Factors affecting inappropriate prescribing of antibiotics and the emergence of antibiotic resistance in patients in primary health care
Sažetak
Introduction. Increasing resistance to antibiotics is of great importance for health professionals around the world. The correlation between the use of antibiotics and rates of resistance has long been established. Physicians who work in primary health care make up a large part of health care personnel responsible for the use of these drugs. This study reveals factors that influence unduly prescribing antibiotics and the emergence of resistance to antibiotics in primary health care.
Methodology. This study has been conducted at the Health center Danilovgrad, Montenegro from November 1st 2015 to June 1st 2016. We used a qualitative method - focus group, where one group consists of 8 members (six doctors for adults, 1 pediatrician am 1 pharmacist) and moderator. Based on previous systematic reviews, we made the agenda, which was followed during the group meetings to facilitate the identification of factors. During discussions within the meetings group audio recordings were made, and then their transcripts were individually analyzed by the researchers.
Results. Our study showed that factors affecting the prescription of medicines in primary health care are: personal interest of referring physician; fear of referring physician; external factors relating to the patient, pharmacist and the influence of the pharmaceutical industry; as well as the patients lack of knowledge and lack of information. Members of the group agreed that the emergence of resistance should be monitored at the level of healthcare institutions.
Conclusion. Identification of factors that influence inappropriate prescribing of antibiotics allows implementation of specific interventions with aim of improving antibiotic use and preventing antibiotic resistance, which is of special importance for developing countries where this problem affects their medical, economic and legal systems.
Reference
- World Health Organization. Global action plan on antimicrobial resistance. Geneva: World Health Organization; 2015. Available at: http://www.who.int/drugresistance/global_action_plan/en/.
- Laxminarayan R, Matsoso P, Pant S, et al. Access to effective antimicrobials: a worldwide challenge. Lancet 2016; 387: 168–175.
- Adriaenssens N, Coenen S, Versporten A, et al. European Surveillance of Antimicrobial Consumption (ESAC): outpatient antibiotic use in Europe (1997–2009). J AntimicrobChemother 2011; 66(Suppl 6):vi3–12.
- Tomson G, Vlad I. The need to look at antibiotic resistance from a health systems perspective. Ups J Med Sci2014; 119:117–24.
- Molstad S, Lundborg CS, Karlsson AK, et al. Antibiotic prescription rates vary markedly between 13 European countries. Scand J Infect Dis 2002; 34:366–71.
- Laxminarayan R, Duse A, Wattal C, et al. Antibiotic resistance-the need for global solutions. Lancet Infect Dis 2013; 13:1057–98.
- Mendelson M, Røttingen JA, Gopinathan U, et al. Maximising access to achieve appropriate human antimicrobial use in low-income and middle-income countries. Lancet 2015; 387:188–98.
- Nord M, Engstrom S, Molstad S. High and variable use of antibiotics in primary care.(Högochvarierandeförskrivningavantibiotika I primärvården). Lakartidningen 2013; 110:1282–4.
- Review on Antimicrobial Resistance Tackling a crisis for the health and wealth of nations. London, United Kingdom: Review on Antimicrobial Resistance; 2014.
- Nathan C, Cars O. Antibiotic resistance – problems, progress, and prospects. N Engl J Med 2014; 371:1761–3.
- Nikolić G, Simović S, Adžović A, Lakićević J. Racionalna primjena antibiotika u primarnoj zdravstvenoj zaštiti. Nacionalne smjernice dobre kliničke prakse, Crna Gora, 2012.
- Zvizdojević J, Radovanović B, Kolić E. Crna Gora u brojkama 2013, Zavod za statistiku Crne Gore- Monstat, Podgorica 2013.
- Mack N, Woodsong C, Macqueen K, Guest G, Namey E. Qualitative Research Methods: A Data Collector’s Field Guide. Family Health International 2005.
- Del Mar C, Glasziou P, Lowe JB, van Driel ML, Hoffmann T, Beller E. Addressing antibiotic resistance - focusing on acute respiratory infections in primary care. AustFam Physician 2012; 41(11):839–840.
- Dallas A, Magin P, Morgan S, Tapley A, Henderson K, Ball J, et al. Antibiotic prescribing for respiratory infections: a cross-sectional analysis of the ReCEnT study exploring the habits of early-career doctors in primary care. FamPract 2015; 32: 49–55.
- Linder JA. Antibiotic Prescribing for acute respiratory infections--success that's way off the mark: comment on "A cluster randomized trial of decision support strategies for reducing antibiotic use in acute bronchitis". JAMA Intern Med 2013; 173: 273–5.
- Surveillance of antimicrobial consumption in Europe 2012. Stockholm: ECDC; 2014.
- Touboul-Lundgren P, Jensen S, Drai J, Lindbæk M. Identification of cultural determinants of antibiotic use cited in primary care in Europe: a mixed research synthesis study of integrated design “Culture is all around us”. BMC Public Health 2015; 15: 908.
- Neumark T, Brudin L, Molstad S. Use of rapid diagnostic tests and choice of antibiotics in respiratory tract infections in primary healthcare–a 6-y follow-up study. Scand J Infect Dis 2010; 42(2):90–6.
- Murphy M, Bradley CP, Byrne S. Antibiotic prescribing in primary care, adherence to guidelines and unnecessary prescribing–an Irish perspective. BMC FamPract 2012; 13: 43.
- Ackerman S, Gonzales R. The context of antibiotic overuse. Ann Intern Med 2012; 157: 211–212.
- Bekkers MJ, Simpson SA, Dunstan F, Hood K, Hare M, Evans CC, et al. Enhancing the quality of antibiotic prescribing in primary care: qualitative evaluation of a blended learning intervention. BMC Fam Pract 2010; 11:34.
- Ostini R, Hegney D, Jackson C, Williamson M, Mackson JM, Gurman K, et al. Systematic review of interventions to improve prescribing. Ann Pharmacother 2009; 43:502-13.
- Strandberg EL, Brorsson A, Hagstam C, Troein M, Hedin K. "I'm Dr Jekyll and Mr Hyde": are GPs' antibiotic prescribing patterns contextually dependent? A qualitative focus group study. Scand J Prim Health Care 2013; 31: 158-65.
- Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ 2010; 340:c2096.
- Hebert C, Beaumont J, Schwartz G, Robicsek A. The influence of context on antimicrobial prescribing for febrile respiratory illness: a cohort study. Ann Intern Med 2012; 15: 160-9.
- Ternhag A, Grünewald M, Nauclér P, Wisell KT. Antibiotic consumption in relation to socio-demographic factors, co-morbidity, and accessibility of primary health care. Scand J Infect Dis 2014; 46: 888-96.
- Marković-Peković V, Grubiša N. Self-medication with antibiotics in the Republic of Srpska community pharmacies: pharmacy staff behavior. Pharmacoepidemiol Drug Saf 2012; 21: 1130-3.
- Konde S, Jairam LS, Peethambar P, Noojady SR, Kumar NC. Antibiotic overuse and resistance: A cross-sectional survey among pediatric dentists. J Indian Soc Pedod Prev Dent. 2016; 34: 145-51.
- Magrini N, Formoso G, MarataAM, et al. Randomised controlled trials for evaluating the prescribing impact of information meetings led by pharmacists and of new information formats, in General Practice in Italy. BMC Health Serv Res 2007; 28: 158.
- Vancelik S, Beyhun NE, Acemoglu H, Calikoglu O. Impact of pharmaceutical promotion on prescribing decisions of general practitioners in Eastern Turkey. BMC Public Health 2007; 25: 7: 122.