To describe the status in knowledge and attitudes regarding antibiotic use among primary care physicians in Hubei Province in 2018 and 2020, analyze the changes and relevant reasons over these two years, and to present relevant interventions, promoting rational antibiotic use in primary care physicians.

Two surveys were separately conducted (one was conducted from April to June 2018 with a stratified two-stage cluster sample, and the other was conducted from November 2019 to January 2020 with a two-stage cluster random sample) among Hubei's primary care physicians with the qualification of prescribing antibiotics who had written over 100 antibiotic prescriptions within 3 months prior to the survey. A self-developed questionnaire was used in the surveys to acquire information about demographics, knowledge of antibiotic use (whether antibiotics should be used in 10 common situations) , and attitudes (5 types of attitudes that may affect antibiotic use behavior) . A descriptive analysis was conducted on the accuracy rate and total scores of antibiotic use knowledge as well as total and item scores of attitudes to examine primary care physicians' knowledge and attitudes towards antibiotic use during 2018 and 2020. To determine changes in knowledge and attitudes within two years, propensity score matching (PSM) was used, with participants in 2018 designated as the control group and those in 2020 as the treatment group.

637 respondents of the 2018 survey and 616 respondents of the 2020 survey were included for final analysis. Before PSM matching, the mean score of antibiotic use knowledge of the2020 survey respondents was statistically higher than that of 2018 survey respondents〔 (5.54±1.46) vs (5.25±1.35) 〕 (P<0.05) . Moreover, the 2020 survey respondents also had statistically higher accuracy ratesin answering questions on the effect of ceftriaxone crossing the blood-brain barrier (48.5% vs 39.6%) and routes of aminoglycoside administration (55.7% vs 44.0%) (P<0.05) . Furthermore, 2020 survey respondents had higher mean overall score of attitudes towards antibiotic use〔 (55.41±5.02) vs (53.29±5.21) 〕 (P<0.05) . In particular, 2020 survey respondents had statistically higher mean overall scores of items regarding attitudes towards prescribing antibiotics due to meeting patient demands, ignoring the problem of antibiotic resistance, and lacking motivation to change their own irrational behaviors (P<0.05) . By PSM matching, 513 2020 respondents were successfully matched to 513 2018 respondents. After achieving a balance of covariates between groups, the2020 respondents still had statistically higher total mean scores of antibiotic use knowledge and attitudes towards antibiotic use (P<0.05) . Further analysis revealed that in those from community health centers, the 2020 survey respondents had statistically higher total scores of antibiotic use attitudes (P<0.05) , while no statistical differences were found in the total score of antibiotic use knowledge (P>0.05) . But in those from township health centers, the 2020 survey respondents had statistically higher total mean scores of antibiotic use knowledge and attitudes towards antibiotic use than did the 2018 survey respondents (P<0.05) .

Compared with 2018, the level of knowledge of antibiotic use in Hubei's primary care physicians was improved, but still was relatively low. Moreover, it seemed that they were more negative toward rational antibiotic use, tendingto prescribe antibiotics inappropriately. A systematic approach should be adopted to improve the knowledge of rational antibiotic use, strengthen the motivation for rational antibiotic use, and reduce irrationally antibiotic prescribing among primary care physicians.

了解2018、2020年湖北省基层医生抗菌药物使用知识水平、对抗菌药物的使用态度，分析其变化特征和原因，并提出针对性的干预措施，以促进基层医生合理使用抗菌药物。

于2018年4—6月采用两阶段分层整群随机抽样方法，于2019年11月至2020年1月采用两阶段整群随机抽样方法，选取湖北省基层医疗卫生机构中具有抗菌药物处方开具权，并在调查前3个月内开具抗菌药物处方≥100张的医生为研究对象。采用自设问卷对其进行调查，内容包括基层医生基本情况、抗菌药物使用知识〔10种常见场景中是否应该使用（目标）抗菌药物〕、对抗菌药物的使用态度（5种可能影响抗菌药物使用行为的态度）。未进行倾向得分匹配（PSM）前，分析并比较2018、2020年湖北省基层医生抗菌药物使用知识总得分及各条目的正确回答率、抗菌药物使用态度总得分及各条目得分情况。将2020年调查对象作为处理组，将2018年调查对象作为控制组，采用PSM法进行配对后，对湖北省基层医生抗菌药物使用知识和态度总得分的变化特征及原因进行分析。

2018、2020年分别回收有效问卷637、616份。未进行PSM前，2020年湖北省基层医生抗菌药物使用知识总得分为（5.54±1.46）分，高于2018年的（5.25±1.35）分，差异有统计学意义（P<0.05）。2020年调查对象对头孢曲松透过血脑屏障的效果（48.5%比39.6%）和氨基糖苷类的给药方法（55.7%比44.0%）的正确回答率高于2018年，差异有统计学意义（P<0.05）。2020年湖北省基层医生抗菌药物使用态度总得分为（55.41±5.02）分，高于2018年的（53.29±5.21）分，差异有统计学意义（P<0.05）。2020年调查对象在因满足患者需求、忽视抗菌药物耐药问题、缺乏改变自身不合理行为的动机而开处抗菌药物上的得分高于2018年，差异有统计学意义（P<0.05）。经过PSM，2020年调查人群与2018年调查人群成功匹配513对。实现组间协变量平衡后，2020年湖北省基层医生抗菌药物使用知识、态度总得分仍高于2018年，差异有统计学意义（P<0.05）。按不同类型基层医疗卫生机构进行分类，2020年湖北省社区卫生服务中心医生抗菌药物使用态度总得分高于2018年，差异有统计学意义（P<0.05）；2020、2018年湖北省社区卫生服务中心医生抗菌药物使用知识总得分比较，差异无统计学意义（P>0.05）。2020年湖北省乡镇卫生院医生抗菌药物使用知识、态度总得分均高于2018年，差异有统计学意义（P<0.05）。

与2018年相比，2020年湖北省基层医生抗菌药物使用知识水平有所提升，但整体水平仍较低，且对于合理使用抗菌药物持更消极的态度，有开具不合理抗菌药物处方的倾向。应系统性地采取方法提高基层医生对抗菌药物合理使用的认知水平，增强其合理使用抗菌药物的动力，进而提升基层抗菌药物合理使用水平。