University of Southampton, Faculty of Medicine, Academic Unit of Primary Care and Population Sciences, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK.
University of Oxford, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
J Antimicrob Chemother. 2018 Mar 1;73(3):795-803. doi: 10.1093/jac/dkx429.
Interventions are needed to reduce unnecessary antibiotic prescribing for respiratory tract infections (RTIs). Although community antibiotic prescribing appears to be decreasing in the UK, figures for out-of-hours (OOH) prescribing have substantially increased. Understanding the factors influencing prescribing in OOH and any perceived differences between general practitioner (GP) and nurse prescriber (NP) prescribing habits may enable the development of tailored interventions promoting optimal prescribing in this setting.
To explore UK GP and NP views on and experiences of prescribing antibiotics for RTIs in primary care OOH services.
Thirty semi-structured interviews were conducted with GPs and NPs working in primary care OOH services. Inductive thematic analysis was used to analyse data.
The research shows that factors particular to OOH influence antibiotic prescribing, including a lack of patient follow-up, access to patient GP records, consultation time, working contracts and implementation of feedback, audit and supervision. NPs reported perceptions of greater accountability for their prescribing compared with GPs and reported they had longer consultations during which they were able to discuss decisions with patients. Participants agreed that more complex cases should be seen by GPs and highlighted the importance of consistency of decision making, illness explanations to patients as well as a perception that differences in clinical training influence communication with patients and antibiotic prescribing decisions.
Environmental and social factors in OOH services and a mixed healthcare workforce provide unique influences on antibiotic prescribing for RTIs, which would need to be considered in tailoring interventions that promote prudent antibiotic prescribing in OOH services.
需要采取干预措施来减少不必要的呼吸道感染（RTI）抗生素处方。尽管英国社区抗生素处方似乎有所减少，但非工作时间（OOH）的处方量却大幅增加。了解影响 OOH 处方的因素以及全科医生（GP）和护士处方者（NP）之间在处方习惯方面的任何差异，可能有助于制定有针对性的干预措施，促进在此环境下的最佳处方。
探讨英国 GP 和 NP 在初级保健 OOH 服务中开具 RTIs 抗生素处方的看法和经验。
对在初级保健 OOH 服务中工作的 GP 和 NP 进行了 30 次半结构化访谈。采用归纳主题分析方法对数据进行分析。
研究表明，OOH 特有的因素会影响抗生素的处方，包括缺乏对患者的随访、获取患者的 GP 记录、咨询时间、工作合同以及实施反馈、审核和监督。NP 报告说，与 GP 相比，他们对自己的处方负有更大的责任，并且报告说他们的咨询时间更长，在此期间，他们能够与患者讨论决策。参与者一致认为，更复杂的病例应由 GP 接诊，并强调了决策一致性、向患者解释疾病以及临床培训差异影响与患者沟通和抗生素处方决策的重要性。
OOH 服务中的环境和社会因素以及混合医疗保健劳动力对 RTI 的抗生素处方产生了独特的影响，在制定促进 OOH 服务中合理使用抗生素的干预措施时需要考虑这些因素。
