Trajectories of symptoms and healthcare use following respiratory tract infections in rural Anhui, China：a cross-sectional study

Wu, Yue; Shi-yu, XU; Shen, Xingrong; Cheng, Jing; Chai, Jing; Feng, Rui; Wang, Debin

doi:10.1016/j.jiph.2020.09.022

Cited by 3 publications

(4 citation statements)

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“…This appears to contradict a proposed strategy to contain bacterial resistance through delaying antimicrobial usage among RTI patients [ 19 , 22 ]. As found in our earlier study [ 20 ], the trajectories of common RTI symptoms all feature a skewed peak, i.e. the frequency of symptom occurrence increased rapidly at the beginning, reached a sharp peak on day 1 or 2 following onset of infection and then tailed off over 15 days; this pattern mirrored the patients' intention to seek professional healthcare.…”

Section: Discussionmentioning

confidence: 99%

“…The study used data from two separate projects funded by the UK-China Strategic Prosperity Fund and National Natural Science Foundation of China respectively. Participants were recruited using a stratified-cluster randomised sampling approach targeting RTI patients at rural primary care settings of Anhui province, and used similar sampling, observation and survey approaches [ 20 , 23 ]. Selection of village clinics proceeded as follows: (i) all cities in the province were divided into north, middle and southern regions; (ii) five cities were randomly selected from each of the three regions, and four village clinics were designated from each of the cities; (iii) a village doctor from each clinic made initial observations and then recruited patients for at least 2 weeks according to preset inclusion/exclusion criteria.…”

Section: Methodsmentioning

confidence: 99%

“…The NDOV index was used since delaying service and antibiotics use among RTI patients has become a proven strategy in containing bacterial resistance [ 19 , 22 ]. Also, our previous studies suggest that the opportunity for RTI patients to visit clinics and receive prescribed antibiotics reduced sharply after 2–3 days following onset of infection [ 20 ]. Likewise, the greater the number of antimicrobials prescribed increased the potential for multi-resistance [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

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Differences in service and antibiotics use following symptomatic respiratory tract infections between 2016 and 2021 in rural Anhui, China

Zhang

et al. 2022

Epidemiol. Infect.

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In the past 10–15 years, the government of China has made various efforts in tackling excessive antibiotics use. Yet, little is known about their effects at rural primary care settings. This study aimed to determine the impact of government policies and the COVID-19 pandemic on antibiotic prescribing practices at such settings utilizing data from separate studies carried out pre- and during the pandemic, in 2016 and 2021 in Anhui province, China, using identical sampling and survey approaches. Data on antibiotics prescribed, diagnosis, socio-demographic, etc., were obtained through non-participative observation and a structured exit survey. Data analysis comprised mainly descriptive comparisons of 1153 and 762 patients with respiratory infections recruited in 2016 and 2021, respectively. The overall antibiotics prescription rate decreased from 89.6% in 2016 to 69.1% in 2021, and the proportion of prescriptions for two or more classes of antibiotics was estimated as 35.9% in 2016 and 11.0% in 2021. There was a statistically significant decrease in the number of days from symptom onset to clinic visits between the year groups. In conclusion, measures to constrain excessive prescription of antibiotics have led to some improvements at the rural primary care level, and the COVID-19 pandemic has had varying effects on antibiotic use.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Differences in service and antibiotics use following symptomatic respiratory tract infections between 2016 and 2021 in rural Anhui, China

Zhang

et al. 2022

Epidemiol. Infect.

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“…Another way of optimizing antibiotic prescribing is addressing clinical drivers. Several studies have found that symptoms reported by patients, diagnosis given by physicians and the social-demographic background of patients are all linked to antibiotic prescribing patterns (11)(12)(13). Other studies have reported that antibiotic prescribing rates are higher in rural (vs. urban) practices, among patients with longer illness duration or acute bronchitis, and when providers experience greater diagnostic uncertainty (14,15).…”

Section: Introductionmentioning

confidence: 99%

Relationships Between Diagnosis, Bacterial Isolation, and Antibiotic Prescription in Out Patients With Respiratory Tract Infection Symptoms in Rural Anhui, China

Shen

Feng

Chai

et al. 2022

Front. Public Health

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ObjectivesThis paper aims to explore the direct associations of antibiotics prescription with clinical diagnosis and bacterial detection. It also analyses the relations of clinical diagnosis with symptoms and bacterial detection, with a hope of revealing indirect links to antibiotic prescription.MethodsThe study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. Observations were conducted to record clinical diagnosis and antibiotic prescription. A semi-structured questionnaire survey was used to collected patients' sociodemographic information and reported symptoms. Sputum and throat swabs were collected for bacterial culture.ResultsAmong 1,068 patients presenting in the study settings who received a diagnosis of respiratory tract infection (RTI), 87.8% of prescriptions included an antibiotic and 35.8% included two or more antibiotics. Symptomatic RTI patients to the site clinics were diagnosed mainly as having upper respiratory tract infection (32.0%), bronchitis/tracheitis (23.4%), others (16.6%), pharyngitis (11.1%), common cold (8.0%), pneumonia/bronchopneumonia (4.6%) and tonsillitis (4.3%). These clinical diagnosis were associated with symptoms to a varied degree especially for upper respiratory tract infection and bronchitis/tracheitis. Prescription of any antibiotics was positively associated with diagnosis of bronchitis/tracheitis (OR: 5.00, 95% CI: 2.63–9.51), tonsillitis (OR: 4.63, 95% CI: 1.48–14.46), pneumonia/bronchopneumonia (OR: 4.28, 95% CI: 1.40–13.04), pharyngitis (OR: 3.22, 95% CI: 1.57–6.59) and upper respiratory tract infection (OR: 3.04, 95% CI: 1.75–5.27). Prescription of two or more antibiotics was statistically significant related to diagnosis of bronchitis/ tracheitis (OR: 2.20, 95% CI: 1.44–3.35) or tonsillitis (OR: 2.97, 95% CI: 1.47–6.00). About 30% of the patients were identified with some type of bacteria. Bacteria detection was linked with pharyngitis (OR: 0.50, 95% CI: 0.28–0.88) but not prescription of antibiotics.ConclusionsAntibiotics prescription were found with a strong relation to diagnosis of RTIs given by the clinician but was not associated with the presence of bacteria in patient samples. Part of the diagnosis may have been given by the clinician to justify their antibiotics prescription. There is clear need to use additional measures (e.g., symptoms) in conjunction with diagnosis to supervise or audit excessive antibiotics use.

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Eliciting parents’ decision-making to antibiotic use for upper respiratory tract infections: A discrete choice experiment

Duan,

Lin,

Wang

et al. 2024

J Glob Health

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Background Addressing antibiotic resistance is important for reducing parents’ self-medication of antibiotics for children’s upper respiratory tract infections (URTIs). However, the decision-making process for parents who irrationally use such antibiotics is still unclear. In this study, we aimed to explore the reasons why parents self-medicate antibiotics for children’s URTIs based on a discrete choice experiment. Methods We conducted a systematic review and in-depth interviews to identify the key attributes of choices when parents self-medicate antibiotics for children’s URTIs. We developed and applied a discrete choice experiment in Wuhan and Chongqing, China. We used a mixed logit model to determine the impact of various attributes on parents’ decisions, while we applied latent class logit models to explore different decision-making patterns within populations. Results A total of 400 valid responses were returned from parents. It was shown that symptom severity was the most important in parents’ decision-making to self-medicate antibiotics for children’s URTIs, followed by risk of side effects or resistance, duration, total cost, onset time of antibiotic, and antibiotic effectiveness. More severe and longer symptoms, perceived higher effectiveness, and fewer side effects of antibiotics consistently were significantly associated with parents’ more likely to self-medicate with antibiotics for children’s URTIs. There are also different patterns of decision-making of parents, including ‘symptoms-oriented,’ ‘safety-oriented,’ and ‘comprehensive consideration.’ Parents’ gender and educational level were associated with decision-making patterns. Conclusions Parents’ self-medication of antibiotics for children’s URTIs was mainly driven by symptoms, followed by perceived antibiotic value. We recommend a multi-faceted intervention strategy to enhance parents’ ability to differentiate mild from severe URTIs, as well as their knowledge of antibiotics.

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Trajectories of symptoms and healthcare use following respiratory tract infections in rural Anhui, China：a cross-sectional study

Cited by 3 publications

References 23 publications

Differences in service and antibiotics use following symptomatic respiratory tract infections between 2016 and 2021 in rural Anhui, China

Differences in service and antibiotics use following symptomatic respiratory tract infections between 2016 and 2021 in rural Anhui, China

Relationships Between Diagnosis, Bacterial Isolation, and Antibiotic Prescription in Out Patients With Respiratory Tract Infection Symptoms in Rural Anhui, China

Eliciting parents’ decision-making to antibiotic use for upper respiratory tract infections: A discrete choice experiment

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