Primary Medical Care, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK.
J Antimicrob Chemother. 2011 Oct;66(10):2215-23. doi: 10.1093/jac/dkr279. Epub 2011 Jul 15.
Numerous interventions have been developed to promote prudent antibiotic use for acute respiratory tract infections (ARTIs). While reviews have assessed which interventions may be most effective, none has examined why some interventions may be more effective than others. Knowing what general practitioners (GPs) feel is acceptable and feasible to implement may help to answer this question.
A systematic review was undertaken of 12 studies of GPs' views and experiences of antibiotic prescribing and/or interventions promoting the prudent use of antibiotics. A meta-ethnographic approach was followed to synthesize the findings.
Thirteen themes were identified from the synthesis. The first discussed GPs' satisfaction with their prescribing decisions. Seven themes highlighted factors that influence GPs' prescribing decisions; these included perceptions of external pressure to reduce prescribing, uncertainty about ARTI management and previous experience of ARTI management. Five themes highlighted the benefits of interventions that had helped GPs to prescribe more prudently in practice. The last two sets of themes were linked to indicate that interventions may only be beneficial for GPs when they address one or more of the factors that influence their prescribing decisions.
The findings suggest that interventions should incorporate five aspects to promote prudent use whilst remaining attractive to GPs and feasible in practice. In order to maximize acceptability, interventions should: allow GPs to reflect on their own prescribing; help decrease uncertainty about appropriate ARTI management; educate GPs about appropriate prescribing; facilitate more patient-centred care; and be beneficial to implement in practice.
为促进急性呼吸道感染（ARTI）合理使用抗生素，已经开发出许多干预措施。虽然已有研究评估了哪些干预措施可能最有效，但尚无研究探讨为何某些干预措施比其他干预措施更有效。了解全科医生（GP）认为可接受且可行的实施措施，可能有助于回答这个问题。
系统检索了 12 项关于 GP 对抗生素处方和/或促进抗生素合理使用干预措施的看法和经验的研究，采用元人种学方法对研究结果进行综合分析。
从综合分析中确定了 13 个主题。第一个主题讨论了 GP 对其处方决策的满意度。有 7 个主题强调了影响 GP 处方决策的因素；这些因素包括减少处方的外部压力、对 ARTI 管理的不确定性以及以前的 ARTI 管理经验。有 5 个主题突出了有助于 GP 在实践中更谨慎处方的干预措施的益处。最后两组主题相关联，表明只有当干预措施解决影响其处方决策的一个或多个因素时，干预措施才可能对 GP 有益。
研究结果表明，干预措施应包含五个方面，以在吸引 GP 并在实践中可行的前提下促进合理使用。为了最大限度地提高可接受性，干预措施应：允许 GP 反思自己的处方；帮助减少对适当 ARTI 管理的不确定性；教育 GP 有关适当的处方；促进更以患者为中心的护理；并在实践中实施有益。
