Pathways to optimising antibiotic use in rural China: identifying key determinants in community and clinical settings, a mixed methods study protocol

Zhao, Linhai; Kwiatkowska, Rachel; Chai, Jing; Cabral, Christie; Chen, Meixuan; Bowker, Karen E.; Coope, Caroline; Shen, Jilu; Shen, Xing Rong; Cheng, Jing; Feng, Rui; Kadetz, Paul; MacGowan, Alasdair; Oliver, Isabel; Hickman, Matthew; Wang, Debin; Lambert, Helen

doi:10.1136/bmjopen-2018-027819

Cited by 17 publications

(31 citation statements)

References 30 publications

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“…The data we present below were collected between 2017 and 2018 in three counties of a province in eastern China (see Zhao et al (2019) for full details of the research design). Each field area included one village clinic (the lowest level of the healthcare system), one township health centre (each of which has oversight of 4-7 village clinics in the geographical area covered by the township) and all retail pharmacies (4-8) in each selected township.…”

Section: Study Settings and Methodsmentioning

confidence: 99%

Antimicrobial resistance, inflammatory responses: a comparative analysis of pathogenicities, knowledge hybrids and the semantics of antibiotic use

2019

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Antimicrobial resistance is widely recognised as a global threat to human health. This paper explores the mobilisation of biomedical concepts and technologies within local semantic registers and addresses the implications of translation and knowledge complexity for attempts to mitigate the problem of antibiotic resistance. In China, antibiotics are frequently prescribed for common complaints and are widely available without prescription. Drawing on field research in three rural counties of one province, we show that current patterns of antibiotic use are the result of sociocultural, economic and systems drivers within a medical context that draws on precepts from both biomedicine and Chinese medical knowledge. Comparative analysis with European settings suggests that pathogenicity, the set of explanatory frameworks regarding the production of disease, varies socio-temporally in the causal mechanisms that are prioritised. Incorporated within diagnostic strategies that direct treatment towards the bodily response to infection rather than to the infecting pathogen, 'anti-inflammatory medicine' as the popular term for antibiotics in parts of Asia foregrounds physiological process over microbial invasion. We examine the articulation of biomedical knowledge paradigms within a non-Pasteurian milieu in relation to socio-historical process, including hybridisation between ontologically distinct medical traditions and the heterogeneity of scientific knowledge claims that underpin contemporary practices of antibiotic prescribing. We conclude that the concept of inflammation functions as a boundary object which effectively mediates the interfaces between popular knowledges, biomedical sciences and local medical practices. Our analysis may have wide relevance because popular and scientific understandings of inflammation alike draw on metaphors grounded in universal sensory experience that provides a common basis for culturally diverse conceptual elaboration. Situated understandings of inflammation and associated treatment preferences constitute a contextually coherent response to available medical technologies in community health care. Our analysis also calls into question simplistic interpretations of antibiotic use for non-bacterial conditions as deriving from lack of education or public awareness and suggests a need to reconsider current public health knowledge translation strategies.

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Section: Study Settings and Methodsmentioning

confidence: 99%

Antimicrobial resistance, inflammatory responses: a comparative analysis of pathogenicities, knowledge hybrids and the semantics of antibiotic use

2019

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“…China is ranked second globally in overall antibiotic consumption in the human and animal sector. Various factors trigger the abuse of antimicrobials [12]; of these factors, the knowledge, attitude, and practices (KAP) of service providers such as community pharmacists may play a leading role [13].…”

Section: Introductionmentioning

confidence: 99%

Knowledge, attitude, and practices of community pharmacy staff toward antimicrobial stewardship programs: a cross-sectional study from Northeastern China

Feng

Hayat

Zhe

et al. 2020

Expert Review of Anti-infective Therapy

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Background: Antimicrobial resistance is one of the most significant challenges of the twenty-first century, and the illegal sale of antimicrobial drugs at community pharmacies is a driver of antimicrobial resistance. This study explores the knowledge, attitudes, and practices (KAP) of pharmacy staff toward antimicrobial stewardship programs (ASPs). Methods: We conducted a descriptive cross-sectional study among community pharmacy staff in Northeastern China, from April 1 to 31 May 2019, using a self-administered KAP questionnaire comprising 20 items. The data analysis was carried out by employing Mann-Whitney and Kruskal-Wallis tests. Results: A response rate of 98.5% (394/400) was obtained. The majority of participants (94.9%) demonstrated a good understanding of antimicrobial use, but they lacked an adequate understanding of ASPs. Nearly half of the participants (40.6%) reported that they sold antimicrobials to patients without a prescription. Education level, age, occupation, and experience were all significantly associated (P < 0.05) with participants' median ASPs scores. Besides, the presence of a licensed pharmacist (OR 46.327, 95% CI 2.443-878.451, P = 0.011) was the main factor associated with the pharmacy staff's understanding of antimicrobial use policies. Conclusions: The participants' knowledge of antimicrobials was good, and their attitudes regarding ASPs were positive, but their practices regarding ASPs were poor.

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“…This research was conducted as part of a large interdisciplinary study investigating levels of antibiotic prescribing and the burden of AMR in rural areas in China [15]. In this component of the study we aimed to assess the feasibility of using routine clinical data to inform antimicrobial stewardship in rural outpatient settings in Anhui province.…”

Section: Aim and Objectivesmentioning

confidence: 99%

Patients without records and records without patients: review of patient records in primary care and implications for surveillance of antibiotic prescribing in rural China

Kwiatkowska

Shen

et al. 2020

BMC Health Serv Res

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Background: We need to monitor patterns of antibiotic prescribing in order to develop and evaluate antibiotic stewardship interventions in rural China. As part of a multidisciplinary study of antibiotic use in Anhui Province we assessed the validity of electronic records (e-records) as a source of surveillance data. Methods: One township healthcare centre and one village clinic were selected in each of three different counties. Patients with symptoms of Upper Respiratory Tract Infection (URTI), exacerbation of Chronic Obstructive Pulmonary Disease (COPD) or Urinary Tract Infection (UTI) were recruited consecutively. Researchers observed and documented clinic consultations and interviewed each of the study participants. E-records were compared to clinic observations and patient interviews. Results: A total of 1030 patients were observed in clinic. Antibiotics were prescribed in 917 (89%) of consultations. Erecords were created only for individuals with health insurance, with considerable between-site variation in completeness (0 to 98.7% of clinic consultations) and in the timing of documentation (within-consultation up to weeks afterwards). Erecord accuracy was better in relation to antibiotics (82.8% of e-records accurately recorded what was prescribed in clinic) than for diagnosis and symptoms (45.0 and 1.1% accuracy). Only 31 participants (3.0%) presented with UTI symptoms. Conclusions: We have confirmed very high rates of outpatient antibiotic prescribing in rural Anhui province. E-records could provide useful information to inform stewardship interventions, however they may be inaccurate and/or biased. Public Health authorities should focus on improving technical infrastructure and record-keeping culture in outpatient settings. Further research is needed into community treatment of UTIs.

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Pathways to optimising antibiotic use in rural China: identifying key determinants in community and clinical settings, a mixed methods study protocol

Cited by 17 publications

References 30 publications

Antimicrobial resistance, inflammatory responses: a comparative analysis of pathogenicities, knowledge hybrids and the semantics of antibiotic use

Antimicrobial resistance, inflammatory responses: a comparative analysis of pathogenicities, knowledge hybrids and the semantics of antibiotic use

Knowledge, attitude, and practices of community pharmacy staff toward antimicrobial stewardship programs: a cross-sectional study from Northeastern China

Patients without records and records without patients: review of patient records in primary care and implications for surveillance of antibiotic prescribing in rural China

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