# Reducing Use of Antibiotics without a Prescription among Outpatients in a Safety Net Healthcare System

> **NIH AHRQ R01** · BAYLOR COLLEGE OF MEDICINE · 2020 · $493,630

## Abstract

Non-prescription antibiotic use is an understudied problem, prevalent in some low-income communities. This
practice includes obtaining and taking antibiotics without a prescription (e.g., from ethnic stores or flea
markets), taking another person's antibiotics, or taking one's own stored antibiotics for an indication other than
that for which the antibiotic was originally prescribed. In our survey of low-income primary care patients in a
large urban area, respondents from public clinics were more likely than respondents from private clinics to
report intention to use antibiotics without a prescription. This survey generated considerable press interest, as
the problem has barely been described in the United States, but we did not explore why the non-prescription
use was occurring. Non-prescription use increases the risk of development of antibiotic resistance, adverse
drug reactions, damage to the microbiome, and other harms. There is a critical need to identify the predictors
of non-prescription use that will guide development of effective antimicrobial stewardship interventions in low-
income populations, given that these populations are at higher risk of developing antibiotic-resistant infections.
The overall objectives of the proposed project are to identify the predictors of non-prescription antibiotic use in
diverse, predominantly uninsured patients of safety net clinics and lay the foundation for a subsequent
intervention. We will use mixed methods and the Kilbourne et al. (2006) conceptual framework for advancing
health disparities research to identify the predictors of non-prescription use. In Aim 1 (quantitative phase), we
will administer a survey in Spanish and English to assess how patient (e.g., health literacy), health care system
(e.g., access to care), and clinical encounter factors (patient-provider communication) are associated with non-
prescription antibiotic use in low-income patients. In Aim 2 (qualitative phase), using in-depth interviews, we
will explore patient perspectives and experiences with non-prescription use among a racially/ethnically diverse
subsample of survey respondents who reported using antibiotics without a prescription. In Aim 3 (development
of a communication tool), we will integrate quantitative and qualitative results into a communication tool to be
used in the clinics to steer patients toward safer antibiotic use and healthcare options. Our team includes an
epidemiologist, an infectious diseases physician, a health disparities researcher, health communications
experts, and a medical anthropologist. This multidisciplinary team will work with a Community Advisory Board
comprised of patient representatives from participating clinics. Our work will be guided by input from a
representative from the Centers for Disease Control and Prevention and two health literacy consultants, one of
whom is bilingual. The proposed research is innovative, because it will provide comprehensive understanding
of the predictors ...

## Key facts

- **NIH application ID:** 9965915
- **Project number:** 5R01HS026901-02
- **Recipient organization:** BAYLOR COLLEGE OF MEDICINE
- **Principal Investigator:** Larisa Grigoryan
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $493,630
- **Award type:** 5
- **Project period:** 2019-07-01 → 2024-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9965915

## Citation

> US National Institutes of Health, RePORTER application 9965915, Reducing Use of Antibiotics without a Prescription among Outpatients in a Safety Net Healthcare System (5R01HS026901-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/9965915. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*