Mehmet UĞURLU, Feride Derya ŞARKLLI, Aylin BAYDAR ARTANTAŞ

Hastalar Neden Antibiyotik İster ve Hekimler Neden Antibiyotik Reçete Eder?: Birinci Basamakta Kesitsel Bir Çalışma

Amaç: Antibiyotiklerin uygunsuz kullanımı dünya çapında bir halk sağlığı sorunudur. Ne yazık ki, Türkiye özellikle yüksek oranda antibiyotik reçetesi ile olumsuz bir üne sahiptir. Bu çalışmanın amacı, Türkiye’deki birinci basamak hekimlerinin antibiyotik reçete etmelerinde etkili olan faktörleri belirlemek ve hekimlerin akılcı antibiyotik kullanımı konusundaki bilgi düzeylerini değerlendirmektir. Materyal ve Metot: Bu kesitsel çalışma, Ankara ilinde 8 farklı ilçedeki Aile Sağlığı Merkezleri ve Toplum Sağlığı Merkezleri'nde gerçekleştirildi. Hekimlere bilgi düzeylerini ve akılcı antibiyotik kullanımı ile ilgili tutumlarını değerlendirmek için, kendilerinin cevaplayacağı bir anket uygulandı. Elde edilen veriler SPSS 21.0 yazılımı kullanılarak analiz edildi. Bulgular: Çalışmaya 84 (%42) erkek ve 116 (%58) kadın olmak üzere 200 doktor katıldı. Hekimlerin %38,5'i hastaların antibiyotik isteğini reddetmiş olduklarını belirttiler. 11 yıl ve daha uzun süredir hekimlik yapanların “hastanın beklenti ve ısrarı”ndan etkilendiği görülürken, 10 yıl ve daha az süredir çalışanların “eşlik eden hastalık varlığı” ndan etkilendiği görüldü. (p1=0,044, p2=0,012). Hekimlerin antibiyotiklerle ilgili en çok antimikrobiyal direnç ve maliyet konularında bilgi eksiklikleri olduğu saptandı.Sonuç: Antibiyotiklerin rasyonel kullanımı açısından, hekimlerinin antibiyotikler ve antibiyotiklerin akılcı kullanımı ile ilgili bilgi düzeyi ve bunların antibiyotik reçeteleme davranışları ile ilişkisi son derece önemlidir. Bu nedenle, toplumda uygun olmayan antibiyotik kullanımını önlemek açısından gereksiz antibiyotik reçetelenmesine neden olan faktörlerin ortaya çıkarılması önemlidir.

Why Do Patients Want Antibiotics and Why Do Physcians Prescribe Antibiotics?: A Cross‐Sectional Study In Primary Health Care

Objectives: The inappropriate use of antibiotics is a worldwide public healthcare problem.Unfortunately, Turkey has a negative reputation with a particularly high rate of antibiotic prescription.The aim of this study is to determine the factors affecting Turkish primary care physicians inprescribing antibiotics and to evaluate the knowledge levels of the physicians on the rational use ofantibiotics.Materials and Methods: This cross ‐ sectional study was carried out in Family Health Centers andCommunity Health Centers in 8 different districts in Ankara. A self‐reporting questionnaire wasadministered to the physicians to evaluate their level of knowledge and attitudes towards the rationaluse of antibiotics. The data obtained were analysed using SPSS 21.0 software. Results: The study included 200 physicians, comprising 84 (42%) males and 116 (58%) females. Of thetotal physicians, 38.5% stated that they had refused patient’s request for antibiotics. Those who hadbeen working for ≥11 years were seen to be affected by ‘the patient’s expectations and insistence’ whenprescribing antibiotics and those working for ≤10 years by ‘the presence of comorbid disease’ (p1=0.044,p2=0.012). The subjects on which the physicians were most lacking in knowledge related to antibioticswere determined to be antimicrobial resistance and cost. Conclusion: In terms of the rational use of antibiotics, physicians’ knowledge level about antibioticsand rational use of antibiotics and their associated behaviour in prescribing antibiotics are extremelyimportant. Therefore, it is important to identify the factors that cause unnecessary antibioticprescription in order to prevent inappropriate antibiotic use in the population.

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1. Management Sciences for Health.2012.MDS‐3:Managing Access to Medicines and Health Technologies.Chapter 27 Managing for rational medicine use.Arlington, VA:Management Sciences for Health.2012:517‐8.
2. Management Sciences for Health.2012.MDS‐3:Managing Access to Medicines and Health Technologies.Chapter 2 Historical and institutional perspective. Arlington, VA:Management Sciences for Health. 2012:33.
3. World Antibiotic Awareness Week, 12‐18 November 2018. http://www.who.int/campaigns/world‐antibiotic‐awareness‐week/2017/launch‐event/en / (Accessed 5 July 2018) 4. Global Action Plan on Antimicrobial Resistance. World Health Organization.Printed by the WHO Document Production Services, Geneva, Switzerland.2015:8. 5. Key Indicators. Turkish Pharmaceutical Market. Pharmaceutical Manufacturers Association of Turkey (IEIS).http://www.ieis.org.tr/ieis/tr/indicators/33/turkiye‐ilacpazari/(Accessed 5 July 2018). 6. Aykan Ş. B, Çiftçi İ. H. Türkiye’de İdrar Kültürlerinden İzole Edilen Escherichia coli Suşlarının Antibiyotiklere Direnç Durumu: Bir Metaanaliz. Mikrobiyol Bul 2013; 47(4):603‐18. 7. Kayhan Tetik B, Baydar Artantaş A. Uygunsuz antibiyotik Kullanımı. Turkish Medical Journal, 2011:5(3):136‐8. 8. Fiona Wood, Sharon Simpson, Christopher C Butler. Socially responsible antibiotic choices in primary care: a qualitative study of GPs’ decisions to prescribe broad‐spectrum a fluroquinolone antibiotics. Family Practice 2007; 24: 427–34. 9. Öztürk II, Avcı IY, Çoşkun Ö, Gül HC, Eyigün CP. Birinci Basamak Sağlık Kurulusunda Görev Yapan Hekimlerin Sık Görülen Toplum Kaynaklı Enfeksiyonlardaki Antibiyotik Seçimleri ve Bunu Etkileyen Faktörler Fırat Tıp Dergisi 2008;13 (4): 255‐60. 10. Cadieux G, Tamblyn R, Dauphinee D, Libman M. Predictors of inappropriate antibiotic prescribing among primary care physicians. CMAJ, 2007; vol. 177 no. 8: 877‐83. 11. George CE, Norman G, Ramana GV, Mukherjee D, Rao T. Treatment of uncomplicated symptomatic urinary tract infections: Resistance patterns and misuse of antibiotics. J FamilyMed Prim Care 2015;4:416‐21. 12. Mishra B, Srivastava S, Singh K, Pandey A, Agarwal J. Symptom‐based diagnosis of urinary tract infection in women: are we over‐prescribing antibiotics? Int J Clin Pract. 2012;66(5):493‐8. 13. World Health Day 2011: policy briefs. Strengthen Surveillance and Laboratory Capacity.World Health Organization. 2011. http://www.who.int/world‐health‐day/2011/en/ (Accessed 13 July 2018). 14. Gonzalez‐Gonzalez C, López‐Vázquez P, Vázquez‐Lago JM, et al. Effect of Physicians’ Attitudes and Knowledge on the Quality of Antibiotic Prescription: A Cohort Study. Aziz RK, ed. PLoS ONE. 2015;10(10). e0141820. doi:10.1371/journal.pone.0141820. 15. Mohammed Mustafa, Fiona Wood, Christopher C. Butler, Glyn Elwyn. Managing Expectations of Antibiotics for Upper RespiratoryTract Infections: A Qualitative Study. Ann Fam Med 2014;29‐36. 16. Mangione‐Smith R, McGlynn EA, Elliott MN, McDonald L, Franz CE, Kravitz RL. Parent Expectations for Antibiotics, Physician‐Parent Communication, and Satisfaction. Arch Pediatr Adolesc Med.2001;155(7):800‐6. 17. Scott JG, Cohen D, DiCicco‐Bloom B, Orzano AJ, Jaen CR, Crabtree BF. Antibiotic use in acute respiratory infections and the ways patients pressure physicians for a prescription. J Fam Pract. 2001 Oct;50(10):853‐8. 18. Hamm RM, Hicks RJ, Bemben DA. Antibiotics and respiratory infections: are patients more satisfied when expectations are met? J Fam Pract. 1996 Jul;43(1):56‐62. 19. Macfarlane J, Holmes W, Macfarlane R,Britten N. Influence of patients' expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. BMJ 1997;315:1211. 20. Björkman I, Berg J, Viberg N, Stålsby Lundborg C. Awareness of antibiotic resistance and antibiotic prescribing in UTI treatment: a qualitative study among primary care physicians in Sweden. Scand J Prim Health Care. 2013 Mar;31(1):50‐5.
21. States Guillermo V. Sanchez, Rebecca M. Roberts, Alison P. Albert, Darcia D. Johnson, Lauri A. Hicks. Effects of Knowledge, Attitudes, and Practices of Primary Care Providers on Antibiotic Selection, United States. Emerg Infect Dis. 2014 Dec; 20(12): 2041–7. 22. Coxeter P, Del Mar CB, McGregor L, Beller EM, Hoffmann TC. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. Cochrane Database Syst Rev. 2015 Nov 12;(11):CD010907. doi:10.1002/14651858.CD010907.pub2. 23. Meropol S.B, Localio A.R, Metlay J.P. Risks And Benefits Associated With Antibiotic Use For Acute Respiratory Infections: A Cohort Study Annals Of Family Medicine.2013; vol:11,number 2:165‐72. 24. Parlak E, Çayır Y, Ertürk A. Aile Hekimlerinin akılcı antibiyotik kullanımı açısından durumları: Erzurum’dan kesitsel bir çalışma. Euras J Fam Med 2013;2(1):27‐32. 25. Baydar Artantas A, Kahveci R, Sunay D, Caylan A. Quality assessment of primary care guidelines inTurkey. HealthMED. 2011; 5(6): 1565–73. 26. Health Statistics Yearbook 2017.Chapter 9.Pharmaceutical Statistics. Republic of Turkey Ministry of Health General Directorate of Health Information Systems. Ministry of Health Publications No: 1107. Edition: Kuban Matbaacılık Yayıncılık, Ankara,2018.