Knowledge, attitude and practice regarding antibiotics resistance among general practitioners in polyclinics in Yerevan, Armenia

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.