Identification des déterminants culturels dans l'usage des antibiotiques en soins primaires en Europe (revue systématique de littérature)

L augmentation de la résistance bactérienne aux antibiotiques est une des menaces mondiales les plus importantes aujourd hui pour la santé publique, notamment en Europe. Les résistances les plus élevées concernent les pays où la consommation d antibiotiques est élevée. Parmi les différents déterminants des différences de consommation d antibiotiques en Europe, les facteurs socioculturels sont souvent cités, rarement définis et n ont jamais fait l objet d une revue systématique de la littérature. Notre objectif est d identifier les facteurs culturels qui influencent l usage des antibiotiques en soins primaires en Europe et d interpréter la façon dont ils agissent. Nous avons donc réalisé une revue systématique de littérature. Dix-huit articles ont été sélectionnés. Nous avons identifié 2 facteurs: les déterminants culturels communs à tous les pays, c est-à-dire la perception et le comportement du patient face à sa maladie, les attentes et la satisfaction du patient, les croyances, connaissances et attitudes du patient vis-à-vis des antibiotiques et des infections, le label diagnostique , la relation entre le médecin et son patient, les attentes et la satisfaction des généralistes et les processus de décision et les dimensions culturelles d Hofstede, qui permettent de comparer les cultures entre elles (une forte distance hiérarchique, une forte intolérance à l incertitude ou une société masculine sont associées à une surconsommation d antibiotiques). Les dimensions culturelles expliquent comment les déterminants influenceraient une consultation et se manifesteraient dans la communication entre le médecin et son patient, laquelle communication influencerait directement la prescription d antibiotiques. Cette étude souligne l omniprésence de la culture dans la consommation des antibiotiques et ouvre des perspectives notamment dans l élaboration des campagnes de santé publique ou l amélioration de la communication entre le médecin et son patient.NICE-BU Médecine Odontologie (060882102) / SudocSudocFranceF

Identification of cultural determinants of antibiotic use cited in primary care in Europe: a mixed research synthesis study of integrated design “Culture is all around us”

Background Inappropriate antibiotic prescribing, particularly for respiratory tract infections (RTI) in ambulatory care, has become a worldwide public health threat due to resulting antibiotic resistance. In spite of various interventions and campaigns, wide variations in antibiotic use persist between European countries. Cultural determinants are often referred to as a potential cause, but are rarely defined. To our knowledge, so far no systematic literature review has focused on cultural determinants of antibiotic use. The aim of this study was to identify cultural determinants, on a country-specific level in ambulatory care in Europe, and to describe the influence of culture on antibiotic use, using a framework of cultural dimensions. Method A computer-based systematic literature review was conducted by two research teams, in France and in Norway. Eligible publications included studies exploring antibiotic use in primary care in at least two European countries based on primary study results, featuring a description of cultural determinants, and published between 1997 and 2015. Quality assessment was conducted independently by two researchers, one in each team, using appropriate checklists according to study design. Each included paper was characterized according to method, countries involved, sampling and main results, and cultural determinants mentioned in each selected paper were extracted, described and categorized. Finally, the influence of Hofstede’s cultural dimensions associated with antibiotic consumption within a primary care setting was described. Results Among 24 eligible papers, 11 were rejected according to exclusion criteria. Overall, 13 papers meeting the quality assessment criteria were included, of which 11 used quantitative methods and two qualitative or mixed methods. The study participants were patients (nine studies) and general practitioners (two studies). This literature review identified various cultural determinants either patient-related (illness perception/behaviour, health-seeking behaviour, previous experience, antibiotic awareness, drug perception, diagnosis labelling, work ethos, perception of practitioner) or practitioner-related (RTI management, initial training, antibiotic awareness, legal issues, practice context) or both (antibiotic awareness). Discussion and Conclusion Cultural factors should be considered as exerting an ubiquitous influence on all the consecutive stages of the disease process and seem closely linked to education. Interactions between determinant categories, cultural dimensions and antibiotic use in primary care are multiple, complex and require further investigation within overlapping disciplines. The context of European projects seems particularly relevant

Additional file 2: of Identification of cultural determinants of antibiotic use cited in primary care in Europe: a mixed research synthesis study of integrated design “Culture is all around us”

Characteristics of selected articles using quantitative methods. (PDF 35 kb