Pattern of antibiotic prescribing and factors associated with it in eight village clinics in rural Shandong Province, China: a descriptive study

BACKGROUND: This study describes the patterns of antibiotic prescribing in eight village clinics in rural China and evaluates factors associated with antibiotic prescribing using quantitative and qualitative methods. METHODS: From January 2015 to July 2017, 60 prescriptions were collected monthly from selected village clinics in Shandong, China. Village clinic doctors completed a questionnaire regarding their knowledge of antibiotic prescribing. Semi-structured interviews were conducted with 15 village doctors and 1 deputy director from the township hospital. RESULTS: Of the 14 526 prescriptions collected, 5851 (40.3%) contained at least one antibiotic, among which 18.4% had two or more antibiotics and 24.3% had parenteral antibiotics. The antibiotic prescribing rate (β=-0.007 [95% confidence interval -0.009 to -0.004]) showed a declining trend (1.7% per month). Higher antibiotic prescribing rates were observed for patients <45 y of age and those diagnosed with upper respiratory tract infections and among village doctors who had less working experience and a lower level of knowledge on antibiotic prescribing. Qualitative analyses suggested that antibiotic prescribing was influenced by the patients' symptoms, patients' requests, policies restraining the overuse of antibiotics, subsidies for referral and routine village doctor training. CONCLUSIONS: Antibiotic prescribing has declined in the included village clinics, which may be due to the policy of reducing antibiotic overuse in primary health care centres in China.