Epidemiologist at the Centre for Food-borne, Environmental and Zoonotic Infectious Diseases at the Public Health Agency of Canada in Guelph, Ont.
Senior Policy Analyst at the Centre for Communicable Diseases and Infection Control at the Public Health Agency of Canada in Ottawa, Ont.
Can Fam Physician. 2017 Dec;63(12):e526-e535.
To establish a baseline for physicians' knowledge of and counseling practices on the use of antibiotics and antimicrobial resistance (AMR), and to determine potential changes in these measures after the implementation of a national AMR awareness campaign.
Cross-sectional design.
Canada.
A total of 1600 physicians.
Physicians' knowledge of and counseling practices on antibiotic use and AMR at baseline and after implementation of the AMR awareness campaign.
A total of 336 physicians responded to the first-cycle survey (before the campaign), and 351 physicians responded to the second-cycle survey (after the campaign). Overall, physicians' knowledge of appropriate antibiotic use and AMR was high and their counseling practices in relation to antibiotics were appropriate in both surveys. Counseling levels about topics related to infection prevention and control (eg, food handling, household hygiene) were slightly lower. Counseling levels were also lower for certain antibiotic-use practices (eg, proper disposal of antibiotics). In addition, physicians with less than 10 years of practice experience had significantly lower odds of counseling their patients on topics related to preventing antibiotic resistance and infection prevention than those with 15 or more years of practice experience (adjusted odds ratio = 0.27, 95% CI 0.10 to 0.74). Significantly more physicians from the second-cycle survey counseled patients on the appropriate disposal of antibiotics ( = .03), as well as on some of the infection prevention topics (eg, using antibacterial hand soap [ = .02] and cleaning supplies [ = .01]). Most respondents in both surveys reported feeling confident with respect to counseling their patients on the appropriate use of antibiotics and AMR.
Physicians' knowledge of and levels of counseling on the use of antibiotics and AMR were high and fairly stable in both survey results. This shows that Canadian physicians are demonstrating behaviour patterns of AMR stewardship. Existing gaps in counseling practices might be a result of physicians believing that pharmacists or nurses are addressing these issues with patients. Future national surveys conducted among pharmacists and nurses would contribute to the evidence base for AMR stewardship activities.
了解医生对抗生素使用和抗菌药物耐药性（AMR）的认知和咨询实践情况，建立基线数据，并确定在开展全国性 AMR 认知活动后这些措施可能发生的变化。
横断面设计。
加拿大。
共 1600 名医生。
医生在开展 AMR 认知活动前后，对抗生素使用和 AMR 的认知及咨询实践情况。
共有 336 名医生对第一轮调查（在活动前）做出回应，351 名医生对第二轮调查（在活动后）做出回应。总的来说，医生对抗生素合理使用和 AMR 的认识水平较高，在两轮调查中，他们在抗生素咨询方面的做法也是恰当的。有关感染预防和控制（如食品处理、家庭卫生）主题的咨询水平略低。某些抗生素使用实践（如合理处置抗生素）的咨询水平也较低。此外，与实践经验 15 年以上的医生相比，实践经验不足 10 年的医生在就预防抗生素耐药和感染预防相关主题对患者进行咨询方面的可能性显著较低（调整后比值比=0.27，95%CI 0.10 至 0.74）。来自第二轮调查的医生中，有更多的人就抗生素的合理处置（ =.03）以及一些感染预防主题（如使用抗菌皂[ =.02]和清洁用品[ =.01]）对患者进行咨询。两轮调查中的大多数受访者都表示对就抗生素和 AMR 的合理使用对患者进行咨询充满信心。
在两轮调查结果中，医生对抗生素使用和 AMR 的认知及咨询水平均较高且较为稳定，这表明加拿大医生正在表现出 AMR 管理行为模式。咨询实践中的现有差距可能是因为医生认为药剂师或护士正在与患者解决这些问题。未来在药剂师和护士中开展的全国性调查将有助于为 AMR 管理活动提供证据基础。
