Szymczak Julia E, Feemster Kristen A, Zaoutis Theoklis E, Gerber Jeffrey S
Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S69-78. doi: 10.1086/677826.
Inappropriate antibiotic prescribing commonly occurs in pediatric outpatients with acute respiratory tract infections. Antimicrobial stewardship programs are recommended for use in the hospital, but less is known about whether and how they will work in the ambulatory setting. Following a successful cluster-randomized trial to improve prescribing for common acute respiratory tract infections using education plus audit and feedback in a large, pediatric primary care network, we sought to explore the perceptions of the intervention and antibiotic overuse among participating clinicians.
We conducted a qualitative study using semistructured interviews with 24 pediatricians from 6 primary care practices who participated in an outpatient antimicrobial stewardship intervention. All interviews were transcribed and analyzed using a modified grounded theory approach.
Deep skepticism of the audit and feedback reports emerged. Respondents ignored reports or expressed distrust about them. One respondent admitted to gaming behavior. When asked about antibiotic overuse, respondents recognized it as a problem, but they believed it was driven by the behaviors of nonpediatric physicians. Parent pressure for antibiotics was identified by all respondents as a major barrier to the more judicious use of antibiotics. Respondents reported that they sometimes "caved" to parent pressure for social reasons.
To improve the effectiveness and sustainability of outpatient antimicrobial stewardship, it is critical to boost the credibility of audit data, engage primary care pediatricians in recognizing that their behavior contributes to antibiotic overuse, and address parent pressure to prescribe antibiotics.
不恰当的抗生素处方在患有急性呼吸道感染的儿科门诊患者中普遍存在。抗菌药物管理计划被推荐用于医院，但对于它们在门诊环境中是否有效以及如何发挥作用，人们了解较少。在一项大型儿科初级保健网络中进行的成功的整群随机试验，通过教育加审核与反馈来改善常见急性呼吸道感染的处方之后，我们试图探讨参与的临床医生对该干预措施以及抗生素过度使用的看法。
我们采用定性研究方法，对来自6家初级保健机构的24名参与门诊抗菌药物管理干预的儿科医生进行了半结构化访谈。所有访谈均进行了转录，并使用改良的扎根理论方法进行分析。
出现了对审核与反馈报告的深度怀疑。受访者要么忽略报告，要么对其表示不信任。一名受访者承认有投机行为。当被问及抗生素过度使用问题时，受访者认识到这是个问题，但他们认为这是由非儿科医生的行为导致的。所有受访者都认为家长对抗生素的压力是更明智地使用抗生素的主要障碍。受访者报告说，出于社会原因，他们有时会屈从于家长对抗生素的压力。
为提高门诊抗菌药物管理的有效性和可持续性，提高审核数据的可信度、让初级保健儿科医生认识到他们的行为会导致抗生素过度使用，以及应对家长对抗生素处方的压力至关重要。
