Antibiotic Resistance in Rural America: Structural Factors that Promote Inappropriate Antibiotic Use Behaviors among Patients

Abstract

Antibiotic resistance is one of the most pressing global health threats today. In the United States specifically, policy tends to focus on decreasing antibiotic prescriptions given by healthcare providers. This paper, however, takes a new approach: one that focuses on the patient. This paper specifically focuses on patients in rural communities, as they are the area of the United States with the greatest barriers to accessing healthcare and education. This paper hypothesizes the following: access to healthcare decreases the frequency of behaviors that contribute to antibiotic resistance, behaviors that contribute to antibiotic resistance decrease in frequency as patient-physician relationships become stronger, access to healthcare increases the strength of patient-physician relationships, knowledge about antibiotics and antibiotic resistance strengthens patient-physician relationships, and knowledge about antibiotics and antibiotic resistance decreases patients’ rates of behaviors that influence antibiotic resistance Through a survey of rural Americans in Alabama and California, this paper is able to glean information about how patients use antibiotics in rural communities and the factors that influence these behaviors to test these hypotheses. The data show that individuals behave more appropriately with regard to antibiotic use when they have greater access to healthcare, especially when receiving private insurance. Furthermore, patients who have better relationships with their physicians behave less riskily with regards to antibiotics. Individuals with greater educational attainment also behave more appropriately. Knowledge decreases the frequency that patients expect antibiotics from their physicians, and access to healthcare strengthens patientphysician relationships. Therefore, policy addressing the antibiotic resistance crisis must start with the individual patient and address structural factors influencing his or her behaviors.