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Grigoryan L, Paasche-Orlow MK, Alquicira O, Laytner L, Schlueter M, Street RL, Salinas J, Barning K, Mahmood H, Porter TW, Khan F, Raphael JL, Faustinella F, Trautner BW. Antibiotic Use Without a Prescription: A Multisite Survey of Patient, Health System, and Encounter Characteristics. Clin Infect Dis 2023; 77:510-517. [PMID: 37094252 DOI: 10.1093/cid/ciad241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/07/2023] [Accepted: 04/19/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Using antibiotics without a prescription is potentially unsafe and may increase the risk of antimicrobial resistance. We evaluated the effect of patient, health system, and clinical encounter factors on intention to use antibiotics without a prescription that were (1) purchased in the United States, (2) obtained from friends or relatives, (3) purchased abroad, or (4) from any of these sources. METHODS The survey was performed January 2020-June 2021 in 6 publicly funded primary care clinics and 2 private emergency departments in Texas, United States. Participants included adult patients visiting 1 of the clinical settings. Nonprescription use was defined as use of antibiotics without a prescription; intended use was professed intention for future nonprescription antibiotic use. RESULTS Of 564 survey respondents (33% Black and 47% Hispanic or Latino), 246 (43.6%) reported prior use of antibiotics without a prescription, and 177 (31.4%) reported intent to use antibiotics without a prescription. If feeling sick, respondents endorsed that they would take antibiotics obtained from friends/relatives (22.3% of 564), purchased in the United States without a prescription (19.1%), or purchased abroad without a prescription (17.9%). Younger age, lack of health insurance, and a perceived high cost of doctor visits were predictors of intended use of nonprescription antibiotics from any of the sources. Other predictors of intended use were lack of transportation for medical appointments, language barrier to medical care, Hispanic or Latino ethnicity, and being interviewed in Spanish. CONCLUSIONS Patients without health insurance who report a financial barrier to care are likely to pursue more dangerous nonprescription antimicrobials. This is a harm of the US fragmented, expensive healthcare system that may drive increasing antimicrobial resistance and patient harm.
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Affiliation(s)
- Larissa Grigoryan
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | | | - Osvaldo Alquicira
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Lindsey Laytner
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | - Richard L Street
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Juanita Salinas
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Kenneth Barning
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Hammad Mahmood
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Thomas W Porter
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Fareed Khan
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jean L Raphael
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Fabrizia Faustinella
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Barbara W Trautner
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA
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Ahmed I, King R, Akter S, Akter R, Aggarwal VR. Determinants of antibiotic self-medication: A systematic review and meta-analysis. Res Social Adm Pharm 2023; 19:1007-1017. [PMID: 37019706 DOI: 10.1016/j.sapharm.2023.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Decreasing the prevalence of antibiotic self-medication among the public requires proper understanding of the risk factors involved. However, the determinants of antibiotic self-medication are not well defined. OBJECTIVES To identify patient and health system-related determinants of antibiotic self-medication among the public. METHODS A systematic review of quantitative observational studies and qualitative studies was undertaken. PubMed, Embase, and Web of Science were searched to identify studies on determinants of antibiotic self-medication. The data were analyzed using meta-analysis, descriptive analysis, and thematic analysis. RESULTS Sixty-eight studies were included in the review. From meta-analyses, male sex (pooled odds ratio [POR]: 1.52, 95% confidence interval [CI]: 1.19-1.75), lack of satisfaction with healthcare services/physicians (POR: 3.53, 95% CI: 2.26-4.75) were associated with antibiotic self-medication. In subgroup analysis, lower age was directly associated with self-medication in high-income countries (POR: 1.61, 95% CI: 1.10-2.36). In low- and middle-income countries, people with greater knowledge of antibiotics were less likely to self-medicate (POR: 0.2, 95% CI: 0.08-0.47). Patient-related determinants identified from descriptive and qualitative studies included previous experience with antibiotics and similar symptoms, perceived low severity of disease, intention to save time and get better quickly, cultural beliefs about curative power of antibiotics, advice from family/friends, and having home stock of antibiotics. Health system-related determinants included high cost of consulting physicians and low cost of self-medication, lack of access to physician/medical care, lack of trust/confidence in physicians, greater trust in pharmacists, long distance of physicians/healthcare facilities, long waiting time at healthcare facilities, easy access to antibiotics from pharmacies, and convenience associated with self-medication. CONCLUSIONS Patient and health system-related determinants are associated with antibiotic self-medication. Interventions to decrease antibiotic self-medication should incorporate community programs along with appropriate policies and healthcare reforms targeting these determinants with specific attention to population at high risk of self-medication.
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Guo H, Hildon ZJL, Chow A. "Antibiotics are for everyone, our past and our future generations, right? If antibiotics are dead, we will be in big trouble": Building on community values for public engagement on appropriate use of antibiotics in Singapore. Front Public Health 2022; 10:1001282. [PMID: 36249259 PMCID: PMC9561345 DOI: 10.3389/fpubh.2022.1001282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/14/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction Shared decision-making (SDM) and trust building through continuity of care are known to play a pivotal role in improving appropriate antibiotic prescribing and use. Problem However, less is known about how to effectively leverage these factors when present-or overcome them when not-to address community needs and improve patient liaison. Methods We addressed this question using a convergent parallel mixed-methods design. Focus group discussions (N = 13; August 2018-September 2020), were analyzed alongside a nationally-representative cross-sectional survey (N = 2004; November 2020-January 2021), in Singapore. Descriptive quantitative analyses and multivariable logistic regression were undertaken to examine antibiotic knowledge and factors associated with preference for SDM. Qualitative applied thematic analysis was integrated with these data to further explain the findings. Findings Poor knowledge and misbeliefs on appropriate antibiotic use and antimicrobial resistance (AMR) were identified. For example, only 9% of the surveyed population understood that AMR occurs when the bacteria, not the human body, become resistant to antibiotics. Qualitative data corroborated the survey findings and suggested a shared value was placed on public education to avoid the fallout from resistant bacterial strains on current and future generations. This study also identified the opportunity to harness community trust in primary care doctors, who were described as highly valued educators for antibiotic use and AMR. Those who had trust in doctors were 75% more likely to prefer SDM (aOR 1.75, 95% CI 1.10-2.77, P = 0.017), especially adults aged ≥50 years who were receiving continued care with a regular doctor (aOR 1.83, 95% CI 1.18-2.86, P = 0.007). Continuity of care was observed to value-add SDM by building trusting relationships, though it was often absent in younger populations. Conclusion This study highlights the long-term value-add of building on cultural capital pertaining to appropriate antibiotic use and AMR, by leveraging on the role of trust in doctors, desire for SDM and anchoring these in continuity of care when possible. Recommendations Using focused messaging and exploring alternative channels of communications such as annual check-ins or tele-consultations with a regular doctor, and emphasizing continuity of care across all age groups would help bridge the identified gaps.
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Affiliation(s)
- Huiling Guo
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore, Singapore
- Saw Swee Hock School of Public Health and National University Health System, National University of Singapore, Singapore, Singapore
| | - Zoe Jane-Lara Hildon
- Saw Swee Hock School of Public Health and National University Health System, National University of Singapore, Singapore, Singapore
- National Centre for Infectious Diseases, Ministry of Health, Singapore, Singapore
| | - Angela Chow
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore, Singapore
- Saw Swee Hock School of Public Health and National University Health System, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Essigmann HT, Aguilar DA, Perkison WB, Bay KG, Deaton MR, Brown SA, Hanis CL, Brown EL. Epidemiology of Antibiotic Use and Drivers of Cross-Border Procurement in a Mexican American Border Community. Front Public Health 2022; 10:832266. [PMID: 35356027 PMCID: PMC8960039 DOI: 10.3389/fpubh.2022.832266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background The U.S.-Mexico Border is an area of opportunity for improved health care access; however, gaps remain as to how and where U.S. border residents, particularly those who are underinsured, obtain care. Antibiotics are one of the most common reported drivers of cross-border healthcare access and a medication of particular concern since indiscriminate or inappropriate use is associated with antimicrobial resistance. In addition, many studies assessing preferences for Mexican pharmaceuticals and healthcare in U.S. border residents were done prior to 2010 when many prescription medications, including antibiotics, were available over the counter in Mexico. Methods Data used in this study were collected during the baseline examination of an ongoing longitudinal cohort study in Starr Country, Texas, one of 14 counties on the Texas-Mexico border. Participants self-reported the name, date of use, and the source country of each antibiotic used in the past 12 months. Logistic regression was used to determine social, cultural, and clinical features associated with cross-border procurement of antibiotics. Results Over 10% of the study cohort reported using antibiotics in the past 30 days with over 60% of all rounds used in the past 12 months sourced from Mexico. A lack of health insurance and generation score, a measure of acculturation, were the strongest predictors of cross-border procurement of antibiotics. Conclusions Factors previously associated with cross-border acquisition of antibiotics are still present despite changes in 2010 to prescription drug regulations in Mexico. These results may be used to inform future public health initiatives to provide culturally sensitive education about responsible antibiotic stewardship and to address barriers to U.S. healthcare and pharmaceutical access in medically underserved, impoverished U.S.-Mexico border communities.
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Affiliation(s)
- Heather T. Essigmann
- Division of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Disease, University of Texas Health Science Center, Houston, TX, United States
| | - David A. Aguilar
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States
| | - William B. Perkison
- Division of Epidemiology, Human Genetics, and Environmental Sciences, Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Katherine G. Bay
- Division of Epidemiology, Human Genetics, and Environmental Sciences, Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Magdalena R. Deaton
- Division of Epidemiology, Human Genetics, and Environmental Sciences, Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Sharon A. Brown
- School of Nursing, University of Texas at Austin, Austin, TX, United States
| | - Craig L. Hanis
- Division of Epidemiology, Human Genetics, and Environmental Sciences, Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Eric L. Brown
- Division of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Disease, University of Texas Health Science Center, Houston, TX, United States
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Re: 'non-biomedical factors affecting antibiotic use in the community' by Sun et al. Clin Microbiol Infect 2022; 28:893-894. [DOI: 10.1016/j.cmi.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/01/2022] [Indexed: 11/17/2022]
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Aponte-González J, Brown P, Eslava-Schmalbach J. Preferences based interventions to address the use of antibiotics without prescription: A discrete choice experiment. Pharm Pract (Granada) 2021; 19:2401. [PMID: 34621451 PMCID: PMC8455123 DOI: 10.18549/pharmpract.2021.3.2401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/05/2021] [Indexed: 11/14/2022] Open
Abstract
Background In many countries, concerns have arisen over the population using antibiotics without consulting a physician. This practice can place patients at risk and increase antibiotic resistance in the community. Objective To evaluate individuals' preferences regarding the use of antibiotics. The study also assessed the likely effectiveness of interventions aimed at reducing inappropriate use of antibiotics. Methods A discrete choice experiment (DCE) was conducted in Bogotá, Colombia. The attributes were determined by a systematic literature review and four focus group sessions. The DCE included nine factors - cost, time to get attention, level of symptoms, efficacy, safety, among others- and one label -using or not antibiotics. Data analysis was carried out using a generalized multinomial logit (GMNL) model. Marginal probabilities of different sets of attributes' levels were compared to estimate the likely effectiveness of interventions. Results The survey was administered to 222 participants from diverse socioeconomic backgrounds. The results suggest that participants preferred not taking antibiotics and having a physician as an advisor, but the probability of inappropriate antibiotic use increased as the waiting time or the cost of receiving advice rose. The pharmacy was the preferred source of antibiotics, and participants chose the pharmacy worker (nonprofessional) as an advisor over the nurse on the phone. In the absence of any interventions aimed at reducing the use of antibiotics, approximately 47.3% of people would misuse antibiotics. This reduces to 26.5% when people perceive the efficacy of the antibiotics as low and the potential risks of self-medicating as high. An alternative model using a nursing service would likely lower inappropriate use of antibiotics. Conclusions Even though people prefer not using antibiotics or visiting a physician in case of disease rather than self-medicating, current access conditions might discourage them from appropriately use antibiotics. The results suggest that interventions that informing people about the risks of self-medication and the low efficacy might significantly reduce inappropriate use of antibiotics. Our results also suggest that programs that empower other health professionals to provide access to antibiotics would likely further lower inappropriate use.
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Affiliation(s)
- Johanna Aponte-González
- Pharm, PhD. Professor. Pharmacy Department, School of Sciences, National University of Colombia. Bogotá (Colombia).
| | - Paul Brown
- PhD. Professor Public Health and Health Economics. University of California, Merced. Merced, CA (United States).
| | - Javier Eslava-Schmalbach
- MD, PhD. Professor. University Hospital, Faculty of Medicine, National University of Colombia. Bogotá (Colombia).
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Wilding S, Kettu V, Thompson W, Howard P, Jeuken LJC, Pownall M, Conner M, Sandoe JAT. Development and randomized controlled trial of an animated film aimed at reducing behaviours for acquiring antibiotics. JAC Antimicrob Resist 2021; 3:dlab083. [PMID: 34223142 PMCID: PMC8251327 DOI: 10.1093/jacamr/dlab083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/17/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a global health crisis but reducing antibiotic use can help. Some antibiotic use is driven by patient demand. OBJECTIVES To develop an intervention to discourage antibiotic-seeking behaviour in adults. METHODS Literature reviewed to identify behaviours for acquiring antibiotics among adults in the community. Behaviour change wheel approach was used to select the target behaviour and behaviour change techniques. An intervention in the form of a short animated film was developed and its potential impact evaluated in a randomized, controlled, online questionnaire study. RESULTS Asking a general medical/dental practitioner for antibiotics was identified as the target behaviour. A short stop-motion animated film was chosen to deliver several behaviour-change techniques. Education and persuasion were delivered around information about the normal microbial flora, its importance for health, the negative effect of antibiotics, and about AMR. 417 UK-based individuals completed the questionnaire; median age 34.5 years, 71% female, 91% white ethnicity. 3.8% of participants viewing the test film intended to ask for antibiotics compared with 7.9% viewing the control film. Test film viewers had significantly higher knowledge scores. At 6 week follow up, knowledge scores remained significantly different, while most attitude and intention scores were not different. CONCLUSIONS Some patients continue to ask for antibiotics. The film increased knowledge and reduced intentions to ask for antibiotics. At 6 weeks, knowledge gains remained but intentions not to ask for antibiotics had waned. Evaluation in the clinical environment, probably at the point of care, is needed to see if antibiotic prescribing can be impacted.
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Affiliation(s)
- Sarah Wilding
- School of Psychology, University of
Leeds, Leeds, UK
| | | | - Wendy Thompson
- Division of Dentistry, University of
Manchester, Manchester, UK
| | - Philip Howard
- School of Healthcare, University of
Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust,
Leeds, UK
| | - Lars J C Jeuken
- School of Biomedical Sciences, University of
Leeds, Leeds, UK
| | | | - Mark Conner
- School of Psychology, University of
Leeds, Leeds, UK
| | - Jonathan A T Sandoe
- Leeds Teaching Hospitals NHS Trust,
Leeds, UK
- Leeds Institute of Medical Research, School of
Medicine, University of Leeds, Leeds, UK
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Do NTT, Vu HTL, Nguyen CTK, Punpuing S, Khan WA, Gyapong M, Asante KP, Munguambe K, Gómez-Olivé FX, John-Langba J, Tran TK, Sunpuwan M, Sevene E, Nguyen HH, Ho PD, Matin MA, Ahmed S, Karim MM, Cambaco O, Afari-Asiedu S, Boamah-Kaali E, Abdulai MA, Williams J, Asiamah S, Amankwah G, Agyekum MP, Wagner F, Ariana P, Sigauque B, Tollman S, van Doorn HR, Sankoh O, Kinsman J, Wertheim HFL. Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach. Lancet Glob Health 2021; 9:e610-e619. [PMID: 33713630 PMCID: PMC8050200 DOI: 10.1016/s2214-109x(21)00024-3] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Antimicrobial misuse is common in low-income and middle-income countries (LMICs), and this practice is a driver of antibiotic resistance. We compared community-based antibiotic access and use practices across communities in LMICs to identify contextually specific targets for interventions to improve antibiotic use practices. METHODS We did quantitative and qualitative assessments of antibiotic access and use in six LMICs across Africa (Mozambique, Ghana, and South Africa) and Asia (Bangladesh, Vietnam, and Thailand) over a 2·5-year study period (July 1, 2016-Dec 31, 2018). We did quantitative assessments of community antibiotic access and use through supplier mapping, customer exit interviews, and household surveys. These quantitative assessments were triangulated with qualitative drug supplier and consumer interviews and discussions. FINDINGS Vietnam and Bangladesh had the largest proportions of non-licensed antibiotic dispensing points. For mild illness, drug stores were the most common point of contact when seeking antibiotics in most countries, except South Africa and Mozambique, where public facilities were most common. Self-medication with antibiotics was found to be widespread in Vietnam (55·2% of antibiotics dispensed without prescription), Bangladesh (45·7%), and Ghana (36·1%), but less so in Mozambique (8·0%), South Africa (1·2%), and Thailand (3·9%). Self-medication was considered to be less time consuming, cheaper, and overall, more convenient than accessing them through health-care facilities. Factors determining where treatment was sought often involved relevant policies, trust in the supplier and the drug, disease severity, and whether the antibiotic was intended for a child. Confusion regarding how to identify oral antibiotics was revealed in both Africa and Asia. INTERPRETATION Contextual complexities and differences between countries with different incomes, policy frameworks, and cultural norms were revealed. These contextual differences render a single strategy inadequate and instead necessitate context-tailored, integrated intervention packages to improve antibiotic use in LMICs as part of global efforts to combat antibiotic resistance. FUNDING Wellcome Trust and Volkswagen Foundation.
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Affiliation(s)
- Nga T T Do
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Huong T L Vu
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Chuc T K Nguyen
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Sureeporn Punpuing
- Institute for Population and Social Research, Mahidol University, Nakhonpathom, Thailand
| | - Wasif Ali Khan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | | | - Khatia Munguambe
- Manhiça Health Research Centre, Manhiça, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - F Xavier Gómez-Olivé
- MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Johannes John-Langba
- School of Applied Human Sciences, University of Kwazulu-Natal, Durban, South Africa
| | - Toan K Tran
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Malee Sunpuwan
- Institute for Population and Social Research, Mahidol University, Nakhonpathom, Thailand
| | - Esperanca Sevene
- Manhiça Health Research Centre, Manhiça, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Hanh H Nguyen
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Phuc D Ho
- Institute of Mathematics, Vietnam Academy of Science and Technology, Hanoi, Vietnam
| | | | - Sabeena Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Olga Cambaco
- Manhiça Health Research Centre, Manhiça, Mozambique
| | | | | | | | | | | | | | | | - Fezile Wagner
- MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Proochista Ariana
- Nuffied Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - Stephen Tollman
- MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Vietnam; Nuffied Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Osman Sankoh
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Statistics Sierra Leone, Freetown, Sierra Leone; University Secretariat, Njala University, Njala, Sierra Leone; Heidelberg Institute for Global Health, University of Heidelberg Medical School, Heidelberg, Germany
| | - John Kinsman
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Heiman F L Wertheim
- Oxford University Clinical Research Unit, Hanoi, Vietnam; Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands.
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Torres NF, Solomon VP, Middleton LE. “Antibiotics heal all diseases”; the factors influencing the pratices of self-medication with antibiotics in Maputo City, Mozambique. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01416-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Lin L, Alam P, Fearon E, Hargreaves JR. Public target interventions to reduce the inappropriate use of medicines or medical procedures: a systematic review. Implement Sci 2020; 15:90. [PMID: 33081791 PMCID: PMC7574316 DOI: 10.1186/s13012-020-01018-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/06/2020] [Indexed: 01/08/2023] Open
Abstract
Background An epidemic of health disorders can be triggered by a collective manifestation of inappropriate behaviors, usually systematically fueled by non-medical factors at the individual and/or societal levels. This study aimed to (1) landscape and assess the evidence on interventions that reduce inappropriate demand of medical resources (medicines or procedures) by triggering behavioral change among healthcare consumers, (2) map out intervention components that have been tried and tested, and (3) identify the “active ingredients” of behavior change interventions that were proven to be effective in containing epidemics of inappropriate use of medical resources. Methods For this systematic review, we searched MEDLINE, EMBASE, the Cochrane Library, and PsychINFO from the databases’ inceptions to May 2019, without language restrictions, for behavioral intervention studies. Interventions had to be empirically evaluated with a control group that demonstrated whether the effects of the campaign extended beyond trends occurring in the absence of the intervention. Outcomes of interest were reductions in inappropriate or non-essential use of medicines and/or medical procedures for clinical conditions that do not require them. Two reviewers independently screened titles, abstracts, and full text for inclusion and extracted data on study characteristics (e.g., study design), intervention development, implementation strategies, and effect size. Data extraction sheets were based on the checklist from the Cochrane Handbook for Systematic Reviews. Results Forty-three studies were included. The behavior change technique taxonomy v1 (BCTTv1), which contains 93 behavioral change techniques (BCTs), was used to characterize components of the interventions reported in the included studies. Of the 93 BCTs, 15 (16%) were identified within the descriptions of the selected studies targeting healthcare consumers. Interventions consisting of education messages, recommended behavior alternatives, and a supporting environment that incentivizes or encourages the adoption of a new behavior were more likely to be successful. Conclusions There is a continued tendency in research reporting that mainly stresses the effectiveness of interventions rather than the process of identifying and developing key components and the parameters within which they operate. Reporting “negative results” is likely as critical as reporting “active ingredients” and positive findings for implementation science. This review calls for a standardized approach to report intervention studies. Trial registration PROSPERO registration number CRD42019139537
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Affiliation(s)
- Leesa Lin
- London School of Hygiene & Tropical Medicine, London, UK.
| | - Prima Alam
- London School of Hygiene & Tropical Medicine, London, UK
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11
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Roberts EP, Roberts BS, Burns A, Goodlet KJ, Chapman A, Cyphers R, Atkinson J. Prevalence and dental professional awareness of antibiotic self-medication among older adults: Implications for dental education. J Dent Educ 2020; 84:1126-1135. [PMID: 32535958 DOI: 10.1002/jdd.12239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/05/2020] [Accepted: 05/16/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Antibiotic stewardship has been recognized as an essential component of dental education. A notable threat to stewardship is the growing trend toward self-medication with nonprescribed antibiotics (SMNPA), particularly among older adults who may be at increased risk for adverse outcomes. This study aimed to assess the need to incorporate SMNPA into dental education by researching (1) professional awareness and (2) self-medication behaviors among older adults. METHODS A SMNPA awareness survey was administered to dentists in Arizona with 148 respondents including general dentists, dental school faculty, and public health clinicians. A second survey was distributed to 410 households in an independent and assisted living facility. RESULTS The dentists were aware of sources of SMNPA such as friends/family, leftover prescriptions, as well as sources outside of the United States; however, most (>80%) were not aware that ornamental fish antibiotics could be obtained online or in pet stores. The survey response rate for the older adults was 46.3%, of which 68.3% reported antibiotic use within the past 2 years (several for dental premedication) and 6.4% (n = 12) admitted to SMNPA for treating cold symptoms or pain. The main reason given for self-treatment was the belief that antibiotics had resolved similar symptoms in the past. One-third of the older adult respondents were unaware that antibiotics only treat bacterial infections. CONCLUSION Approximately 1 in 16 older adults surveyed reported SMNPA. Dental professionals reported some knowledge of SMNPA but were unaware of all sources. This study highlights the need for SMNPA education, awareness, and implementation within dental curricula.
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Affiliation(s)
- Eugenia P Roberts
- College of Dental Medicine - Arizona, Midwestern University, Glendale, USA
| | - Bradley S Roberts
- College of Dental Medicine - Arizona, Midwestern University, Glendale, USA
| | - Andrea Burns
- College of Pharmacy - Glendale, Midwestern University, Glendale, Arizona, USA
| | - Kellie J Goodlet
- College of Pharmacy - Glendale, Midwestern University, Glendale, Arizona, USA
| | - Alice Chapman
- College of Graduate Studies, Midwestern University, Glendale, Arizona, USA
| | - Russel Cyphers
- College of Dental Medicine - Arizona, Midwestern University, Glendale, USA
| | - Jennifer Atkinson
- College of Dental Medicine - Arizona, Midwestern University, Glendale, USA
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12
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Satterfield J, Miesner AR, Percival KM. The role of education in antimicrobial stewardship. J Hosp Infect 2020; 105:130-141. [PMID: 32243953 DOI: 10.1016/j.jhin.2020.03.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/23/2020] [Indexed: 02/03/2023]
Abstract
The role of antimicrobial stewardship programmes (ASPs) has expanded in health systems. ASP interventions often contain an educational component; however, current guidelines suggest that educational interventions should not be used alone but to support other stewardship interventions. Such interventions are most commonly directed towards prescribers (often general practice physicians) with few studies offering education towards other healthcare providers such as pharmacists, nurses, or even members of the stewardship team. Educational interventions are offered most frequently, but not exclusively, with concomitant stewardship interventions such as prospective audit and feedback. Such strategies appear to positively impact prescribing behaviours, but it is not possible to isolate the effect of education from other interventions. Common educational methods include one-time seminars and online e-learning modules, but unique strategies such as social media platforms, educational video games and problem-based learning modules have also been employed. Education directed towards patients often occurs in conjunction with education of local prescribers and wider community-based efforts to impact prescribing. Such studies evaluating patient education often include passive educational leaflets and focus most often on appropriate treatment of upper respiratory tract infections. Educational interventions appear to be an integral component of other interventions of ASPs; however, there is a paucity of evidence to support use as a stand-alone intervention outside of regional public health interventions. Future studies should focus on efficacy of educational interventions including providing education to non-prescribers and disease states beyond upper respiratory tract infections to demonstrate a broader role for education in ASP activities.
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Affiliation(s)
- J Satterfield
- University of Iowa College of Pharmacy, Iowa City, IA, USA
| | - A R Miesner
- Drake University College of Pharmacy & Health Sciences, Department of Clinical Sciences, Des Moines, IA, USA.
| | - K M Percival
- University of Iowa Hospitals and Clinics, Department of Pharmaceutical Care, Iowa City, IA, USA
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Price L, Gozdzielewska L, Young M, Smith F, MacDonald J, McParland J, Williams L, Langdridge D, Davis M, Flowers P. Effectiveness of interventions to improve the public's antimicrobial resistance awareness and behaviours associated with prudent use of antimicrobials: a systematic review. J Antimicrob Chemother 2019; 73:1464-1478. [PMID: 29554263 DOI: 10.1093/jac/dky076] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/07/2018] [Indexed: 11/14/2022] Open
Abstract
Background A global antimicrobial resistance (AMR) awareness intervention targeting the general public has been prioritized. Objectives To evaluate the effectiveness of interventions that aim to change AMR awareness and subsequent stewardship behaviours amongst the public. Methods Five databases were searched between 2000 and 2016 for interventions to change the public's AMR awareness and/or antimicrobial stewardship behaviours. Study designs meeting the Cochrane Effective Practice and Organization of Care (EPOC) criteria, non-controlled before-and-after studies and prospective cohort studies were considered eligible. Participants recruited from healthcare settings and studies measuring stewardship behaviours of healthcare professionals were excluded. Quality of studies was assessed using EPOC risk of bias criteria. Data were extracted and synthesized narratively. Registration: PROSPERO international prospective register of systematic reviews (PROSPERO 2016: CRD42016050343). Results Twenty studies were included in the review with nine meeting the EPOC criteria. The overall risk of bias was high. Nineteen studies were conducted in high-income countries. Mass media interventions were most common (n = 7), followed by school-based (n = 6) and printed material interventions (n = 6). Seventeen studies demonstrated a significant effect on changing knowledge, attitudes or the public's antimicrobial stewardship behaviours. Analysis showed that interventions targeting schoolchildren and parents have notable potential, but for the general public the picture is less clear. Conclusions Our work provides an in-depth examination of the effectiveness of AMR interventions for the public. However, the studies were heterogeneous and the quality of evidence was poor. Well-designed, experimental studies on behavioural outcomes of such interventions are required.
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Affiliation(s)
- Lesley Price
- Safeguarding Health through Infection Prevention Research Group, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Lucyna Gozdzielewska
- Safeguarding Health through Infection Prevention Research Group, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Mairi Young
- Safeguarding Health through Infection Prevention Research Group, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Fraser Smith
- Safeguarding Health through Infection Prevention Research Group, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Jennifer MacDonald
- Safeguarding Health through Infection Prevention Research Group, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Joanna McParland
- Safeguarding Health through Infection Prevention Research Group, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Lynn Williams
- School of Psychological Sciences and Health, University of Strathclyde, 40 George Street, Glasgow G1 1QE, UK
| | - Darren Langdridge
- Faculty of Arts & Social Sciences, Open University, Walton Hall, Milton Keynes MK7 6AA, UK
| | - Mark Davis
- School of Social Sciences, Monash University, Chancellors Walk, Melbourne, Victoria, 3800, Australia
| | - Paul Flowers
- Safeguarding Health through Infection Prevention Research Group, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
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Grigoryan L, Germanos G, Zoorob R, Juneja S, Raphael JL, Paasche-Orlow MK, Trautner BW. Use of Antibiotics Without a Prescription in the U.S. Population: A Scoping Review. Ann Intern Med 2019; 171:257-263. [PMID: 31330541 DOI: 10.7326/m19-0505] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Use of antibiotics without a prescription may increase unnecessary and inappropriate drug use or doses as well as global risk for antimicrobial resistance. PURPOSE To perform a scoping review of research on the prevalence of nonprescription antibiotic use in the United States and to examine the factors that influence it. DATA SOURCES Searches of PubMed, EMBASE, CINAHL, Scopus, and relevant Web sites without language restrictions from January 2000 to March 2019. STUDY SELECTION Studies reporting nonprescription use of antibiotics, storage of antibiotics, intention to use antibiotics without a prescription, and factors influencing nonprescription use. DATA EXTRACTION Two reviewers independently screened citations and full texts and performed data abstraction. DATA SYNTHESIS Of 17 422 screened articles, 31 met inclusion criteria. Depending on population characteristics, prevalence of nonprescription antibiotic use varied from 1% to 66%, storage of antibiotics for future use varied from 14% to 48%, and prevalence of intention to use antibiotics without a prescription was 25%. Antibiotics were obtained without a prescription from various sources, including previously prescribed courses, local markets or stores, and family or friends. Reported factors contributing to nonprescription use included easy access through markets or stores that obtain antibiotics internationally for under-the-counter sales, difficulty accessing the health care system, costs of physician visits, long waiting periods in clinics, and transportation problems. LIMITATION Scarce evidence and heterogeneous methods and outcomes. CONCLUSION Nonprescription antibiotic use is a seemingly prevalent and understudied public health problem in the United States. An increased understanding of risk factors and pathways that are amenable to intervention is essential to decrease this unsafe practice. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
| | - George Germanos
- Baylor College of Medicine, Houston, Texas (L.G., G.G., R.Z.)
| | - Roger Zoorob
- Baylor College of Medicine, Houston, Texas (L.G., G.G., R.Z.)
| | - Shivanki Juneja
- University of Pennsylvania, Philadelphia, Pennsylvania (S.J.)
| | - Jean L Raphael
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas (J.L.R., B.W.T.)
| | | | - Barbara W Trautner
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas (J.L.R., B.W.T.)
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15
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Communication interventions to promote the public's awareness of antibiotics: a systematic review. BMC Public Health 2019; 19:899. [PMID: 31286948 PMCID: PMC6615171 DOI: 10.1186/s12889-019-7258-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 06/28/2019] [Indexed: 12/03/2022] Open
Abstract
Background Inappropriate antibiotic use is implicated in antibiotic resistance and resultant morbidity and mortality. Overuse is particularly prevalent for outpatient respiratory infections, and perceived patient expectations likely contribute. Thus, various educational programs have been implemented to educate the public. Methods We systematically identified public-directed interventions to promote antibiotic awareness in the United States. PubMed, Google Scholar, Embase, CINAHL, and Scopus were queried for articles published from January 1996 through January 2016. Two investigators independently assessed titles and abstracts of retrieved articles for subsequent full-text review. References of selected articles and three review articles were likewise screened for inclusion. Identified educational interventions were coded for target audience, content, distribution site, communication method, and major outcomes. Results Our search yielded 1,106 articles; 34 met inclusion criteria. Due to overlap in interventions studied, 29 distinct educational interventions were identified. Messages were primarily delivered in outpatient clinics (N = 24, 83%) and community sites (N = 12, 41%). The majority included clinician education. Antibiotic prescription rates were assessed for 22 interventions (76%). Patient knowledge, attitudes, and beliefs (KAB) were assessed for 10 interventions (34%). Similar rates of success between antibiotic prescription rates and patient KAB were reported (73 and 70%, respectively). Patient interventions that did not include clinician education were successful to increase KAB but were not shown to decrease antibiotic prescribing. Three interventions targeted reductions in Streptococcus pneumoniae resistance; none were successful. Conclusions Messaging programs varied in their designs, and many were multifaceted in their approach. These interventions can change patient perspectives regarding antibiotic use, though it is unclear if clinician education is also necessary to reduce antibiotic prescribing. Further investigations are needed to determine the relative influence of interventions focusing on patients and physicians and to determine whether these changes can influence rates of antibiotic resistance long-term. Electronic supplementary material The online version of this article (10.1186/s12889-019-7258-3) contains supplementary material, which is available to authorized users.
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Aponte-González J, González-Acuña A, Lopez J, Brown P, Eslava-Schmalbach J. Perceptions in the community about the use of antibiotics without a prescription: Exploring ideas behind this practice. Pharm Pract (Granada) 2019; 17:1394. [PMID: 31015877 PMCID: PMC6463418 DOI: 10.18549/pharmpract.2019.1.1394] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/20/2019] [Indexed: 11/29/2022] Open
Abstract
Objective: The use of antibiotics without prescription is common in Colombia as well as
in other developing countries. The objective of this study is to explore the
attitudes and motivations associated with the use of antibiotics without
prescription. Methods: Focus group sessions were held with residents of Bogotá. Different
socioeconomic groups were approached to identify possible differences of
opinion. A semi-structured interview guide was used to guide the discussion,
with thematic analysis used to identify central themes. Results: In total, 21 people, aged between 25 and 50 years participated in four focus
groups. The results suggest that the use of antibiotics without prescription
is common practice. The main reasons included barriers to access to
prescribed medications due to limited health insurance. Even those with
adequate access to health insurance report being willing to use a treatment
without a prescription if they have confidence in its effectiveness. The
relationship with the physician is important, but pharmacy storekeepers are
also highly trusted. While some participants understood that antibiotics can
cure infections but cause serious adverse events, several misconceptions
about antibiotics therapy were identified. These included a lack of
knowledge of resistance transmissibility among communities. Conclusions: The results have implications for interventions aimed at reducing
inappropriate use of antibiotics, highlighting i) how lack of access to
timely care creates an incentive to self-prescribe, ii) the key role that
pharmacy storekeepers play in the Colombian healthcare system and the need
to include them in interventions, and iii) the misconceptions about
inappropriate use of medications that need to be addressed by educational
programs. These findings provide insights to other countries where
antibiotics misuse is also a problem.
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Affiliation(s)
- Johanna Aponte-González
- Pharmacy Department, School of Sciences, Universidad Nacional de Colombia. Bogotá (Colombia).
| | - Angélica González-Acuña
- Pharmacy Department, School of Sciences, Universidad Nacional de Colombia. Bogotá (Colombia).
| | - José Lopez
- Pharmacy Department, School of Sciences, Universidad Nacional de Colombia. Bogotá (Colombia).
| | - Paul Brown
- Director Public Health and Health Sciences Research Institute, University of California. Merced, CA (United States).
| | - Javier Eslava-Schmalbach
- Hospital Universitario Nacional de Colombia; & Clinical Research Institute, Faculty of Medicine, Universidad Nacional de Colombia. Bogotá (Colombia).
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Lescure D, Paget J, Schellevis F, van Dijk L. Determinants of Self-Medication With Antibiotics in European and Anglo-Saxon Countries: A Systematic Review of the Literature. Front Public Health 2018; 6:370. [PMID: 30619809 PMCID: PMC6304439 DOI: 10.3389/fpubh.2018.00370] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 12/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Self-medication with antibiotics, which comes in different forms [e.g., leftover or over-the-counter (OTC) use], contributes to antimicrobial resistance as it often happens in a non-prudent manner. In order to tackle this persistent public health problem, its drivers need to be known. The aim of this study was therefore to identify determinants of self-medication with antibiotics via a systematic literature review. Methods: A comprehensive search on determinants of self-medication with antibiotics in the ambulatory care was conducted in PubMed, Scopus, and Embase for studies published between January 2000 and March 2017. There was no limit on the language nor on the type of study. The search was restricted to European and Anglo-Saxon countries. Pairs of reviewers independently screened the abstracts and full texts and performed a quality assessment. Results: From the initial 664 abstracts, 54 publications that included 44 countries were retrieved of which most identified patient related determinants. Important determinants include storing antibiotics at home, poor access to healthcare, and having the intention to self-medicate. Healthcare professionals contribute to the practice of self-medication when catering for demanding and socially vulnerable patients. Healthcare system related determinants include dispensing antibiotics in whole packages and the lack of enforcement of medicine regulations. For some determinants (e.g., patients' age) contradictory results were found. Conclusion: Self-medication with antibiotics is driven by a variety of determinants on the patient, healthcare professional, and system levels. Policy makers should recognise the complexity of self-medication in order to develop multifaceted interventions that target healthcare professionals and patients simultaneously.
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Affiliation(s)
- Dominique Lescure
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - John Paget
- Department of Primary Care, Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - Francois Schellevis
- Department of General Practice and Elderly Care Medicine, Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, Netherlands
| | - Liset van Dijk
- Department of Primary Care, Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
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18
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Langdridge D, Davis M, Gozdzielewska L, McParland J, Williams L, Young M, Smith F, MacDonald J, Price L, Flowers P. A visual affective analysis of mass media interventions to increase antimicrobial stewardship amongst the public. Br J Health Psychol 2018; 24:66-87. [PMID: 30221433 PMCID: PMC6585774 DOI: 10.1111/bjhp.12339] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/08/2018] [Indexed: 11/26/2022]
Abstract
Objectives In an innovative approach to improve the contribution of health psychology to public health we have analysed the presence and nature of affect within the visual materials deployed in antimicrobial stewardship interventions targeting the public identified through systematic review. Design A qualitative analysis focused on the affective content of visual materials garnered from a systematic review of antibiotic stewardship (k = 20). Methods A novel method was devised drawing on concepts from semiotics to analyse the affective elements within intervention materials. Results Whilst all studies examined tacitly rely on affect, only one sought to explicitly deploy affect. Three thematic categories of affect are identified within the materials in which specific ideological machinery is deployed: (1) monsters, bugs, and superheroes; (2) responsibility, threat, and the misuse/abuse of antibiotics; (3) the figure of the child. Conclusions The study demonstrates how affect is a present but tacit communication strategy of antimicrobial stewardship interventions but has not – to date – been adequately theorized or explicitly considered in the intervention design process. Certain affective features were explored in relation to the effectiveness of antimicrobial resistance interventions and warrant further investigation. We argue that further research is needed to systematically illuminate and capitalize upon the use of affect to effect behaviour change concerning antimicrobial stewardship. Statement of contribution What is already known on this subject? The (mis)use of antibiotics and consequent risk of antimicrobial resistance is a critical public health problem. If sufficient action is not taken, global society will face the ‘post‐antibiotic’ era, in which common infections will lead to death for many millions. Key desirable behavioural changes are decreased patient demands for antibiotics, use of them for targeted purposes alone, and compliance with prescribed dosing. There is a growth of interest in the role of affect in mass media interventions designed to engage publics and produce health‐related behavioural change.
What does this study add? This article presents a novel analytic approach to understanding and intervening within behaviour change in public health that may complement other types of analysis. We present findings specifically from an ‘affective’ analysis based on semiotics in which we critically interrogated the visual imagery being deployed in mass media public health interventions concerning antimicrobial stewardship. Three thematic categories of affect are identified within the materials in which specific ideological machinery is deployed and that demonstrate some association with intervention effectiveness worthy of further investigation and testing.
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Affiliation(s)
- Darren Langdridge
- Faculty of Arts & Social Sciences, Open University, Milton Keynes, UK
| | - Mark Davis
- School of Social Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lucyna Gozdzielewska
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Joanna McParland
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Lynn Williams
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Mairi Young
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Fraser Smith
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Jennifer MacDonald
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Lesley Price
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Paul Flowers
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
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McParland JL, Williams L, Gozdzielewska L, Young M, Smith F, MacDonald J, Langdridge D, Davis M, Price L, Flowers P. What are the 'active ingredients' of interventions targeting the public's engagement with antimicrobial resistance and how might they work? Br J Health Psychol 2018; 23:804-819. [PMID: 29804314 PMCID: PMC6175406 DOI: 10.1111/bjhp.12317] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/25/2018] [Indexed: 12/23/2022]
Abstract
Objectives Changing public awareness of antimicrobial resistance (AMR) represents a global public health priority. A systematic review of interventions that targeted public AMR awareness and associated behaviour was previously conducted. Here, we focus on identifying the active content of these interventions and explore potential mechanisms of action. Methods The project took a novel approach to intervention mapping utilizing the following steps: (1) an exploration of explicit and tacit theory and theoretical constructs within the interventions using the Theoretical Domains Framework (TDFv2), (2) retrospective coding of behaviour change techniques (BCTs) using the BCT Taxonomy v1, and (3) an investigation of coherent links between the TDF domains and BCTs across the interventions. Results Of 20 studies included, only four reported an explicit theoretical basis to their intervention. However, TDF analysis revealed that nine of the 14 TDF domains were utilized, most commonly ‘Knowledge’ and ‘Environmental context and resources’. The BCT analysis showed that all interventions contained at least one BCT, and 14 of 93 (15%) BCTs were coded, most commonly ‘Information about health consequences’, ‘Credible source’, and ‘Instruction on how to perform the behaviour’. Conclusions We identified nine relevant TDF domains and 14 BCTs used in these interventions. Only 15% of BCTs have been applied in AMR interventions thus providing a clear opportunity for the development of novel interventions in this context. This methodological approach provides a useful way of retrospectively mapping theoretical constructs and BCTs when reviewing studies that provide limited information on theory and intervention content. Statement of contribution What is already known on this subject? Evidence of the effectiveness of interventions that target the public to engage them with AMR is mixed; the public continue to show poor knowledge and misperceptions of AMR. Little is known about the common, active ingredients of AMR interventions targeting the public and information on explicit theoretical content is sparse. Information on the components of AMR public health interventions is urgently needed to enable the design of effective interventions to engage the public with AMR stewardship behaviour.
What does this study add? The analysis shows very few studies reported any explicit theoretical basis to the interventions they described. Many interventions share common components, including core mechanisms of action and behaviour change techniques. The analysis suggests components of future interventions to engage the public with AMR.
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Affiliation(s)
| | - Lynn Williams
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | | | - Mairi Young
- Institute for Applied Health, Glasgow Caledonian University, UK
| | - Fraser Smith
- Institute for Applied Health, Glasgow Caledonian University, UK
| | | | - Darren Langdridge
- Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK
| | - Mark Davis
- School of Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lesley Price
- Institute for Applied Health, Glasgow Caledonian University, UK
| | - Paul Flowers
- Institute for Applied Health, Glasgow Caledonian University, UK
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Orkin AM, Bharmal A, Cram J, Kouyoumdjian FG, Pinto AD, Upshur R. Clinical Population Medicine: Integrating Clinical Medicine and Population Health in Practice. Ann Fam Med 2017; 15:405-409. [PMID: 28893808 PMCID: PMC5593721 DOI: 10.1370/afm.2143] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/26/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- Aaron M Orkin
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, Ontario
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
- Department of Family Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Aamir Bharmal
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
- Fraser Health Authority, Surrey, British Columbia
| | - Jenni Cram
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Fiona G Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, Ontario
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario
| | - Andrew D Pinto
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
- Department of Family Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario
| | - Ross Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario
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21
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King S, Exley J, Taylor J, Kruithof K, Larkin J, Pardal M. Antimicrobial Stewardship: The Effectiveness of Educational Interventions to Change Risk-Related Behaviours in the General Population: A Systematic Review. RAND HEALTH QUARTERLY 2016; 5:2. [PMID: 28083399 PMCID: PMC5158204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
RAND Europe undertook a systematic review of the evidence of effectiveness and cost effectiveness on changing the public's risk related behaviour pertaining to antimicrobial use to inform the development of a NICE public health guideline aimed at delaying antimicrobial resistance (AMR). The review considered educational interventions targeting individuals, communities or the general public delivered via any mode. Specifically, it aimed to address: 1. Which educational interventions are effective and cost-effective in changing the public's behaviour to ensure they only ask for antimicrobials when appropriate and use them correctly? 2. Which educational interventions are effective and cost-effective in changing the public's behaviour to prevent infection and reduce the spread of antimicrobial resistance? Overall, 60 studies met the inclusion criteria; 29 related to research question 1, and 36 related to research question 2 (five studies were applicable to both). The key findings are summarised in "Evidence Statements" in accordance with NICE guidelines. Evidence Statements provide a high level overview of the key features of the evidence including: the number of studies, the quality of evidence, and the direction of the estimated effect followed by a brief summary of each of the supporting studies. Studies are grouped into Evidence Statements by setting and intervention.
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Puspitasari HP, Faturrohmah A, Hermansyah A. Do Indonesian community pharmacy workers respond to antibiotics requests appropriately? Trop Med Int Health 2011; 16:840-6. [PMID: 21545380 DOI: 10.1111/j.1365-3156.2011.02782.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To quantify antibiotics sales without a prescription and to explore provision of patient assessment and medicine information related to antibiotics requested with or without a prescription in Surabaya community pharmacies. METHODS Scenarios of specific product requests (ciprofloxacin tablets and tetracycline capsules) and a request of amoxicillin dry syrups based on a new prescription were presented by simulated patients to 105 purposively selected pharmacies. Data were recorded by simulated patients after their purchase of each product. They documented the questions asked in patient assessment, the content of information given, recommendations provided and pharmacy workers' characteristics. RESULTS Antibiotics requested without a prescription were sold in 80 (91%) pharmacies. Information related to ciprofloxacin tablets and tetracycline capsules was only provided when requested by the simulated patient in 69% and 68% of pharmacies for the two scenarios, respectively. Very few pharmacies assessed patients. Medicine information on indication, dosing, duration and direction for use was provided more frequently in all cases. Medicine information was more likely to be given when a new prescription of amoxicillin dry syrups being presented. Overall, the majority of sampled pharmacies responded antibiotics requests inappropriately. CONCLUSION Inappropriate responses to antibiotic requests with or without a prescription remain an issue in Indonesia with pharmacy workers often failing to adequately assess patients. The illegality of delivering antibiotics without a prescription is of a considerable concern. Therefore, strategies to control antibiotics dispensing in community pharmacies should be seriously considered.
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Affiliation(s)
- H P Puspitasari
- Community Pharmacy Department, Faculty of Pharmacy, Airlangga University, Surabaya, Indonesia.
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Jules A, Kaltenbach LA, Arbogast PG, Caples TL, Po'e EK, Cooper WO. Use of drugs known to cause fetal harm among women delivering infants in Haiti. Acad Pediatr 2010; 10:395-9. [PMID: 21075320 DOI: 10.1016/j.acap.2010.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 09/10/2010] [Accepted: 09/17/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the prevalence of use of fetal-harm drugs among women who received postpartum care in hospitals in Haiti and to identify groups of women at higher risk for potentially harmful medication exposures. METHODS Women who received postpartum care in 2 large hospitals in Port-au-Prince, Haiti, from August 18 to December 1, 2008, were surveyed in Creole about their use of medications in pregnancy, including fetal-harm drugs. RESULTS We surveyed 482 women who had a median age of 26 years. Approximately 75% reported using at least 1 medicine in pregnancy, with the most common being amoxicillin (n = 127), acetaminophen (n = 109), metronidazole (n = 79), and misoprostol (n = 38). More than 13% used fetal-harm drugs, including misoprostol and tetracycline. Unmarried women (adjusted relative risk [RR] 2.2; 95% confidence interval [CI], 1.0-4.7) and separated women (adjusted RR 4.6; CI, 1.8-11.9) were more likely than married women to report use of fetal-harm drugs. In addition, women with 4 or more children were more likely to report use of medications known to cause fetal harm (adjusted RR 4.3; CI, 1.9-9.9). CONCLUSION Women who delivered infants in Haiti commonly report use of fetal-harm drugs. The public health implications of these findings are broad and relate to complex issues such as pregnancy planning and regulation of medications to prevent potentially harmful exposures.
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Affiliation(s)
- Astride Jules
- Master of Public Health Program, Vanderbilt University School of Medicine, Nashville, Tenn 37232-4313, USA
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Carrasco-Garrido P, Hernández-Barrera V, López de Andrés A, Jiménez-Trujillo I, Jiménez-García R. Sex-Differences on self-medication in Spain. Pharmacoepidemiol Drug Saf 2010; 19:1293-9. [DOI: 10.1002/pds.2034] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 07/15/2010] [Accepted: 07/19/2010] [Indexed: 11/08/2022]
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Vissman AT, Bloom FR, Leichliter JS, Bachmann LH, Montaño J, Topmiller M, Rhodes SD. Exploring the Use of Nonmedical Sources of Prescription Drugs Among Immigrant Latinos in the Rural Southeastern USA. J Rural Health 2010; 27:159-67. [DOI: 10.1111/j.1748-0361.2010.00323.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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