Reducing Use of Antibiotics without a Prescription among Outpatients in a Safety Net Healthcare System

在安全网医疗系统中减少门诊患者非处方抗生素的使用

• 批准号: 10609827
• 负责人: Larisa Grigoryan
• 金额: $ 48.69万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10609827
• 关键词: Reducing; Use; Antibiotics; without; Prescription

Non-prescription antibiotic use is an understudied problem, prevalent in some low-income communities. This practice includes obtaining and taking antibiotics without a prescription (e.g., from ethnic stores or flea markets), taking another person's antibiotics, or taking one's own stored antibiotics for an indication other than that for which the antibiotic was originally prescribed. In our survey of low-income primary care patients in a large urban area, respondents from public clinics were more likely than respondents from private clinics to report intention to use antibiotics without a prescription. This survey generated considerable press interest, as the problem has barely been described in the United States, but we did not explore why the non-prescription use was occurring. Non-prescription use increases the risk of development of antibiotic resistance, adverse drug reactions, damage to the microbiome, and other harms. There is a critical need to identify the predictors of non-prescription use that will guide development of effective antimicrobial stewardship interventions in low- income populations, given that these populations are at higher risk of developing antibiotic-resistant infections. The overall objectives of the proposed project are to identify the predictors of non-prescription antibiotic use in diverse, predominantly uninsured patients of safety net clinics and lay the foundation for a subsequent intervention. We will use mixed methods and the Kilbourne et al. (2006) conceptual framework for advancing health disparities research to identify the predictors of non-prescription use. In Aim 1 (quantitative phase), we will administer a survey in Spanish and English to assess how patient (e.g., health literacy), health care system (e.g., access to care), and clinical encounter factors (patient-provider communication) are associated with non- prescription antibiotic use in low-income patients. In Aim 2 (qualitative phase), using in-depth interviews, we will explore patient perspectives and experiences with non-prescription use among a racially/ethnically diverse subsample of survey respondents who reported using antibiotics without a prescription. In Aim 3 (development of a communication tool), we will integrate quantitative and qualitative results into a communication tool to be used in the clinics to steer patients toward safer antibiotic use and healthcare options. Our team includes an epidemiologist, an infectious diseases physician, a health disparities researcher, health communications experts, and a medical anthropologist. This multidisciplinary team will work with a Community Advisory Board comprised of patient representatives from participating clinics. Our work will be guided by input from a representative from the Centers for Disease Control and Prevention and two health literacy consultants, one of whom is bilingual. The proposed research is innovative, because it will provide comprehensive understanding of the predictors of this unsafe use of antibiotics in a low-income population. The research is significant, because it will inform understanding of disparities in use of antibiotics and future development of interventions to reduce harms associated with non-prescription use, such as the spread of antibiotic-resistant bacteria.

非处方抗生素使用是一个研究的问题，在某些低收入社区中普遍存在。这 练习包括在没有处方的情况下获得和服用抗生素（例如，来自种族商店或跳蚤 市场），服用另一个人的抗生素，或以自己的储存抗生素来表明 最初规定的抗生素。在我们对低收入初级保健患者的调查中 大型城市地区，公共诊所的受访者比私人诊所的受访者更有可能 报告意图在没有处方的情况下使用抗生素。这项调查引起了广泛的新闻关注，如 这个问题在美国几乎没有描述，但我们没有探讨为什么非处方 使用正在发生。非处方使用会增加抗生素耐药性发展的风险 药物反应，对微生物组的损害和其他危害。识别预测变量的迫切需要 非处方使用将指导在低 - 鉴于这些人群患有抗生素耐药性感染的风险更高，收入人群。 拟议项目的总体目标是确定非处方抗生素使用的预测因子 安全网诊所的多样化，主要是没有保险的患者，并为随后的 干涉。我们将使用混合方法和Kilbourne等。 （2006）前进的概念框架 健康差异研究以确定非处方使用的预测因素。在AIM 1（定量阶段）中，我们 将使用西班牙语和英语进行调查，以评估患者（例如健康素养），医疗保健系统的方式 （例如，获得护理的访问）和临床遭遇因素（患者提供的沟通）与非 - 低收入患者的处方抗生素使用。在AIM 2（定性阶段）中，使用深入的访谈，我们 将探索患者的观点和经验，在种族/种族多样性中使用非处方使用 调查受访者的子样本报告未经处方使用抗生素。在AIM 3（发展 通信工具的），我们将将定量和定性结果整合到通信工具中 在诊所中用于引导患者采用更安全的抗生素使用和医疗保健选择。我们的团队包括一个 流行病学家，一种传染病医师，健康差异研究人员，健康传播 专家和医学人类学家。这个多学科团队将与社区顾问委员会合作 由参与诊所的患者代表组成。我们的工作将以来自 疾病控制与预防中心的代表和两名健康素养顾问，其中之一 谁是双语。拟议的研究具有创新性，因为它将提供全面的理解 在低收入人群中这种不安全使用抗生素的预测因素。这项研究很重要， 因为它将告知人们对使用抗生素的差异的理解以及干预措施的未来发展 为了减少与非处方使用相关的危害，例如抗生素耐药细菌的扩散。

项目成果

Acculturation and Subjective Norms Impact Non-Prescription Antibiotic Use among Hispanic Patients in the United States.

• DOI: 10.3390/antibiotics12091419
• 发表时间: 2023-09-08
• 期刊: ANTIBIOTICS-BASEL
• 影响因子: 4.8
• 作者: Laytner, Lindsey A.;Olmeda, Kiara;Salinas, Juanita;Alquicira, Osvaldo;Nash, Susan;Zoorob, Roger;Paasche-Orlow, Michael K.;Trautner, Barbara W.;Grigoryan, Larissa
• 通讯作者: Grigoryan, Larissa