Table 2 Appropriateness of antimicrobial prescribing in rural/remote primary health
From: Antimicrobial stewardship in rural and remote primary health care: a narrative review
Reference # | First author | Year | Study type | JBI checklist used (score/total) | Country | Setting/population | Main findings |
|---|---|---|---|---|---|---|---|
Rural and remote | |||||||
[59] | Chai | 2019 | Cross-sectional quantitative study | Cross Sectional Study (8/8) | China | Residents of 12 rural villages | In China, excessive antimicrobial use is prevalent in primary care settings. Use of antimicrobials bought from medicine shops without prescriptions ranged from 8.8 to 17.2% whereas use of antimicrobials leftover from previous illnesses or given by a relative ranged from 7.6 to 13.4% |
[34] | Giles | 2019 | Single-centre, retrospective study | Prevalence Study (5/9) | United States | Rural outpatient family medicine clinic | 75% of 28 patients received a first-line antimicrobial based on treatment guidelines, of which 18 obtained a recommended dose. However, an appropriate treatment duration was prescribed for only 17% of patients |
[42] | Kwiatkowska | 2020 | Cross-sectional quantitative study | Cross Sectional Study (7/8) | China | Township health care centre and village clinic | The rural Anhui province in China had considerably high rates of outpatient antibiotic prescribing. While e-records could be useful to inform antimicrobial stewardship, they may have inaccuracies and/or biases |
[36] | Sarwar | 2018 | Cross-sectional quantitative study | Cross Sectional Study (7/8) | Pakistan | 16 rural health care centres and 16 basic health units | Antimicrobial agents were frequently prescribed in primary health care centres in Pakistan, a large proportion of which were inappropriate |
[38] | Xue | 2019 | Quasi-experimental | Quasi-experimental Study (9/9) | China | Rural village clinics and township health centres | Primary care providers in rural China frequently prescribed antibiotics inappropriately, predominantly due to deficits in diagnostic knowledge but also to financial incentives linked to drug sales and perceived patient demand |
Mixed urban and rural | |||||||
[44] | Davey | 2020 | Cross-sectional quantitative analysis | Cross Sectional Study (7/8) | Australia | General practitioners (16% rural) | Recommendations by Australian therapeutic guidelines were adhered when choosing antibiotics. Antibiotic treatment was more likely given to adults than children |
[40] | Kumar | 2008 | Cross-sectional quantitative study | Cross Sectional Study (8/8) | India | Primary and secondary health care settings in rural and urban areas | Higher antibiotic use was correlated with rural settings, lower patient age and higher socioeconomic status. Lower antibiotic prescribing was correlated with government health facilities which have larger allied health support and better infrastructure and specialist practices with more qualified staff |
[41] | Kumari Indira | 2008 | Cross-sectional quantitative study | Cross Sectional Study (7/8) | India | Primary and secondary health care settings in rural and urban areas | Antimicrobials were more commonly prescribed by physicians practising in rural and public/government settings, and to patients presenting with fever and high-income patients |
[35] | Rhee | 2019 | Cross-sectional quantitative study | Cross Sectional Study (7/8) | Kenya | Primary health care facilities in a rural and urban slum | Antibiotics were commonly prescribed inappropriately in the management of diarrhoea in children. Over-prescription was associated with a diagnosis of gastroenteritis in a rural setting and concurrent signs of respiratory infection in an urban setting |
[49] | Salm | 2018 | Questionnaire-based survey | Qualitative Research (8/10) | Germany | Urban and rural general practitioners | While knowledge on bacterial antimicrobial resistance was acceptable, delayed prescription was more commonly adopted by general practitioners in urban areas than those in rural areas |
[46] | Silverman | 2017 | Retrospective database analysis | Prevalence Study (9/9) | Canada | Older patients who presented to a primary care physician with a nonbacterial acute upper respiratory tract infection (8% rural) | Antibiotics were more commonly prescribed by mid- or late-career physicians with high patient volumes as well as those trained outside of the United States or Canada |
[39] | Singer | 2018 | Retrospective cohort study | Cohort Study (8/11) | Canada | 32 urban and rural primary care clinics | A potentially inappropriate antimicrobial prescription was given in 18% of primary care visits. For viral infections, older patients, patients with more comorbidities, more office visits and larger or rural practices were more likely to be prescribed antimicrobials inappropriately. For bacterial infections, female patients, younger age and less office visits were more likely |
[43] | Staub | 2019 | Retrospective database analysis | Prevalence Study (7/9) | United States | Retail pharmacies filling outpatient antibiotic prescriptions | Those born in the 1960s and working in rural practices were more likely to be high prescribers, who tend to prescribe broader-spectrum antibiotics |
[37] | Wang | 2014 | Cross-sectional quantitative study | Cross Sectional Study (6/8) | China | 39 primary health care facilities (23 city and 16 rural primary health care centres) | Antibiotics were frequently prescribed in primary health care centres in China, a large proportion of which were inappropriate |
[56] | Wood | 2007 | Cross-sectional qualitative study | Cross Sectional Study (6/8) | Wales | General practitioners in practices from urban, post-industrial and rural settings | General practitioners' decision to prescribe a broad-spectrum antibiotic over one with narrow spectrum was influenced by clinical considerations, perceptions of patient expectations and organisational pressures. While both stated their desire to best serve their patients and society, high prescribers were more likely to prioritise immediate needs of patients while average prescribers were more likely to acknowledge long-term consequences |
[48] | Yuguero | 2019 | Cross-sectional qualitative study | Cross Sectional Study (7/8) | Spain | 108 general practitioners from 22 primary care centres (54.65% rural) | Prescribing performance was superior in general practitioners who are more empathic, less burned-out, and older |