促进抗菌药物合理使用医学生宣教干预研究
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摘要
背景
全球细菌耐药发展迅速、危害巨大,抗菌药物不合理使用是其主要原因。各国针对抗菌药物不合理使用出台了相应的干预策略、措施,并开展了一系列的干预研究,但是针对医学生的宣教干预研究或是活动很少。
目的
了解医学生抗菌药物合理使用现况,提高医学生对抗菌药物合理使用原则和常识的掌握程度,增强其对细菌耐药危害的认识,促进医学生抗菌药物合理使用正确观念树立,改善其用药行为,从而从源头上促进抗菌药物合理使用。
方法
①设计:华中科技大学同济医学院院内宣教干预,自身前后对照(类试验);
②干预方案:本研究以与抗菌药物使用、细菌耐药预防紧密相关的专业——临床、药学和预防专业——二年级全体学生为对干预对象,对其进行维持一个半月的宣教干预。宣传主要内容包括我国抗菌药物不合理使用现状、不合理使用的危害、抗菌药物使用原则、常见感染性疾病抗菌药物的适用、细菌耐药情况等。宣教材料包括宣传短片和宣传小册子,短片采用课间休息时播放,每两周一次,宣传小册子分发给个人。
③资料收集、分析:本研究采用问卷调查的方式评价干预效果,对干预对象进行分层随机抽样,每个专业各抽取30名,分别在干预前1周、干预后2周内开展。问卷主体部分包括知识、意识、态度和行为四大部分。资料收集后,采用以下方法进行分析:按照得分越高、反映抗菌药物使用越合理的标准,各题被统一转化成分数,并对其进行描述性分析;知识每题正确率专业、性别的差异采用χ2检验,意识、态度和行为每题得分及各部分得分专业、性别的差异,采用方差分析、t检验;干预对知识、意识、态度和行为各部分整体得分的影响采用协方差分析,专业、性别作为协变量。
结果与分析
1.研究在知-信-行等模型或理论的基础上构建了本次干预的理论模型:①通过积累的知识和暗示因素的作用下,人们意识到了问题的严重性和易感性;②在特定的人口学特征、社会环境和知识背景下产生的信念,决定了其态度、判断标准和自我效能;③在前述两个方面的共同影响下,人们产生了行动的意图,最终导致行为的发生。
2.基线时医学生抗菌药物知识掌握有限,总体平均得分为4.21分,对“预防用抗菌药物术后用药时间”以及“流黄绿色浓性鼻涕是否需要使用抗菌药物”回答正确率最低,分别为24.4%和32.2%;意识方面,总体平均得分为16.21,“一些细菌变得很难用抗菌药物治疗”平均得分为4.21分,其次为“限制抗菌药物使用对预防细菌耐药很重要”,平均得分为4.09分;态度方面,总体平均得分为19.82分,医学生不赞同患者要求医务人员开处抗菌药物的行为,平均得分为3.61分,较为赞成使用广谱抗菌药物治疗细菌感染性疾病,平均得分为3.13分;行为方面,总体平均得分为20.39分,发现周围人员不合理用药行为及时纠正得分为3.13分,使用抗菌药物治疗感染性疾病时,感觉病情好转或症状消失即停止使用抗菌药物的行为较为严重,平均得分为2.75分。知识总体得分与意识总体得分存在回归关系(β=0.430,P=0.005),而与态度之间,此关系不明确;意识与行为之间回归关系不确定,而态度与行为之间存在回归关系(β=0.201,P=0.023)。
3.干预后,干预对象知识、意识和态度总体得分有所提高,其中在协方差分析中,知识校正平均得分从4.22分上升到5.07分(P=0.001),而行为校正得分从20.34分降低到20.03分(P=0.515)。医学生在抗菌药物基础知识和适应症的得分改善较大(P值分别为0.000和0.000);进一步意识到不合理使用抗菌药物的严重性,得分从4.04上升到4.29分(P=0.017);逐渐反对患者感冒症状3天即开处抗菌药物治疗(P=0.021);“采用抗菌药物治疗感染性疾病时,感觉病情好转或症状消失即停止”的行为得到改善,但是反映医学生对周围人抗菌药物使用影响方面的两个题目没有改善,平均得分反而下降了约0.2分(差异均无统计学意义)。
结论
医学生有关抗菌药物合理使用的知识掌握差、存在错误的用药行为;本次针对医学生的院内宣教干预措施,提高了医学生在抗菌药物合理使用方面的知识,增强了医学生对抗菌药物合理使用的意识,具有一定的效果;医学生抗菌药物使用的知识与其意识存在回归关系,态度与行为之间也存在此种关系,这与本研究构建的模型一致;要重视医学生抗菌药物合理使用方面的教育,同时必须将抗菌药物合理使用的有关课程纳入到医学生课程中,特别是研究生课程,才能达到长远效果。
创新性
采用干预的方式研究在医学生中开展抗菌药物合理使用促进活动的效果在国内少见;其次本研究在知-信-行模型、健康信念理论、理性行为理论等的基础上构建了一个理论模型,模型具有一定的稳定性,并解释了本次研究的结果。
Background
Antimicrobial resistance is rapidly developing and has caused enormous hazards all over the world. The major causes for the widespread resistance of antimicrobes are attributed to their irrational use. In some countries, kinds of strategies and methods are implemented to intervene on irrational use of antimicrobial, and varities of researches are also excuted; however, there is seldom one about eductation intervention on medical students.
Objective
Find out the medical students’current understanding of rational use of antimicrobial (RUA) and promote RUA from the source of health care, which are achievable through mastering information, increasing awareness, and enhancing the attitudes and behaviors of medical students.
Subjects and Methods
Design
An educational intervention at Tongji Medical College of Huazhong University of Science and Technology, pre-post self-comparison (quasi-experiment) were performed.
Intervention
In this study, sophomores majoring in clinical medicine, pharmacology and preventive medicine, who are closely related to RUA, were selected as the study subjects. The 1.5 months educational interventions were conducted, and the main promotional contents were the irrational use of antimicrobials and their hazards in China, the principles of RUA, prescribing antibacterial medicines for common infectious diseases, bacterial resistance to antimicrobials and so on. The educational materials used included video and pamphlets of RUA. Video was broadcasted during the class intervals, once every two weeks, and pamphlets were distributed to every student.
Data collection and analysis
A questionnaire survey was adopted to evaluate the intervention effects. Subjects were chosen by stratified random sampling, where 30 students in each major were sampled one week before the intervention and two weeks after the intervention, respectively. The questionnaire contained four main parts: knowledge, awareness, attitudes and behaviors. Data were collected and analyzed as the following: First, data were scaled by scores according to a standard i.e., the higher the score the more RUA existed, and were desriptively analyzed. For each knowledge item, differences of genders and majors in correct rates was tested byχ2 test, and differences among scores concerning awareness, attitudes and behaviors were analyzed by t-test and variance analysis; the impact of educational intervention on overall scores of knowledge, awareness, attitude and behavior were done by covariance analysis, with professional and gender as covariates.
Results
1. Based on some models or theories, such as Knowledge- Attitude- belive- Practice model, a model was structed in this study:
a. Influnted by the accumulated knowledge and clues, an awareness of the severity and susceptivity arises;
b. Under certain demographic characters, social circumstance and knowledge background, a belief generates, which determines the attitude, decision criterion and self-efficiency;
c. Affected by the former two aspects combined, intention forms, and graduatedly leads to the real action.
2. At baseline, medical students showed very limited knowledge on RUA, with a total average score (AS) was 4.21; the items "how long should post-surgery antibacterial drug use must lasts" and "whether yellow-green dense nose flow requires antimicrobials or not" got the lowest correct rates, 24.4% and 32.2%, respectively. For the awareness aspect, the total AS was 16.21; the item "some bacteria becoming difficult to treat with antibiotic therapy" got an AS of 4.21, followed by "it is very important to prevent bacterial resistance by restricting antimicrobials use ", with an AS of 4.09. On the attitude aspect, total AS was 19.82, medical students did not agree with patient’s behaviors requiring health professional staff to describe antibacterial medicines (AS was 3.61), and they were in favor of using broad-spectrum antibacterial drug to treat bacterial infection disease (AS was 3.13). On the behavior aspect (total AS was 20.39), medical students reported that“when found some one around with irrational use of antimicrobials, immediate correction of behavior were put into action”, however the AS was only 3.13, and“when felt the health condition turned to better, or symptoms disappeared, cessation of antibacterial use took place”, scored an average of 2.75. The overall score of knowledge had a regression relationship with the overall score of awareness (β=0.430,P=0.005), and was not with overall score of attitude; there were no regression relationship between consciousness and behavior, however attitude had such relationship with behavior (β= 0.201, P = 0.023).
3. After the execution of the educational intervention, the scores of knowledge, awareness and attitude of medical students did improve, with a corrected AS of knowledge increasing from 4.22 to 5.07 (P = 0.001); however, a corrected AS of behavior decreased from 20.34 to 20.03 (P = 0.515). Medical students have had improved their basic knowledge about antibacterial drugs and their indications (P values were both 0.000) and received a higher recognition on that there has been a larger magnitude of irrational use of antimicrobials where AS increased from 4.04 to 4.29 (P = 0.017). Medical students gradually started to oppose the use of antimicrobial for treating flu-like symptoms lasting for three days (P = 0.021); the action of“when felt the health condition turned to better, or symptoms disappeared, cessation of antibacterial use took place”changed better, however, the scores for the two evaluated items which reflected medical students’influence on their prescription of antibacterial for people did not improve, but decreased by about 0.2 points (both were no statistically significal).
Conclusion
Medical students have poor knowledge on RUA as well as having medication. In this study, the executed educational intervention at the medical college did have some effects towards enhancing medical students’knowledge and raising their awareness on RUA. There were regression relationships with knowledge on RUA among medical students and their awareness, while for attitudes were regression to their behaviors, which was consistent with that in the model established in this study. More attention should be paid to medical students’education on RUA; at the same time, courses on RUA must be merged into the curriculum for medical students, especially for the postgraduates, in order to achieve a long-lasting effect.
Innovation
The intervention method were seldom adapted to research on the education effect of promoting RUA among medical students in China; and a Knowledge-awareness-attitude-behavior model was established on the basic of KAP, Health Belife Model, Theroy of Reasoned Action and other models, which got a comparative stability and excellently interpreted the result of this study.
全球细菌耐药发展迅速、危害巨大,抗菌药物不合理使用是其主要原因。各国针对抗菌药物不合理使用出台了相应的干预策略、措施,并开展了一系列的干预研究,但是针对医学生的宣教干预研究或是活动很少。
目的
了解医学生抗菌药物合理使用现况,提高医学生对抗菌药物合理使用原则和常识的掌握程度,增强其对细菌耐药危害的认识,促进医学生抗菌药物合理使用正确观念树立,改善其用药行为,从而从源头上促进抗菌药物合理使用。
方法
①设计:华中科技大学同济医学院院内宣教干预,自身前后对照(类试验);
②干预方案:本研究以与抗菌药物使用、细菌耐药预防紧密相关的专业——临床、药学和预防专业——二年级全体学生为对干预对象,对其进行维持一个半月的宣教干预。宣传主要内容包括我国抗菌药物不合理使用现状、不合理使用的危害、抗菌药物使用原则、常见感染性疾病抗菌药物的适用、细菌耐药情况等。宣教材料包括宣传短片和宣传小册子,短片采用课间休息时播放,每两周一次,宣传小册子分发给个人。
③资料收集、分析:本研究采用问卷调查的方式评价干预效果,对干预对象进行分层随机抽样,每个专业各抽取30名,分别在干预前1周、干预后2周内开展。问卷主体部分包括知识、意识、态度和行为四大部分。资料收集后,采用以下方法进行分析:按照得分越高、反映抗菌药物使用越合理的标准,各题被统一转化成分数,并对其进行描述性分析;知识每题正确率专业、性别的差异采用χ2检验,意识、态度和行为每题得分及各部分得分专业、性别的差异,采用方差分析、t检验;干预对知识、意识、态度和行为各部分整体得分的影响采用协方差分析,专业、性别作为协变量。
结果与分析
1.研究在知-信-行等模型或理论的基础上构建了本次干预的理论模型:①通过积累的知识和暗示因素的作用下,人们意识到了问题的严重性和易感性;②在特定的人口学特征、社会环境和知识背景下产生的信念,决定了其态度、判断标准和自我效能;③在前述两个方面的共同影响下,人们产生了行动的意图,最终导致行为的发生。
2.基线时医学生抗菌药物知识掌握有限,总体平均得分为4.21分,对“预防用抗菌药物术后用药时间”以及“流黄绿色浓性鼻涕是否需要使用抗菌药物”回答正确率最低,分别为24.4%和32.2%;意识方面,总体平均得分为16.21,“一些细菌变得很难用抗菌药物治疗”平均得分为4.21分,其次为“限制抗菌药物使用对预防细菌耐药很重要”,平均得分为4.09分;态度方面,总体平均得分为19.82分,医学生不赞同患者要求医务人员开处抗菌药物的行为,平均得分为3.61分,较为赞成使用广谱抗菌药物治疗细菌感染性疾病,平均得分为3.13分;行为方面,总体平均得分为20.39分,发现周围人员不合理用药行为及时纠正得分为3.13分,使用抗菌药物治疗感染性疾病时,感觉病情好转或症状消失即停止使用抗菌药物的行为较为严重,平均得分为2.75分。知识总体得分与意识总体得分存在回归关系(β=0.430,P=0.005),而与态度之间,此关系不明确;意识与行为之间回归关系不确定,而态度与行为之间存在回归关系(β=0.201,P=0.023)。
3.干预后,干预对象知识、意识和态度总体得分有所提高,其中在协方差分析中,知识校正平均得分从4.22分上升到5.07分(P=0.001),而行为校正得分从20.34分降低到20.03分(P=0.515)。医学生在抗菌药物基础知识和适应症的得分改善较大(P值分别为0.000和0.000);进一步意识到不合理使用抗菌药物的严重性,得分从4.04上升到4.29分(P=0.017);逐渐反对患者感冒症状3天即开处抗菌药物治疗(P=0.021);“采用抗菌药物治疗感染性疾病时,感觉病情好转或症状消失即停止”的行为得到改善,但是反映医学生对周围人抗菌药物使用影响方面的两个题目没有改善,平均得分反而下降了约0.2分(差异均无统计学意义)。
结论
医学生有关抗菌药物合理使用的知识掌握差、存在错误的用药行为;本次针对医学生的院内宣教干预措施,提高了医学生在抗菌药物合理使用方面的知识,增强了医学生对抗菌药物合理使用的意识,具有一定的效果;医学生抗菌药物使用的知识与其意识存在回归关系,态度与行为之间也存在此种关系,这与本研究构建的模型一致;要重视医学生抗菌药物合理使用方面的教育,同时必须将抗菌药物合理使用的有关课程纳入到医学生课程中,特别是研究生课程,才能达到长远效果。
创新性
采用干预的方式研究在医学生中开展抗菌药物合理使用促进活动的效果在国内少见;其次本研究在知-信-行模型、健康信念理论、理性行为理论等的基础上构建了一个理论模型,模型具有一定的稳定性,并解释了本次研究的结果。
Background
Antimicrobial resistance is rapidly developing and has caused enormous hazards all over the world. The major causes for the widespread resistance of antimicrobes are attributed to their irrational use. In some countries, kinds of strategies and methods are implemented to intervene on irrational use of antimicrobial, and varities of researches are also excuted; however, there is seldom one about eductation intervention on medical students.
Objective
Find out the medical students’current understanding of rational use of antimicrobial (RUA) and promote RUA from the source of health care, which are achievable through mastering information, increasing awareness, and enhancing the attitudes and behaviors of medical students.
Subjects and Methods
Design
An educational intervention at Tongji Medical College of Huazhong University of Science and Technology, pre-post self-comparison (quasi-experiment) were performed.
Intervention
In this study, sophomores majoring in clinical medicine, pharmacology and preventive medicine, who are closely related to RUA, were selected as the study subjects. The 1.5 months educational interventions were conducted, and the main promotional contents were the irrational use of antimicrobials and their hazards in China, the principles of RUA, prescribing antibacterial medicines for common infectious diseases, bacterial resistance to antimicrobials and so on. The educational materials used included video and pamphlets of RUA. Video was broadcasted during the class intervals, once every two weeks, and pamphlets were distributed to every student.
Data collection and analysis
A questionnaire survey was adopted to evaluate the intervention effects. Subjects were chosen by stratified random sampling, where 30 students in each major were sampled one week before the intervention and two weeks after the intervention, respectively. The questionnaire contained four main parts: knowledge, awareness, attitudes and behaviors. Data were collected and analyzed as the following: First, data were scaled by scores according to a standard i.e., the higher the score the more RUA existed, and were desriptively analyzed. For each knowledge item, differences of genders and majors in correct rates was tested byχ2 test, and differences among scores concerning awareness, attitudes and behaviors were analyzed by t-test and variance analysis; the impact of educational intervention on overall scores of knowledge, awareness, attitude and behavior were done by covariance analysis, with professional and gender as covariates.
Results
1. Based on some models or theories, such as Knowledge- Attitude- belive- Practice model, a model was structed in this study:
a. Influnted by the accumulated knowledge and clues, an awareness of the severity and susceptivity arises;
b. Under certain demographic characters, social circumstance and knowledge background, a belief generates, which determines the attitude, decision criterion and self-efficiency;
c. Affected by the former two aspects combined, intention forms, and graduatedly leads to the real action.
2. At baseline, medical students showed very limited knowledge on RUA, with a total average score (AS) was 4.21; the items "how long should post-surgery antibacterial drug use must lasts" and "whether yellow-green dense nose flow requires antimicrobials or not" got the lowest correct rates, 24.4% and 32.2%, respectively. For the awareness aspect, the total AS was 16.21; the item "some bacteria becoming difficult to treat with antibiotic therapy" got an AS of 4.21, followed by "it is very important to prevent bacterial resistance by restricting antimicrobials use ", with an AS of 4.09. On the attitude aspect, total AS was 19.82, medical students did not agree with patient’s behaviors requiring health professional staff to describe antibacterial medicines (AS was 3.61), and they were in favor of using broad-spectrum antibacterial drug to treat bacterial infection disease (AS was 3.13). On the behavior aspect (total AS was 20.39), medical students reported that“when found some one around with irrational use of antimicrobials, immediate correction of behavior were put into action”, however the AS was only 3.13, and“when felt the health condition turned to better, or symptoms disappeared, cessation of antibacterial use took place”, scored an average of 2.75. The overall score of knowledge had a regression relationship with the overall score of awareness (β=0.430,P=0.005), and was not with overall score of attitude; there were no regression relationship between consciousness and behavior, however attitude had such relationship with behavior (β= 0.201, P = 0.023).
3. After the execution of the educational intervention, the scores of knowledge, awareness and attitude of medical students did improve, with a corrected AS of knowledge increasing from 4.22 to 5.07 (P = 0.001); however, a corrected AS of behavior decreased from 20.34 to 20.03 (P = 0.515). Medical students have had improved their basic knowledge about antibacterial drugs and their indications (P values were both 0.000) and received a higher recognition on that there has been a larger magnitude of irrational use of antimicrobials where AS increased from 4.04 to 4.29 (P = 0.017). Medical students gradually started to oppose the use of antimicrobial for treating flu-like symptoms lasting for three days (P = 0.021); the action of“when felt the health condition turned to better, or symptoms disappeared, cessation of antibacterial use took place”changed better, however, the scores for the two evaluated items which reflected medical students’influence on their prescription of antibacterial for people did not improve, but decreased by about 0.2 points (both were no statistically significal).
Conclusion
Medical students have poor knowledge on RUA as well as having medication. In this study, the executed educational intervention at the medical college did have some effects towards enhancing medical students’knowledge and raising their awareness on RUA. There were regression relationships with knowledge on RUA among medical students and their awareness, while for attitudes were regression to their behaviors, which was consistent with that in the model established in this study. More attention should be paid to medical students’education on RUA; at the same time, courses on RUA must be merged into the curriculum for medical students, especially for the postgraduates, in order to achieve a long-lasting effect.
Innovation
The intervention method were seldom adapted to research on the education effect of promoting RUA among medical students in China; and a Knowledge-awareness-attitude-behavior model was established on the basic of KAP, Health Belife Model, Theroy of Reasoned Action and other models, which got a comparative stability and excellently interpreted the result of this study.
引文
1.包定元.抗菌药物概述.见:向继洲主编.药理学.北京:科学出版社,2002. 421~431
2. WHO. Antimicrobial resistance. http://www.who.int/mediacentre/factsheets/fs194/en/
3. Byarugaba DK. A view on antimicrobial resistance in developing countries and responsible risk factors. International Journal of Antimicrobial Agents, 2004, 24: 105~110
4.余自成.细菌耐药性的流行趋势及其控制措施.世界临床药物, 2006, 27(3): 169
5. WHO. The big guns of resistance. http://www.who.int/infectious-disease-report/2000/ch4.htm
6. Goossens H, Ferech M, Vander SR, et al. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet, 2005, 365:579~87
7. Palmer NO, Martin MV, Pealing R, et al. An analysis of antibiotic prescriptions from general dental practitioners in England. J Antimicrob Chemother, 2000, 46:1033~1035.
8.唐宏.抗生素损害人类健康之忧:是否回到黑暗时代. http://tech.sina.com.cn/d/2005-01-13/1801503769.shtml
9.张新平,李少丽主编.药物政策学.第一版.北京:科技出版社, 2003: 130~155
10. Kathy Holloway. Irrational Use of Medicines Is a Global Problem. INRUD NEWS, December 2006: 3~5
11. WHO. WHO Global Strategy for Containment of Antimicrobial Resistance. Switzerland: WHO, 2001.
12.杨晓军,吴万征,吴雪梅,等. 2002年-2004年我院抗菌药物的使用与细菌耐药性分析.中国药房, 2006, 17 (8):556, 595~596
13. le Grand A, Hogerzeil HV, Haaijer-Ruskamp FM.Intervention research in rational use of drugs: a review. Health Policy Plan. 1999, 14(2):89~102
14.田丽娟,于培明.我国不合理用药原因分析及对策探讨.中国药房, 2005, 16 (16): 1204~1206
15.张新平,王贤吉.不合理用药的原因研究.中国初级卫生保健, 2005, 19(12):23~26
16.孙家跃.医院不合理用药现状分析及对策.安徽医药, 2005, 9(10): 784~785
17. CDC of USA. CDC 12-Step program to prevent antimicrobial resistance in health care settings. [CDC antimicrobial resistance website] 2000. Available at: http://www.cdc.gov/drugresistance/healthcare/default.html.
18. Principles and strategies to limit the spread of antimicrobial resistance http://www.idsociety.org/Template.cfm?Section=Antimicrobial_Resistance.
19.中华人民共和国卫生部,国家中医药管理局,总后卫生部.关于施行《抗菌药物临床应用指导原则》的通知. http://www.sda.gov.cn/WS01/CL0056/10752.html
20. Pshetizky Y, Naimer S, Shvartzman P. Acute otitis media--a brief explanation to parents and antibiotic use. Fam Pract. 2003, 20(4):417~419
21. Taylor JA, Kwan-Gett TS, McMahon EM. Effectiveness of an educational intervention in modifying parental attitudes about antibiotic usage in children. Pediatrics. 2003, 111(5 Pt 1):e548~554
22. Briel M, Langewitz W, Tschudi P, Young J, et al. Communication training and antibiotic use in acute respiratory tract infections. A cluster randomised controlled trial in general practice. Swiss Med Wkly. 2006, 136(15-16):241~247
23. Doyne EO, Alfaro MP, Siegel RM, et al. A randomized controlled trial to change antibiotic prescribing patterns in a community. Arch Pediatr Adolesc Med. 2004, 158(6):577~583
24. Wheeler JG, Fair M, Simpson PM, et al. Impact of a waiting room videotape message on parent attitudes toward pediatric antibiotic use. Pediatrics. 2001, 108(3):591~596
25. Belongia EA, Sullivan BJ, Chyou PH, et al. A community intervention trial to promote judicious antibiotic use and reduce penicillin~ resistant Streptococcus pneumoniae carriage in children. Pediatrics. 2001, 108(3):575~583
26. Razon Y, Ashkenazi S, Cohen A, et al. Effect of educational intervention on antibiotic prescription practices for upper respiratory infections in children: a multicentre study. J Antimicrob Chemother. 2005, 56(5):937~940
27. Juzych NS, Banerjee M, Essenmacher L, Lerner SA. Improvements in antimicrobial prescribing for treatment of upper respiratory tract infections through provider education. J Gen Intern Med. 2005, 20(10):901~905
28. Dollman WB, LeBlanc VT, Stevens L, et al. A community~based intervention to reduce antibiotic use for upper respiratory tract infections in regional South Australia. Med J Aust. 2005, 182(12):617~620
29. WHO. How to develop and implement a national drug policy(Second edition).Malaya: WHO, 2001.
30. The Interdepartmental Steering Group on Resistance to Antibiotics and other Antimicrobial Agents Clinical Prescribing Subgroup 2001. Optimizing the clinical useof antimicrobials: Report and recommendations for further work. http://www.dh.gov.uk/assetRoot/~04/06/56/22/04065622.pdf
31.马骁主编.健康教育学.北京:人民卫生出版社, 2004.
32. Baranowski T, Cullen KW, Nicklas T, Thompson D, Baranowski J. Are current health behavioral change models helpful in guiding prevention of weight gain efforts? Obes Res 2003, 11(Suppl):S23~S43
33. Sara M. Baker, Richard E. Petty, and Faith Gleicher. Persuasion Theory and Drug Abuse Prevention. HEALTH COMMUNICATION, 1991, 3(4):193~203
34.熊明生.锻炼健康信念模型及其研究评述.湖北体育科技,2004,23(3):323~324, 329.
35. Glanz, K., Rimer, B.K. & Lewis, F.M. Health Behavior and Health Education. Theory, Research and Practice. San Fransisco: Wiley & Sons, 2002. http://www.tcw.utwente.nl/theorieenoverzicht/Theory%20clusters/Health%20Communication/Health_Belief_Model.doc/
36. John P. Elder, Guadalupe X. Ayala, Stewart Harris. Theories and Intervention Approaches to Health~Behaviour Change. ttp://www.cacr.ca/news/2002/0212elder.htm
37. Smith, M. K. (1999) 'Learning theory', the encyclopedia of informal education. www.infed.org/biblio/b~learn.htm, Last update: December 04, 2007
38. WHO. Interventions and strategies to improve the use of antimicrobials in developing countries. Switzerland: WHO, 2001.
39. Conan MacDougall, Ron E. Polk. Antimicrobial Stewardship Programs in Health Care Systems. CLINICAL MICROBIOLOGY REVIEWS, 2005, 18(4):638~656
40. Timothy H. Dellit, Robert C. Owens, John E. McGowan, etc. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship. Clinical Infectious Diseases, 2007, 44:159~177
41.胡清伟.医学教学与合理使用抗生素.检验医学与临床, 2007, 4(8): 785~786
42.高晓虹,马莉,张翠丽,等.高年级医学生抗生素认知情况调查.中国医师杂志,2005,7(2):282~283
43.马莉,高晓虹,李晓枫,等.加强医学生对抗生素认识的医学教育.卫生职业教育, 2005, 23(16):27~28
44. Wright EP and Jain P. Survey of antibiotic knowledge amongst final year medical students. The Journal of Antimicrobial Chemotherapy, 2004, 53(3): 550
45. Bauchner H, Osganian S, Smith K, et al. Improving parent knowledge about antibiotics:a video intervention. Pediatrics, 2001, 108(4): 845~850
46.叶利贞.大学生抗生素应用认知及行为的健康教育效果评价.中国学校卫生, 2004, 25(4):196
47.刘皈阳,柴栋,钱皎,等.医务人员抗菌药物合理应用知识水平调查.药物不良反应杂志, 2005, 7(3):175~178
48.曾颖,佃少娜,杨敏.对我院医务人员抗菌药物合理应用知识水平的调查与分析.中国药房,2006,17(24):1915~1916
49.许顺清,王育英,王国鼐,等.对泉州市县级以上医务人员合理使用抗菌药物知识的调查.海峡药学, 2004, 16(6): 138~139
50. Standing Medical Advisory Committee, Sub~Group on Antimicrobial Resistance. The path of least resistance. Department of Health, HK, 1998. 98
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1. WHO. Media Center Fact sheet N°194, 2002. http://www.who.int/mediacentre/factsheets/fs194/en/
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3.余自成.细菌耐药性的流行趋势及其控制措施.世界临床药物, 2006, 27(3):169
4.蒋红霞,曾振灵.细菌耐药机制及耐药性控制对策.动物医学进展, 2001, 22(4):4~7
5. Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infection, 1999. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol, 1999, 20:250~278
6. Anucha Apisarnthanarak, Somwang Danchaivijitr, Thana hawcharoenporn, etc. Effectiveness of Education and an Antibiotic-Control Program in a Tertiary Care Hospital in Thailand. Clinical Infectious Diseases, 2006, 42:768~775
7. WHO. WHO Global Strategy for Containment of Antimicrobial Resistance. Switzerland: WHO, 2001.
8.唐宏.抗生素损害人类健康之忧:是否回到黑暗时代. http://tech.sina.com.cn/d/2005-01-13/1801503769.shtml
9.张新平,李少丽主编.药物政策学.第一版.北京:科技出版社, 2003. 130~155
10. Kathy Holloway. Irrational Use of Medicines Is a Global Problem. INRUD NEWS, December 2006:3~5
11. Rekha Murthy. Implementation of Strategies to Control Antimicrobial Resistance. Chest, 2001, 119:405-411. http://www.chestjournal.org/cgi/content/full/119/2_suppl/405S
12. WHO. Interventions and strategies to improve the use of antimicrobials in developing countries. WHO: Switzerland, 2001.
13. Conan MacDougall and Ron E. Polk. Antimicrobial Stewardship Programs in Health Care Systems. CLINICAL MICROBIOLOGY REVIEWS, 2005, 18(4):638~656
14. Timothy H. Dellit, Robert C. Owens, John E. McGowan, etc. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship. Clinical Infectious Diseases, 2007, 44:159~177
15. Briel M, Langewitz W, Tschudi P, Young J, et al. Communication training and antibiotic use in acute respiratory tract infections. A cluster randomised controlled trial in general practice. Swiss Med Wkly, 2006, 136(15-16):241~247
16. Razon Y, Ashkenazi S, Cohen A, et al. Effect of educational intervention on antibiotic prescription practices for upper respiratory infections in children: a multicentre study. J Antimicrob Chemother, 2005, 56(5):937~940
17. Juzych NS, Banerjee M, Essenmacher L, Lerner SA. Improvements in antimicrobial prescribing for treatment of upper respiratory tract infections through provider education. J Gen Intern Med, 2005, 20(10):901~905
18. Dollman WB, LeBlanc VT, Stevens L, et al. A community-based intervention to reduce antibiotic use for upper respiratory tract infections in regional South Australia. Med J Aust, 2005, 182(12):617~620
19. Gonzales R, Corbett KK, Leeman-Castillo BA, Glazner J, Erbacher K, Darr CA, Wong S, Maselli JH, Sauaia A, Kafadar K. The "minimizing antibiotic resistance in Colorado" project: impact of patient education in improving antibiotic use in private office practices. Health Serv Res, 2005, 40(1):101~116
20. Doyne EO, Alfaro MP, Siegel RM, et al. A randomized controlled trial to change antibiotic prescribing patterns in a community. Arch Pediatr Adolesc Med, 2004, 158(6):577~583
21. Pshetizky Y, Naimer S, Shvartzman P. Acute otitis media--a brief explanation to parents and antibiotic use. Fam Pract, 2003, 20(4):417~419
22. Harris RH, MacKenzie TD, Leeman-Castillo B, et al. Optimizing antibiotic prescribingfor acute respiratory tract infections in an urban urgent care clinic. J Gen Intern Med. 2003, 18(5):326~334
23. Taylor JA, Kwan-Gett TS, McMahon EM Jr. Effectiveness of an educational intervention in modifying parental attitudes about antibiotic usage in children. Pediatrics, 2003, 111(5 Pt 1):e548~554
24. Perz JF, Craig AS, Coffey CS, Jorgensen DM, Mitchel E, Hall S, Schaffner W, Griffin MR. Changes in antibiotic prescribing for children after a community-wide campaign. JAMA, 2002, 287(23):3103~3109
25. Macfarlane J, Holmes W, Gard P, et al. Reducing antibiotic use for acute bronchitis in primary care: blinded, randomised controlled trial of patient information leaflet. BMJ, 2002, 324(7329):91~94
26. Bauchner H, Osganian S, Smith K, Triant R. Improving parent knowledge about antibiotics: a video intervention. Pediatrics, 2001, 108(4):845~850
27. Wheeler JG, Fair M, Simpson PM, et al. Impact of a waiting room videotape message on parent attitudes toward pediatric antibiotic use. Pediatrics, 2001, 108(3):591~596
28. Belongia EA, Sullivan BJ, Chyou PH, et al. A community intervention trial to promote judicious antibiotic use and reduce penicillin-resistant Streptococcus pneumoniae carriage in children. Pediatrics, 2001, 108(3):575~583
29. Finkelstein JA, Davis RL, Dowell SF, et al. Reducing antibiotic use in children: a randomized trial in 12 practices. Pediatrics, 2001, 108(1):1~7
30. Trepka MJ, Belongia EA, Chyou PH, et al. The effect of a community intervention trial on parental knowledge and awareness of antibiotic resistance and appropriate antibiotic use in children. Pediatrics, 2001, 107(1):E6
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32. Philip Carling, Teresa Fung, Ann Killion, Norma Terrin, et al. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol, 2003, 24(9):699~706
33. Jan Jelrik Oosterheert, Marc J M Bonten, Margriet M E Schneider, et al. Effectiveness of early switch from intravenous to oral antibiotics in severe community acquired pneumonia: multicentre randomised trial. BMJ, 2006, 333:1193-1197; BMJ, doi:10.1136/bmj.38993.560984.BE
34. Laurence Senn, Bernard Burnand, Patrick Francioli, et al. Improving appropriateness ofantibiotic therapy: randomized trial of an intervention to foster reassessment of prescription after 3 days. J Antimicrob Chemother, 2004, 53(6):1062~1067
35. Ansari F, Gray K, Nathwani D, etc. Outcomes of an intervention to improve hospital antibiotic prescribing: interrupted time series with segmented regression analysis. J Antimicrob Chemother, 2003, 52(5):842~848
36. Sintchenko V, Coiera E, Iredell JR, Gilbert GL. Comparative impact of guidelines, clinical data, and decision support on prescribing decisions: an interactive web experiment with simulated cases. J Am Med Inform Assoc, 2004, 11(1):71~77
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38. Anucha Apisarnthanarak, Somwang Danchaivijitr, Thana hawcharoenporn, etc. Effectiveness of Education and an Antibiotic-Control Program in a Tertiary Care Hospital in Thailand. Clinical Infectious Diseases, 2006, 42:768~775
39. Michael A. Rubin, Kim Bateman, Stephen Alder, et al. A Multifaceted Intervention to Improve Antimicrobial Prescribing for Upper Respiratory Tract Infections in a Small Rural Community. Clinical Infectious Diseases, 2005, 40:546~553
40. Greene RA, Beckman H, Chamberlain J, et al. Increasing adherence to a community-based guideline for acute sinusitis through education, physician profiling, and financial incentives. Am J Manag Care, 2004, 10(10):670~678.
41. Welschen I, Kuyvenhoven MM, Hoes AW, Verheij TJ. Effectiveness of a multiple intervention to reduce antibiotic prescribing for respiratory tract symptoms in primary care: randomised controlled trial. BMJ, 2004, 329(7463):431
42. Coenen S, Van Royen P, Michiels B, Denekens J. Optimizing antibiotic prescribing for acute cough in general practice: a cluster-randomized controlled trial. J Antimicrob Chemother, 2004, 54(3):661~672
43. Halm EA, Horowitz C, Silver A, et al. Limited impact of a multicenter intervention to improve the quality and efficiency of pneumonia care. Chest, 2004, 126(1):100~107
44. Zwar N, Wolk J, Gordon J, et al. Influencing antibiotic prescribing in general practice: a trial of prescriber feedback and management guidelines. Fam Pract, 1999, 16(5):495~500
45. Palmer NA, Dailey YM, Martin MV. Can audit improve antibiotic prescribing in general dental practice? Br Dent J, 2001, 191(5):253~255
46. Gonzales R, Steiner JF, Lum A, et al. Decreasing antibiotic use in ambulatory practice:impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. JAMA, 1999, 281(16):1512~1519
47.赵烁伟.农村社区不合理使用抗生素及激素的控制探索.中国初级卫生保健, 2005, 19(5):12~13
2. WHO. Antimicrobial resistance. http://www.who.int/mediacentre/factsheets/fs194/en/
3. Byarugaba DK. A view on antimicrobial resistance in developing countries and responsible risk factors. International Journal of Antimicrobial Agents, 2004, 24: 105~110
4.余自成.细菌耐药性的流行趋势及其控制措施.世界临床药物, 2006, 27(3): 169
5. WHO. The big guns of resistance. http://www.who.int/infectious-disease-report/2000/ch4.htm
6. Goossens H, Ferech M, Vander SR, et al. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet, 2005, 365:579~87
7. Palmer NO, Martin MV, Pealing R, et al. An analysis of antibiotic prescriptions from general dental practitioners in England. J Antimicrob Chemother, 2000, 46:1033~1035.
8.唐宏.抗生素损害人类健康之忧:是否回到黑暗时代. http://tech.sina.com.cn/d/2005-01-13/1801503769.shtml
9.张新平,李少丽主编.药物政策学.第一版.北京:科技出版社, 2003: 130~155
10. Kathy Holloway. Irrational Use of Medicines Is a Global Problem. INRUD NEWS, December 2006: 3~5
11. WHO. WHO Global Strategy for Containment of Antimicrobial Resistance. Switzerland: WHO, 2001.
12.杨晓军,吴万征,吴雪梅,等. 2002年-2004年我院抗菌药物的使用与细菌耐药性分析.中国药房, 2006, 17 (8):556, 595~596
13. le Grand A, Hogerzeil HV, Haaijer-Ruskamp FM.Intervention research in rational use of drugs: a review. Health Policy Plan. 1999, 14(2):89~102
14.田丽娟,于培明.我国不合理用药原因分析及对策探讨.中国药房, 2005, 16 (16): 1204~1206
15.张新平,王贤吉.不合理用药的原因研究.中国初级卫生保健, 2005, 19(12):23~26
16.孙家跃.医院不合理用药现状分析及对策.安徽医药, 2005, 9(10): 784~785
17. CDC of USA. CDC 12-Step program to prevent antimicrobial resistance in health care settings. [CDC antimicrobial resistance website] 2000. Available at: http://www.cdc.gov/drugresistance/healthcare/default.html.
18. Principles and strategies to limit the spread of antimicrobial resistance http://www.idsociety.org/Template.cfm?Section=Antimicrobial_Resistance.
19.中华人民共和国卫生部,国家中医药管理局,总后卫生部.关于施行《抗菌药物临床应用指导原则》的通知. http://www.sda.gov.cn/WS01/CL0056/10752.html
20. Pshetizky Y, Naimer S, Shvartzman P. Acute otitis media--a brief explanation to parents and antibiotic use. Fam Pract. 2003, 20(4):417~419
21. Taylor JA, Kwan-Gett TS, McMahon EM. Effectiveness of an educational intervention in modifying parental attitudes about antibiotic usage in children. Pediatrics. 2003, 111(5 Pt 1):e548~554
22. Briel M, Langewitz W, Tschudi P, Young J, et al. Communication training and antibiotic use in acute respiratory tract infections. A cluster randomised controlled trial in general practice. Swiss Med Wkly. 2006, 136(15-16):241~247
23. Doyne EO, Alfaro MP, Siegel RM, et al. A randomized controlled trial to change antibiotic prescribing patterns in a community. Arch Pediatr Adolesc Med. 2004, 158(6):577~583
24. Wheeler JG, Fair M, Simpson PM, et al. Impact of a waiting room videotape message on parent attitudes toward pediatric antibiotic use. Pediatrics. 2001, 108(3):591~596
25. Belongia EA, Sullivan BJ, Chyou PH, et al. A community intervention trial to promote judicious antibiotic use and reduce penicillin~ resistant Streptococcus pneumoniae carriage in children. Pediatrics. 2001, 108(3):575~583
26. Razon Y, Ashkenazi S, Cohen A, et al. Effect of educational intervention on antibiotic prescription practices for upper respiratory infections in children: a multicentre study. J Antimicrob Chemother. 2005, 56(5):937~940
27. Juzych NS, Banerjee M, Essenmacher L, Lerner SA. Improvements in antimicrobial prescribing for treatment of upper respiratory tract infections through provider education. J Gen Intern Med. 2005, 20(10):901~905
28. Dollman WB, LeBlanc VT, Stevens L, et al. A community~based intervention to reduce antibiotic use for upper respiratory tract infections in regional South Australia. Med J Aust. 2005, 182(12):617~620
29. WHO. How to develop and implement a national drug policy(Second edition).Malaya: WHO, 2001.
30. The Interdepartmental Steering Group on Resistance to Antibiotics and other Antimicrobial Agents Clinical Prescribing Subgroup 2001. Optimizing the clinical useof antimicrobials: Report and recommendations for further work. http://www.dh.gov.uk/assetRoot/~04/06/56/22/04065622.pdf
31.马骁主编.健康教育学.北京:人民卫生出版社, 2004.
32. Baranowski T, Cullen KW, Nicklas T, Thompson D, Baranowski J. Are current health behavioral change models helpful in guiding prevention of weight gain efforts? Obes Res 2003, 11(Suppl):S23~S43
33. Sara M. Baker, Richard E. Petty, and Faith Gleicher. Persuasion Theory and Drug Abuse Prevention. HEALTH COMMUNICATION, 1991, 3(4):193~203
34.熊明生.锻炼健康信念模型及其研究评述.湖北体育科技,2004,23(3):323~324, 329.
35. Glanz, K., Rimer, B.K. & Lewis, F.M. Health Behavior and Health Education. Theory, Research and Practice. San Fransisco: Wiley & Sons, 2002. http://www.tcw.utwente.nl/theorieenoverzicht/Theory%20clusters/Health%20Communication/Health_Belief_Model.doc/
36. John P. Elder, Guadalupe X. Ayala, Stewart Harris. Theories and Intervention Approaches to Health~Behaviour Change. ttp://www.cacr.ca/news/2002/0212elder.htm
37. Smith, M. K. (1999) 'Learning theory', the encyclopedia of informal education. www.infed.org/biblio/b~learn.htm, Last update: December 04, 2007
38. WHO. Interventions and strategies to improve the use of antimicrobials in developing countries. Switzerland: WHO, 2001.
39. Conan MacDougall, Ron E. Polk. Antimicrobial Stewardship Programs in Health Care Systems. CLINICAL MICROBIOLOGY REVIEWS, 2005, 18(4):638~656
40. Timothy H. Dellit, Robert C. Owens, John E. McGowan, etc. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship. Clinical Infectious Diseases, 2007, 44:159~177
41.胡清伟.医学教学与合理使用抗生素.检验医学与临床, 2007, 4(8): 785~786
42.高晓虹,马莉,张翠丽,等.高年级医学生抗生素认知情况调查.中国医师杂志,2005,7(2):282~283
43.马莉,高晓虹,李晓枫,等.加强医学生对抗生素认识的医学教育.卫生职业教育, 2005, 23(16):27~28
44. Wright EP and Jain P. Survey of antibiotic knowledge amongst final year medical students. The Journal of Antimicrobial Chemotherapy, 2004, 53(3): 550
45. Bauchner H, Osganian S, Smith K, et al. Improving parent knowledge about antibiotics:a video intervention. Pediatrics, 2001, 108(4): 845~850
46.叶利贞.大学生抗生素应用认知及行为的健康教育效果评价.中国学校卫生, 2004, 25(4):196
47.刘皈阳,柴栋,钱皎,等.医务人员抗菌药物合理应用知识水平调查.药物不良反应杂志, 2005, 7(3):175~178
48.曾颖,佃少娜,杨敏.对我院医务人员抗菌药物合理应用知识水平的调查与分析.中国药房,2006,17(24):1915~1916
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