六安市城乡居民抗生素相关认知和自我用药行为调查

Investigation of Cognition and Self-medication Behavior of Antibiotics among Urban and Rural Residents in Lu’an City

目的:了解安徽省六安市城乡居民抗生素相关认知水平和自我用药行为,探讨其影响因素,为促进抗生素的合理使用提供参考。方法:采用分阶段抽样法随机选取六安市684位18~80岁的城乡居民作为研究对象,采用自行编制的问卷进行入户调查,调查内容包括一般人口学特征、抗生素相关认知水平、抗生素使用行为及相关影响因素等。结果:共获得有效问卷657份,应答率为96.1%,其中来自城市305份、来自农村352份。657位调查对象中,男性占38.2%、女性占61.8%;年龄(50.30±13.26)岁;受教育水平在小学及以下者占44.7%。7.8%的调查对象能正确认识到抗生素对病毒无效,12.6%知道抗生素耐药性,55.1%认为频繁使用抗生素会降低细菌对其敏感性,23.1%表示知道处方药与非处方药的区别,58.0%可以说出至少1种不需要使用抗生素的情况。7个知识条目得分中,调查地区居民抗生素认知总分不超过3分者占75.3%;城市地区、受教育水平高的人群抗生素认知水平更高。66.5%的调查对象在调查近1年内使用过抗生素,其中61.0%通过医师开具处方获得,50.7%到药店自行购买获得,有13.1%同时使用了以上2种途径。在调查近1年内使用过抗生素的人群中,81.9%表示无需凭处方就能购买抗生素,超过半数(53.8%)有过未咨询医师而自行使用抗生素的行为。在657位调查对象中,49.0%表示在服用抗生素时必须找医师开处方;68.9%表示在服用抗生素时症状好转就停药,19.3%会为了增强疗效而自行加大服药剂量,28.3%在用药时会频繁更换药物。农村地区的居民相比于城市居民更倾向于服用抗生素时由医师开处方[比值比(OR)=1.693,95%置信区间(CI)(1.191,2.407)]。认知得分越高者服用抗生素时必须由医师开出处方的行为率越低[OR=0.882,95%CI(0.785,0.991)],也更倾向于症状好转就停药[OR=1.163,95%CI(1.025,1.319)],男性更倾向于为增强疗效自行加大服药剂量[OR=1.841,95%CI(1.214,2.792)];认知得分越高者越不倾向于为增强疗效而自行加大服药剂量[OR=0.894,95%CI(0.773,1.034)],也不倾向于频繁更换药物[OR=0.873,95%CI(0.767,0.992)]。结论:六安市城乡居民的抗生素相关认知水平亟待提高,合理的抗生素使用行为有待规范;单纯的抗生素知识不必然与期望的合理用药行为相关。因此,除了针对居民合理用药的健康教育,还需营造促进抗生素合理使用的系统环境,为居民提供多渠道的合理用药药事服务。

OBJECTIVE:To know about the cognition level and self-medication behavior of antibiotics among urban and rural residents in Lu’an city of Anhui province,and to investigate its influential factors and to provide reference for promoting rational use of antibiotics.METHODS:Totally 684 urban and rural residents aged 18-80 years in Lu’an city were randomly selected as the research objects by stage sampling method.A self-designed questionnaire was used for household survey,involving general demographic characteristics,antibiotics related cognitive level,antibiotics use behavior and related influential factors,etc.RESULTS:A total of 657 questionnaires were collected,with effective rate of 96.1%.Among them,305 were from urban residents and 352 from rural residents.Among the 657 respondents,38.2%were male and 61.8%were female;their age was(50.30±13.26)years old;44.7%of them were educated in primary school or below.7.8%of the respondents correctly recognized that antibiotics were not effective to the virus;12.6%knew antibiotic resistance;55.1%thought that frequent use of antibiotics would reduce the sensitivity of bacteria to it;23.1%said they knew the difference between prescription drugs and over-the-counter drugs;58.0%could tell at least one case of not using antibiotics.For 7 knowledge items,75.3%of the residents in the survey area had a total score of less than 3;the cognition level of antibiotics was higher in urban areas and people with higher education level.66.5%of the respondents had used antibiotics in the past one year,of which 61.0%obtained antibiotics by prescription from doctors,50.7%purchased antibiotics by themselves in pharmacies,and 13.1%used the above two ways both.Among the people who have used antibiotics in the past year,81.9%said they could buy antibiotics without prescription.Among the 657 respondents,49.0%said that they had to obtain prescription from doctor when taking antibiotics;68.9%said that they would stop taking antibiotics when their symptoms improved;19.3%would increase their dosage in order to enhance the curative effect;28.3%would change drugs frequently.Compared with urban residents,rural residents were more likely to take antibiotics based on prescriptions by physicians[odds ratio(OR)=1.693,95%confidence interval(CI)(1.191,2.407)].The higher the cognitive score,the lower the behavior rate of having to prescribe antibiotics by doctors[OR=0.882,95%CI(0.785,0.991)],and they were more likely to stop taking antibiotics when symptoms improved[OR=1.163,95%CI(1.025,1.319)],and male were more inclined to increase the dosage of antibiotics to enhance the efficacy[OR=1.841,95%CI(1.214,2.792)].The higher the cognitive score was,the less likely they were to increase drug dosage to enhance the curative effect[OR=0.894,95%CI(0.773,1.034)],nor were they inclined to change drugs frequently[OR=0.873,95%CI(0.767,0.992)].CONCLUSIONS:The cognition level to antibiotics of urban and rural residents in Lu’an city needs to be improved urgently,and reasonable antibiotic use behavior needs to be standardized.Pure knowledge of antibiotics is not necessarily related to the expected rational drug use behavior.Therefore,in addition to health promotion for the rational use of drugs for residents,it is also necessary to create a systematic environment that promotes the rational use of antibiotics and provide residents with multi-channel services for rational use of drugs.