Abstract:
Background: Antibiotic resistance is a global problem and an important public health issue.
Resistance to antibiotics can develop in case of inappropriate use of antibacterial drugs, self-
medication of general population, antibiotics misuse by providers, which includes
inappropriate choice of antibacterial drugs as well as incorrect dose, spectrum and period of
treatment. Poor prescribing practices and insufficient knowledge about antibiotics
prescribing among physicians may increase bacterial resistance. Antibiotics prescribing
practice may be influenced by the socioeconomic class of a patient, competition among
physicians, cost of diagnostic tests, pressure by patients, physician’s qualification, education
and experience. Also, influence of pharmaceutical company representatives through
incentives to physicians can have a negative impact on antibiotics prescription practices. The
objectives of the study were: measuring the knowledge, attitude and practice scores on
antibiotics resistance; exploring the association between antibiotics prescribing practice score
among GPs and their knowledge and attitude scores after adjusting for other factors; and
identifying barriers for rational antibiotics prescription by GPs. Methods: A cross-sectional study design was used. Data collection was conducted through a self-administered survey among GPs in private and public polyclinics in Yerevan. The survey questionnaire included sections on demographic characteristics of GPs, professional experience, knowledge of GPs about antibiotics and antibiotics resistance, attitude of GPs towards antibiotics resistance, GPs’ prescribing practices, and barriers to rational prescribing
of antibiotics. Descriptive, simple and multivariable linear regression analyses were
performed using SPSS 22 software. Results: Overall, 291 GPs participated in the study. The mean age of GPs was 55.1 (SD =
9.9). Knowledge, attitude and practice mean percent scores were 58.3%, 67.5%, 63.0%,
respectively. In the univariate analyses attitude and knowledge % scores, age of GPs, years
of experience after graduation were found to be significantly associated with the practice %
score. After adjusting for attitude and knowledge % scores, type of polyclinic, years of
experience, professional education after graduation and number of patients served per day,
practice % score was significantly associated with attitude % score (β = 0.58; 95% CI: 0.41,
0.75; p < 0.001) and years of experience of GPs (β = -0.19; 95% CI: -0.37, -0.03; p = 0.022).
The main barriers reported by GPs were: lack of rapid diagnostic tests, high costs of
laboratory tests, high costs of some antibiotics and lack of guidelines.
Conclusion: The study revealed a low knowledge, attitude and practice mean % scores,
suggesting a need for improvements in these areas. Also, difference in prescribing practice
between different age groups of GPs was found in the study, which suggests the need to focus
on older generation of primary health care physicians when planning training programs.
Availability of rapid and inexpensive diagnostic tests, enforcement of prescriptions and
regulation of antibiotic’s prices could help to overcome antibiotics resistance. This study
provides a groundwork for the future research among primary health care physicians in
marzes and other specialists to determine their prescribing practices.