รูปแบบและปัจจัยที่ส่งผลต่อความเหมาะสมในการสั่งใช้ยา ปฏิชีวนะ สำหรับผู้ป่วยโรคติดเชื้อทางเดินหายใจส่วนบน ในโรงพยาบาลส่งเสริมสุขภาพตำบลในเขตอำเภอสามเงา จังหวัดตาก

Abstract

This descriptive study aimed to study antibiotic prescribing patterns for patients with upper respiratory tract infections among healthcare personal at Tambon health promoting hospitals in Samngao district, Tak province; and to identify factors influencing the antibiotic prescribing behaviors. The target samples were 440 patients with upper respiratory tract infection selected by multistage sampling. Their patient information records were retrieved from JHCIS database at Tambon health promotion hospitals in Samngao district, Tak province during Octobert 1, 2011 to September 30, 2012. The prescribing patterns were compared against the standard criteria of the National Antibiotic Smart Use program (ASU). The results showed that almost half of the patient received antibiotics for upper respiratory tract infection treatment. Of those receiving antibiotics, 40.68% were prescribed inappropriately as 38.18% of them received antibiotics without appropriate indication, especially found in pharyngitis and tonsillitis cases. Factors influencing the inappropriate prescribing behaviors included disease condition and prescriber’s length of experience. Patients with otitis media were significantly more likely to received inappropriate antibiotic prescription than those with common cold, OR otitis media/ common cold = 79.20 (95% CI = 9.87-635.49), p ≤. 0.001. Patients with tonsillitis were significantly more likely to received inappropriate antibiotic prescription than those with common cold, OR tonsillitis / common cold = 40.00 (95% CI = 17.86-89.54), p ≤. 0.001. Patients with pharyngitis were significantly more likely to received inappropriate antibiotic prescription than those with common cold, OR pharyngitis / common cold = 31.74 (95% CI = 17.42-57.84), p ≤. 0.001. Patients with sinusitis were significantly more likely to received inappropriate antibiotic prescription than those with common cold, OR sinusitis / common cold = 21.60 (95% CI = 2.17-214.40), p =. 0.009. Prescribers having more than 20 years and having 11-20 years of experience were more likely to inappropriately prescribe antibiotic than those having less than 10 years of experience, significantly; OR > 20 years / <10 years = 3.10 (95% CI = 1.86-5.17), p ≤. 0.001 and OR 11- 20 years / <10 years = 3.02 (95% CI = 1.75-5.22), p ≤ 0.001. The study findings could be concluded that the majority of healthcare personal at Tambon health promoting hospitals in Samngao district, Tak province inappropriately prescribed antibiotic for patients with upper respiratory tract infection. The major reason might be an inability to make clear disease diagnosis in order to make decision for prescribing antibiotic appropriately. Therefore, they are in need for better knowledge about diagnosis, dose and duration of antibiotic use, especially among those with more than ten years of working experience.