Access to medicines for acute illness and antibiotic use in residents: A medicines household survey in Sichuan Province, western China

Pengqing Deng,Jianlong Yu,Naitong Zhou,Ming Hu,Jing Sun

doi:10.1371/journal.pone.0201349

Abstract

ObjectiveTo investigate medicine accessibility and antibiotic use in households in western China using World Health Organization (WHO) methodology as well as to identify the influencing factor of care-seeking outside the home and primary determinant factors that influence the use of antibiotics in Chinese residents.MethodsA cross-sectional household survey was conducted from March to July 2015, and 1200 households from six cities in Sichuan China were selected for a questionnaire survey using stratified multistage random cluster sampling. We used logistic regression models to identify the determinants of care-seeking outside the home and subsequent antibiotic use among the surveyed residents.ResultsOverall, 1103 valid questionnaires were collected, and 458 households reported that they had had experienced at least one acute illness in the previous 2 weeks. Of these households, 97.2% of individuals with acute conditions sought care outside their homes and 40.1% of individuals who took medicine received antibiotics. Only 15.9% of the individuals with acute conditions reported that the medical insurance reimbursement covered at least one medicine. According to the multivariate analyses, women were less likely to seek care outside the home compared to men. Among those who sought outside care, fever and upper respiratory symptoms increased the odds of taking antibiotics, and visiting a private hospital also increased antibiotic use. Low-income households were less likely to receive antibiotics. Symptoms were strong determinants of antibiotic use when patients sought outside care.ConclusionThe accessibility of medicine for acute illness among households in western China was favorable; however, medical insurance reimbursement must be improved. The nature of the symptoms and patterns of care-seeking had the greatest influence on the decision to take antibiotics among residents with acute conditions. The percentage of antibiotic use in patients with acute illness has declined, but the indications for using antibiotics must be standardized.

Highlights

Acute health conditions are characterized by the sudden onset of and rapid change in symptoms, a typical course of illness, and a finite duration if the illness is self-limiting or effectively treated.[1]
15.9% of the individuals with acute conditions reported that the medical insurance reimbursement covered at least one medicine
Among those who sought outside care, fever and upper respiratory symptoms increased the odds of taking antibiotics, and visiting a private hospital increased antibiotic use

Summary

Introduction

Acute health conditions are characterized by the sudden onset of and rapid change in symptoms, a typical course of illness, and a finite duration if the illness is self-limiting or effectively treated.[1]. Inappropriate self-treatment may bring some negative consequences, such as masking symptoms, delaying professional health care, having an incorrect diagnosis, or being exposed to unnecessary medications.[2] It is important for patients with acute conditions to have access to affordable and safe medicines and the ability to rationally use these medicines. Equitable access to essential medicines is considered to be a fundamental human right by the World Health Organization (WHO) and many national constitutions.[3] For many in China, poor access to medical services and high cost for medicines were problems that residents most concerned about, and even today, these issues trigger the most intense response. Community health service facilities and grass-roots health care facilities managed by the government were required to be fully equipped with essential medicines and to implement zero-margin sales.[6]

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Results

Conclusion