Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Glasgow.
Institute of Health Research, University of Exeter Medical School, Exeter.
Br J Gen Pract. 2018 Sep;68(674):e633-e645. doi: 10.3399/bjgp18X697889. Epub 2018 Jun 18.
Reducing unnecessary prescribing remains a key priority for tackling the global rise of antibiotic-resistant infections.
The authors sought to update a 2011 qualitative synthesis of GPs' experiences of antibiotic prescribing for acute respiratory tract infections (ARTIs), including their views of interventions aimed at more prudent prescribing. They expanded the original scope to encompass all primary care professionals (PCPs) who can prescribe or dispense antibiotics for ARTIs (for example, nurses and pharmacists).
Systematic review and meta-ethnography of qualitative studies.
A systematic search was conducted on MEDLINE, EMBASE, PsycINFO, CINAHL, ASSIA, and Web of Science. No date or language restrictions were used. Identified studies were grouped according to their thematic focus (usual care versus intervention), and two separate syntheses were performed.
In all, 53 articles reporting the experiences of >1200 PCPs were included. Analysis of usual-care studies showed that PCPs tend to assume multiple roles in the context of ARTI consultations (the expert self, the benevolent self, the practical self), depending on the range of intrapersonal, interpersonal, and contextual situations in which they find themselves. Analysis of intervention studies identified four possible ways in which PCPs may experience quality improvement interventions (compromise, 'supportive aids', source of distress, and unnecessary).
Contrary to the original review, these results suggest that the use of the same intervention is experienced in a totally different way by different PCPs, and that the same elements that are perceived as benefits by some could be viewed as drawbacks by others. Acceptability of interventions is likely to increase if these are context sensitive and take into account PCPs' varying roles and changing priorities.
减少不必要的处方仍然是应对全球抗生素耐药性感染上升的关键优先事项。
作者试图更新 2011 年对全科医生治疗急性呼吸道感染（ARTI）时开具抗生素经验的定性综合分析，包括他们对旨在更谨慎开具处方的干预措施的看法。他们将原始范围扩大到包括所有可以为 ARTI 开具或配药抗生素的初级保健医生（PCP）（例如护士和药剂师）。
对定性研究的系统综述和元人种学。
对 MEDLINE、EMBASE、PsycINFO、CINAHL、ASSIA 和 Web of Science 进行了系统检索。未使用日期或语言限制。根据主题重点（常规护理与干预）对确定的研究进行分组，并进行了两次单独的综合分析。
总共纳入了 53 篇文章，报道了 1200 多名 PCP 的经验。对常规护理研究的分析表明，PCP 在 ARTI 咨询中倾向于承担多种角色（专家自我、仁慈自我、实用自我），这取决于他们所处的内在、人际和环境情况的范围。对干预研究的分析确定了 PCP 可能体验质量改进干预的四种可能方式（妥协、“支持性辅助工具”、困扰源和不必要）。
与原始综述相反，这些结果表明，不同的 PCP 以完全不同的方式体验相同的干预措施，并且一些人认为是好处的相同元素可能被其他人视为缺点。如果干预措施具有上下文敏感性并考虑到 PCP 不断变化的角色和优先级，那么它们的可接受性可能会增加。
