To describe the status in knowledge and attitudes regarding antibiotic use among primary care physicians in Hubei Province in 2018 and 2020, analyze the changes and relevant reasons over these two years, and to present relevant interventions, promoting rational antibiotic use in primary care physicians.

Two surveys were separately conducted (one was conducted from April to June 2018 with a stratified two-stage cluster sample, and the other was conducted from November 2019 to January 2020 with a two-stage cluster random sample) among Hubei's primary care physicians with the qualification of prescribing antibiotics who had written over 100 antibiotic prescriptions within 3 months prior to the survey. A self-developed questionnaire was used in the surveys to acquire information about demographics, knowledge of antibiotic use (whether antibiotics should be used in 10 common situations) , and attitudes (5 types of attitudes that may affect antibiotic use behavior) . A descriptive analysis was conducted on the accuracy rate and total scores of antibiotic use knowledge as well as total and item scores of attitudes to examine primary care physicians' knowledge and attitudes towards antibiotic use during 2018 and 2020. To determine changes in knowledge and attitudes within two years, propensity score matching (PSM) was used, with participants in 2018 designated as the control group and those in 2020 as the treatment group.

637 respondents of the 2018 survey and 616 respondents of the 2020 survey were included for final analysis. Before PSM matching, the mean score of antibiotic use knowledge of the2020 survey respondents was statistically higher than that of 2018 survey respondents〔 (5.54±1.46) vs (5.25±1.35) 〕 (P<0.05) . Moreover, the 2020 survey respondents also had statistically higher accuracy ratesin answering questions on the effect of ceftriaxone crossing the blood-brain barrier (48.5% vs 39.6%) and routes of aminoglycoside administration (55.7% vs 44.0%) (P<0.05) . Furthermore, 2020 survey respondents had higher mean overall score of attitudes towards antibiotic use〔 (55.41±5.02) vs (53.29±5.21) 〕 (P<0.05) . In particular, 2020 survey respondents had statistically higher mean overall scores of items regarding attitudes towards prescribing antibiotics due to meeting patient demands, ignoring the problem of antibiotic resistance, and lacking motivation to change their own irrational behaviors (P<0.05) . By PSM matching, 513 2020 respondents were successfully matched to 513 2018 respondents. After achieving a balance of covariates between groups, the2020 respondents still had statistically higher total mean scores of antibiotic use knowledge and attitudes towards antibiotic use (P<0.05) . Further analysis revealed that in those from community health centers, the 2020 survey respondents had statistically higher total scores of antibiotic use attitudes (P<0.05) , while no statistical differences were found in the total score of antibiotic use knowledge (P>0.05) . But in those from township health centers, the 2020 survey respondents had statistically higher total mean scores of antibiotic use knowledge and attitudes towards antibiotic use than did the 2018 survey respondents (P<0.05) .

Compared with 2018, the level of knowledge of antibiotic use in Hubei's primary care physicians was improved, but still was relatively low. Moreover, it seemed that they were more negative toward rational antibiotic use, tendingto prescribe antibiotics inappropriately. A systematic approach should be adopted to improve the knowledge of rational antibiotic use, strengthen the motivation for rational antibiotic use, and reduce irrationally antibiotic prescribing among primary care physicians.