Abstract
ObjectivesTo analyse demographic, social and geographic predictors of incompliant attitudes towards prescription completion in the UK.MethodsTwo waves of the Eurobarometer survey (85.1 and 90.1) were analysed, with a final sample size of 2016. Using logistic regression, the best-fitting combination of a set of identified variables was specified. The regression output and the model-averaged importance of each variable were analysed.ResultsCompared with a median prevalence region, respondents in the Nomenclature of Territorial Units for Statistics (NUTS) 1 London (OR = 2.358, 95% CI = 1.100–5.398) and Scotland (OR = 2.418, 95% CI = 1.083–5.693) regions were most likely to report an incompliant attitude. Respondents who correctly answered questions about whether unnecessary use of antibiotics could make them ineffective in future (OR = 0.353, 95% CI = 0.230–0.544), whether antibiotics kill viruses (OR = 0.644, 95% CI = 0.450–0.919) and whether antibiotics treat colds (OR = 0.412, 95% CI = 0.287–0.591) were less likely to report incompliant attitudes. Conversely, respondents who correctly responded that antibiotics can cause side effects (OR = 1.419, 95% CI = 1.014–1.999) were more likely to report incompliant attitudes. There was some evidence of associations between political orientation and level of compliance. Uncooperative survey respondents (OR = 2.001, 95% CI = 1.108–3.526) were more likely to report incompliant attitudes.ConclusionsIncompliant attitudes towards antibiotic prescription compliance in the UK are associated with a variety of factors, including regional geographic variation in attitudes. Knowledge about antibiotics can relate to good stewardship attitudes, but concerns over side effects are associated with poor attitudes. Further research should examine the underlying attitudes and beliefs that political orientation may be a marker for in the context of antibiotic stewardship. Survey samples reliant on self-selection are likely to be biased towards good stewardship.
Highlights
Antimicrobial resistance (AMR) has a biological mechanism and socially patterned drivers and consequences.[1,2] One example of such a driver is incompliance with prescription instructions leading to patients underdosing and potentially later self-medicating with antibiotics
The results of the multivariable AICmin logistic regression model are presented in Table 1 with estimated ORs and 95% confidence limits (CLs)
Respondents in North East England (OR = 0.151, 95% confidence interval (CI) = 0.010–0.818) were less likely to report an incompliant response. These results suggest that a regional geography at the Nomenclature of Territorial Units for Statistics (NUTS) 1 level, visualized using predicted probabilities in Figure 3, persists after controlling for other factors including local geography
Summary
Antimicrobial resistance (AMR) has a biological mechanism and socially patterned drivers and consequences.[1,2] One example of such a driver is incompliance with prescription instructions leading to patients underdosing and potentially later self-medicating with antibiotics. The NHS website[3] informs the public that ‘taking antibiotics when you do not need them can mean they will not work for you in the future’ and highlights that antibiotics should be taken ‘as instructed by your GP or pharmacist’. Compliance with instructions for medication-taking is influenced by several identified factors, including age, patient–physician relationship, beliefs about medications, misconceptions about disease conditions, experience and management of side effects and individual personality traits.[4,5,6] Meta-analyses of adherence to medication have shown that individuals believing that the medication is necessary for their health are more likely to follow medication-taking instructions, while individuals who have strong concerns about the medication such as beliefs about side effects are less likely to follow instructions.[4,7] In the Wellcome Monitor survey, 60% of respondents who reported not taking their antibiotics as prescribed said it was because they felt better, with 25% saying that it was because they experienced side effects.[8]
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