,and the proportion was the highest in the elderly and children(73.4% [15-60 years old] vs 87.5% [0-14 years old],vs87.9% [61-year-old],P < 0.001).Cephalosporins,penicillins and macrolides are the most common antibiotics in the grass-roots,among which penicillins and macrolides are the most commonly used in the elderly(P < 0.001),while cephalosporins are the most commonly used in adults(P < 0.001),with the third generation cephalosporins as the main group.According to 162 questionnaires collected,69% of doctors know that the acute respiratory tract infection is mainly caused by virus,73% of doctors think that their use of antibiotics is very low,only3.7% of doctors can realize that they are high users of antibiotics.In response to the above survey,a series of multiple intervention kits for medical service providers and patients have been developed and implemented,including participatory training for doctors,prescription reviews,development of training manuals,etc.;popular science posters,three fold pages,video playback,etc.for patients;and the application of online wechat applet.After six months of intervention study,it was found that the antibacterial prescription rate of the intervention group decreased from 90% to 36%(P < 0.001),while that of the control group increased from 94% to 95%(P = 0.589).In the intervention group,the rate of combined use of antibiotics decreased from 42% to21%(P < 0.001),the rate of antiviral prescription decreased from 15% to 8%(P <0.001),the rate of vitamin prescription increased from 16% to 33%(P < 0.001),while in the broad-spectrum use of antibiotics,the rate of intravenous use of antibiotics,the rate of use of middle-level drugs and the rate of use of glucocorticoids had no significant effect(P > 0.05).Interview all the outpatient doctors in the intervention group with the topics related to antibacterial drugs.The cognition of the doctors in the intervention group has changed greatly before and after the intervention.Most of them are willing to standardize their prescription behavior,at the same time,to educate the patients more,and change the views of the patients--antibacterial drugs are "omnipotent drugs".Conclusion:1.The unreasonable use of antibiotics in upper respiratory tract infection in rural areas of Guangdong Province is serious.There is a contradiction between doctors’ cognition of acute respiratory tract infection and prescription behavior.It is necessary to pay more attention to and improve patients’ education,doctors’ knowledge level and access to knowledge.At the same time,it also needs more effective supervision of drug market and prescription behavior.2.It is of great help to reduce the abuse of antibiotics in rural areas of China to carry out multiple interventions for doctors and patients,improve the diagnosis and treatment level and professional knowledge of doctors,enhance the communication skills between doctors and patients,educate and popularize science for patients,and improve patients’ awareness of antibiotics at the same time.It is a long way to promote the rational use of antibiotics.We need to draw on the experience of good management and evaluation methods at home and abroad,and formulate reasonable management strategies. |
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