Yates Traci D, Davis Marion E, Taylor Yhenneko J, Davidson Lisa, Connor Crystal D, Buehler Katherine, Spencer Melanie D
Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, NC, USA.
Division of Infectious Disease, Atrium Health, Charlotte, NC, USA.
BMC Fam Pract. 2018 Jun 23;19(1):96. doi: 10.1186/s12875-018-0788-4.
Inappropriate prescribing of antibiotics poses an urgent public health threat. Limited research has examined factors associated with antibiotic prescribing practices in outpatient settings. The goals of this study were to explore elements influencing provider decisions to prescribe antibiotics, identify provider recommendations for interventions to reduce inappropriate antibiotic use, and inform the clinical management of patients in the outpatient environment for infections that do not require antibiotics.
This was a qualitative study using semi-structured interviews with key informants. Seventeen outpatient providers (10 medical doctors and 7 advanced care practitioners) within a large healthcare system in Charlotte, North Carolina, participated. Interviews were audio recorded, transcribed, and analyzed for themes.
Primary barriers to reducing inappropriate antibiotic prescribing included patient education and expectations, system-level factors, and time constraints. Providers indicated they would be interested in having system-wide, evidence-based guidelines to inform their prescribing decisions and that they would also be receptive to efforts to improve their awareness of their own prescribing practices. Results further suggested that providers experience a high demand for antibiotic prescriptions; consequently, patient education around appropriate use would be beneficial.
Findings suggest that antibiotic prescribing in the outpatient setting is influenced by many pressures, including patient demand and patient satisfaction. Training on appropriate antibiotic prescribing, guideline-based decision support, feedback on prescribing practices, and patient education are recommended interventions to improve levels of appropriate prescribing.
抗生素的不恰当使用对公众健康构成了紧迫威胁。针对门诊环境中抗生素处方行为相关因素的研究有限。本研究的目的是探究影响医疗服务提供者开具抗生素处方决策的因素，确定医疗服务提供者对减少不恰当抗生素使用干预措施的建议，并为门诊环境中不需要使用抗生素治疗感染的患者的临床管理提供参考。
这是一项采用对关键信息提供者进行半结构化访谈的定性研究。北卡罗来纳州夏洛特市一个大型医疗系统内的17名门诊医疗服务提供者（10名医生和7名高级护理从业者）参与了研究。访谈进行了录音、转录并分析主题。
减少不恰当抗生素处方的主要障碍包括患者教育和期望、系统层面因素以及时间限制。医疗服务提供者表示，他们希望有全系统基于证据的指南来指导他们的处方决策，并且他们也会接受提高自身处方行为意识的努力。结果还表明，医疗服务提供者面临对抗生素处方的高需求；因此，围绕合理使用进行患者教育将是有益的。
研究结果表明，门诊环境中的抗生素处方受到多种压力的影响，包括患者需求和患者满意度。建议进行关于合理抗生素处方的培训、基于指南的决策支持、处方行为反馈以及患者教育等干预措施，以提高合理处方水平。
