Preferences based interventions to address the use of antibiotics without prescription: a discrete choice experiment
Keywords:Anti-Bacterial Agents, Self Medication, Drug Utilization, Pharmacies, Patient Preference, Patient Acceptance of Health Care, Attitude to Health, Health Knowledge, Attitudes, Practice, Waiting Lists, Socioeconomic Factors, Focus Groups, Surveys and Questionnaires, Colombia
Background: In many countries, concerns have arisen over the population using antibiotics without consulting a physician. This practice can place patients at risk and increase antibiotic resistance in the community.
Objective: To evaluate individuals' preferences regarding the use of antibiotics. The study also assessed the likely effectiveness of interventions aimed at reducing inappropriate use of antibiotics.
Methods: A discrete choice experiment (DCE) was conducted in Bogotá, Colombia. The attributes were determined by a systematic literature review and four focus group sessions. The DCE included nine factors – cost, time to get attention, level of symptoms, efficacy, safety, among others- and one label -using or not antibiotics. Data analysis was carried out using a generalized multinomial logit (GMNL) model. Marginal probabilities of different sets of attributes' levels were compared to estimate the likely effectiveness of interventions.
Results: The survey was administered to 222 participants from diverse socioeconomic backgrounds. The results suggest that participants preferred not taking antibiotics and having a physician as an advisor, but the probability of inappropriate antibiotic use increased as the waiting time or the cost of receiving advice rose. The pharmacy was the preferred source of antibiotics, and participants chose the pharmacy worker (nonprofessional) as an advisor over the nurse on the phone. In the absence of any interventions aimed at reducing the use of antibiotics, approximately 47.3% of people would misuse antibiotics. This reduces to 26.5% when people perceive the efficacy of the antibiotics as low and the potential risks of self-medicating as high. An alternative model using a nursing service would likely lower inappropriate use of antibiotics.
Conclusions: Even though people prefer not using antibiotics or visiting a physician in case of disease rather than self-medicating, current access conditions might discourage them from appropriately use antibiotics. The results suggest that interventions that informing people about the risks of self-medication and the low efficacy might significantly reduce inappropriate use of antibiotics. Our results also suggest that programs that empower other health professionals to provide access to antibiotics would likely further lower inappropriate use.
Hughes CM, McElnay JC, Fleming GF. Benefits and risks of self medication. Drug Saf. 2001;24(14):1027-1037. https://doi.org/10.2165/00002018-200124140-00002
Reynolds CA, Finkelstein JA, Ray GT, Moore MR, Huang SS. Attributable healthcare utilization and cost of pneumonia due to drug-resistant streptococcus pneumonia: a cost analysis. Antimicrob Resist Infect Control. 2014;3:16. https://doi.org/10.1186/2047-2994-3-16
Machowska A, Stålsby Lundborg C. Drivers of Irrational Use of Antibiotics in Europe. Int J Environ Res Public Health. 2018;16(1):27. https://doi.org/10.3390/ijerph16010027
Morgan DJ, Okeke IN, Laxminarayan R, Perencevich EN, Weisenberg S. Non-prescription antimicrobial use worldwide: a systematic review. Lancet Infect Dis. 2011;11(9):692-701. https://doi.org/10.1016/s1473-3099(11)70054-8
Ocan M, Obuku EA, Bwanga F, et al. Household antimicrobial self-medication: a systematic review and meta-analysis of the burden, risk factors and outcomes in developing countries. BMC Public Health. 2015;15:742. https://doi.org/10.1186/s12889-015-2109-3
Ahmad A, Patel I, Mohanta G, Balkrishnan R. Evaluation of self medication practices in rural area of town sahaswan at northern India. Ann Med Health Sci Res. 2014;4(Suppl 2):S73-S78. https://doi.org/10.4103/2141-9248.138012
Fajardo-Zapata ÁL, Méndez-Casallas FJ, Hernández-Niño JF, et al. Automédication with antibiotics: public health problem. Salud Uninorte. 2013;29(2):226-235.
Shah DA. The self-medication epidemic: the prevailing use and abuse of non-prescription medications in developing countries like Pakistan. J Pak Med Assoc. 2013;63(12):1574.
Wirtz VJ, Herrera-Patino JJ, Santa-Ana-Tellez Y, Dreser A, Elseviers M, Vander Stichele RH. Analysing policy interventions to prohibit over-the-counter antibiotic sales in four Latin American countries. Trop Med Int Health. 2013;18(6):665-673. https://doi.org/10.1111/tmi.12096
Torres NF, Chibi B, Middleton LE, Solomon VP, Mashamba-Thompson TP. Evidence of factors influencing self-medication with antibiotics in low and middle-income countries: a systematic scoping review. Public Health. 2019;168:92-101. https://doi.org/10.1016/j.puhe.2018.11.018
Coffman MJ, Shobe MA, O'Connell B. Self-prescription practices in recent Latino immigrants. Public Health Nurs. 2008;25(3):203-211. https://doi.org/10.1111/j.1525-1446.2008.00697.x
López Romo A, Quirós R. Appropriate use of antibiotics: an unmet need. Ther Adv Urol. 2019;11:1756287219832174. https://doi.org/10.1177/1756287219832174
Santa-Ana-Tellez Y, Mantel-Teeuwisse AK, Dreser A, Leufkens HG, Wirtz VJ. Impact of over-the-counter restrictions on antibiotic consumption in Brazil and Mexico. PLoS One. 2013;8(10):e75550. https://doi.org/10.1371/journal.pone.0075550
Dreser A, Vázquez-Vélez E, Treviño S, Wirtz VJ. Regulation of antibiotic sales in Mexico: an analysis of printed media coverage and stakeholder participation. BMC Public Health. 2012;12:1051. https://doi.org/10.1186/1471-2458-12-1051
Alden DL, Tice AD, Berthiaume JT. Investigating approaches to improving appropriate antibiotic use among higher risk ethnic groups. Hawaii Med J. 2010;69(11):260-263.
Reeves D. The 2005 Garrod Lecture: the changing access of patients to antibiotics--for better or worse?. J Antimicrob Chemother. 2007;59(3):333-341. https://doi.org/10.1093/jac/dkl502
Göttems LBD, Mollo MLR. Neoliberalism in Latin America: effects on health system reforms. Rev Saude Publica. 2020;54:74. https://doi.org/10.11606/s1518-8787.2020054001806
Mosquera PA, Hernández J, Vega R, et al. Primary health care contribution to improve health outcomes in Bogota-Colombia: a longitudinal ecological analysis. BMC Fam Pract. 2012;13:84. https://doi.org/10.1186/1471-2296-13-84
Aponte-González J, González-Acuña A, Lopez J, Brown P, Eslava-Schmalbach J. Perceptions in the community about the use of antibiotics without a prescription: Exploring ideas behind this practice. Pharm Pract (Granada). 2019;17(1):1394. https://doi.org/10.18549/pharmpract.2019.1.1394
Vacca CP, Niño CY, Reveiz L. Restricción de la venta de antibióticos en farmacias de Bogotá, Colombia: estudio descriptivo [Restriction of antibiotic sales in pharmacies in Bogotá, Colombia: a descriptive study]. Rev Panam Salud Publica. 2011;30(6):586-591.
Foley H, Steel A, Cramer H, Wardle J, Adams J. Disclosure of complementary medicine use to medical providers: a systematic review and meta-analysis. Sci Rep. 2019;9(1):1573. https://doi.org/10.1038/s41598-018-38279-8
Kjær T. A review of the discrete choice experiment - with emphasis on its application in health care. https://www.sdu.dk/~/media/52E4A6B76FF340C3900EB41CAB67D9EA.ashx (accessed Apr 18, 2021).
Orme BK. Sample size issues for conjoin analysis. In: Getting started with conjoint analysis: strategies for product design and pricing research. Madison: Research Publichers; 2010.
Mott DJ, Chami N, Tervonen T. Reporting Quality of Marginal Rates of Substitution in Discrete Choice Experiments That Elicit Patient Preferences. Value Health. 2020;23(8):979-984. https://doi.org/10.1016/j.jval.2020.04.1831
Moen J, Bohm A, Tillenius T, Antonov K, Nilsson JL, Ring L. "I don't know how many of these [medicines] are necessary.." - a focus group study among elderly users of multiple medicines. Patient Educ Couns. 2009;74(2):135-141. https://doi.org/10.1016/j.pec.2008.08.019
Linsky A, Simon SR, Bokhour B. Patient perceptions of proactive medication discontinuation. Patient Educ Couns. 2015;98(2):220-225. https://doi.org/10.1016/j.pec.2014.11.010
Larson EL, Dilone J, Garcia M, Smolowitz J. Factors which influence Latino community members to self-prescribe antibiotics. Nurs Res. 2006;55(2):94-102. https://doi.org/10.1097/00006199-200603000-00004
Gartin M, Brewis AA, Schwartz NA. Nonprescription antibiotic therapy: cultural models on both sides of the counter and both sides of the border. Med Anthropol Q. 2010;24(1):85-107. https://doi.org/10.1111/j.1548-1387.2010.01086.x
Mota LRAD, Ferreira CCG, Costa Neto HAAD, Falbo AR, Lorena SB. Is doctor-patient relationship influenced by health online information?. Rev Assoc Med Bras (1992). 2018;64(8):692-699. https://doi.org/10.1590/1806-9282.64.08.692
Mainous AG 3rd, Diaz VA, Carnemolla M. Factors affecting Latino adults' use of antibiotics for self-medication. J Am Board Fam Med. 2008;21(2):128-134. https://doi.org/10.3122/jabfm.2008.02.070149
Horton S, Stewart A. Reasons for self-medication and perceptions of risk among Mexican migrant farm workers. J Immigr Minor Health. 2012;14(4):664-672. https://doi.org/10.1007/s10903-011-9562-6
Ortiz P, Buitrago MT, Eslava DG, Caro Á, Iguarán DH. Characterising the purchase of antibiotics in drugstores in Bogotá : a users ’ perspective. Rev Investig Segur Soc Salud. 2011;13(1):15-29.
Selvaraj K, Kumar SG, Ramalingam A. Prevalence of self-medication practices and its associated factors in Urban Puducherry, India. Perspect Clin Res. 2014;5(1):32-36. https://doi.org/10.4103/2229-3485.124569
Mainous AG 3rd, Diaz VA, Carnemolla M. A community intervention to decrease antibiotics used for self-medication among Latino adults. Ann Fam Med. 2009;7(6):520-526. https://doi.org/10.1370/afm.1061
Maier CB. Nurse prescribing of medicines in 13 European countries. Hum Resour Health. 2019;17(1):95. https://doi.org/10.1186/s12960-019-0429-6
Nuttall D. Nurse prescribing in primary care: a metasynthesis of the literature. Prim Health Care Res Dev. 2018;19(1):7-22. https://doi.org/10.1017/s1463423617000500
Ramay BM, Lambour P, Cerón A. Comparing antibiotic self-medication in two socio-economic groups in Guatemala City: a descriptive cross-sectional study. BMC Pharmacol Toxicol. 2015;16:11. https://doi.org/10.1186/s40360-015-0011-3
Zhang J, Reed Johnson F, Mohamed AF, Hauber AB. Too many attributes: A test of the validity of combining discrete-choice and best-worst scaling data. J Choice Model. 2015;15:1-13. https://doi.org/10.1016/j.jocm.2014.12.001
How to Cite
Copyright (c) 2021 The Authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.