基层医疗卫生机构医务人员抗生素处方行为的效用模型及因素分解研究

Over provision of antibiotics is associated with antimicrobial resistance, a major public health concerns worldwide, and It has also been identified as a major health challenge in China. Physicians’ prescription decisions play a crucial part on overuse of antibiotics. This study aims to further explore the mechanism of antibiotic prescribing decision-making process of medical staff in primary care settings In China. First, a discrete choice experiment will be conducted to better understand how clinicians make decisions about whether or not to offer antibiotics to patients with upper respiratory tract infection in primary care. Especially, physicians’ economic motivation and patients’ direct request will be taken into account. After calculating utility value for all included possible factors, a utility model for physicians’ antibiotic prescribing decision will be established. Second, a randomized controlled trial will be conducted, involving four groups created by crossing 2 economic motivation conditions with 2 patients’ request conditions. “Standard patients” will be employed to monitor primary physicians’ antibiotic prescribing behavior in treating upper respiratory tract infection patients. Fixed effect model will be used to establish the casual relationship between antibiotic prescribing and the 2 factors of concern. Finally, focus group discussion will be used to interpret the findings and identify the targeted priority intervention strategy to improve antibiotic prescribing practice in primary care settings in China. This research will enable us better understand physicians’ antibiotic prescribing decision - making process. Evidences generated through this study will be used to support evidence based policy making for improving rational use of antibiotics.

抗生素的过度使用及其导致的细菌耐药是全球范围内的重大公共问题，也是我国面临的巨大健康挑战，医生的处方行为对抗生素的不合理使用有着至关重要的影响。为深入探索基层医疗卫生机构医务人员抗生素处方决策过程机理，本研究拟采用离散选择实验的设计分析方法从微观层面，建立医务人员抗生素处方行为的效用函数，量化各个因素特别是经济因素和患者需求因素对基层医疗卫生机构医务人员抗生素处方行为的效用值；设计随机对照实验，基于是否存在经济动机和患者是否直接要求处方抗生素两个维度，设立4个组别，结合标准化病人的调研方法，采用固定效应回归模型，分析经济因素和患者需求因素对我国基层医疗卫生机构医务人员抗生素处方行为的因果关系；通过焦点小组讨论，提出促进基层医疗卫生机构抗生素合理使用的优先靶向干预策略。研究结果将有助于识别基层医疗卫生机构抗生素过度处方的关键问题，为我国基层医疗卫生机构合理用药的宏观政策制定提供依据。