Page 90 - 中国全科医学2022-10

http://www.chinagp.net E-mail:zgqkyx@chinagp.net.cn ·1239·

【Abstract】 Background Physicians' irrational antibiotic prescriptions are fueling antibiotic resistance and seriously
threatening public health. Physicians' knowledge and attitudes towards antibiotic use will directly affect their behaviors. Objective
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. Methods 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. Results 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）. Conclusion 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.
【Key words】 Primary healthcare institutions；Antibiotic；Knowledge；Attitude；Propensity score matching；Hubei

抗菌药物耐药性正严重威胁着全球居民健康和经济 医生抗菌药物使用知识水平及其对抗菌药物使用的态度
发展 ［1-2］ 。尽管抗菌药物耐药性产生的原因复杂，但 是影响其抗菌药物处方开具行为的重要因素 ［7-11］ 。现
医生开具不合理抗菌药物处方被认为是导致其发生、发 有研究主要基于知识 - 态度 - 行为、计划行为理论等理
展的重要因素 ［3］ 。2015 年世界卫生组织发布的《抗菌 论模型，探讨基层医生抗菌药物使用知识、态度和行为
药物耐药全球行动计划》，把通过教育培训等手段提高 现状及三者之间的关系 ［7，9-10，12］ ，较少关注基层医生
所有人，尤其是卫生机构医务人员，对于抗菌药物耐药 抗菌药物使用知识水平及其对抗菌药物使用态度的长期
性的认识和理解作为行动的首要目标 ［4］ 。我国在 2016 变化。知识和态度的变化，可反映行为在未来一段时间
年出台了《遏制细菌耐药国家行动计划（2016—2020 内的转变方向。因此，有必要了解基层医生抗菌药物使
年）》，以促进抗菌药物的合理使用 ［5］ 。作为卫生服 用知识、态度状况的变化情况，以为未来政策的制定提
务的主要提供者之一，基层医疗卫生机构医生开具不合 供依据。湖北省拟长期对基层医疗卫生机构医务人员抗
理抗菌药物处方的行为仍较为普遍。来自我国 6 个省份 菌药物使用知识和态度状况进行监测，本课题组分别于
基层医疗卫生机构的调查数据显示，门诊抗菌药物处方 2018 年和 2020 年对全省基层医疗卫生机构医生进行了
中，有 60.6% 的处方为不合理处方 ［6］ 。影响基层医生 抽样调查，但由于抽样、调查误差的存在，若直接比较
开具不合理抗菌药物处方的因素亦较为复杂，其中基层 两次调查结果，会存在选择性偏差和内生性问题，进而