了解家长-临床医生沟通对初级保健中儿童呼吸道感染抗生素处方的影响：使用会话分析方法的定性观察研究。
Understanding the influence of parent-clinician communication on antibiotic prescribing for children with respiratory tract infections in primary care: a qualitative observational study using a conversation analysis approach.
机构信息
Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.
Children and Families Research Centre, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK.
出版信息
BMC Fam Pract. 2019 Jul 19;20(1):102. doi: 10.1186/s12875-019-0993-9.
BACKGROUND
Acute respiratory tract infections (RTI) in children are a common reason for antibiotic prescribing. Clinicians' prescribing decisions are influenced by perceived parental expectations for antibiotics, however there is evidence that parents actually prefer to avoid antibiotics. This study aimed to investigate the influence of parent-clinician communication on antibiotic prescribing for RTI in children in England.
METHODS
A mixed methods analysis of videoed primary care consultations for children (under 12 years) with acute cough and RTI. Consultations were video-recorded in six general practices in southern England, selected for socio-economic diversity. 56 recordings were transcribed in detail and a subset of recordings and transcripts used to develop a comprehensive interaction-based coding scheme. The scheme was used to examine communication practices between parents and clinicians and how these related to antibiotic or non-antibiotic treatment strategies.
RESULTS
Parents' communication rarely implied an expectation for antibiotics, some explicitly offering a possible viral diagnosis. Clinicians mostly gave, or implied, a viral diagnosis and mainly recommended non-antibiotic treatment strategies. In the minority of cases where parents' communication behaviours implied they may be seeking antibiotic treatment, antibiotics were not usually prescribed. Where clinicians did prescribe antibiotics, they voiced concern about symptoms or signs, including chest pain, discoloured phlegm, prolonged fever, abnormal chest sounds, or pink /bulging ear drums.
CONCLUSIONS
We found little evidence of a relationship between parents' communication behaviours and antibiotic prescribing. Rather, where antibiotics were prescribed, this was associated with clinicians' expressed concerns regarding symptoms and signs.
背景
儿童急性呼吸道感染（RTI）是开具抗生素的常见原因。临床医生的处方决策受到家长对使用抗生素期望的影响，然而有证据表明家长实际上更倾向于避免使用抗生素。本研究旨在调查英国家长-临床医生沟通对儿童急性呼吸道感染（RTI）抗生素处方的影响。
方法
对英格兰南部六家普通实践中儿童（12 岁以下）急性咳嗽和 RTI 的视频初级保健咨询进行混合方法分析。在这些实践中，选择了具有社会经济多样性的 56 个咨询记录进行详细转录，并使用部分记录和转录内容来开发全面的基于互动的编码方案。该方案用于检查家长和临床医生之间的沟通实践，以及这些沟通实践如何与抗生素或非抗生素治疗策略相关。
结果
家长的沟通很少暗示他们期望使用抗生素，有些家长明确提出可能是病毒诊断。临床医生大多给出或暗示病毒诊断，并主要推荐非抗生素治疗策略。在少数情况下，家长的沟通行为暗示他们可能在寻求抗生素治疗，但通常不会开抗生素。当临床医生开抗生素时，他们会对症状或体征表示担忧，包括胸痛、变色痰、持续发热、异常胸部声音或粉红色/肿胀的鼓膜。
结论
我们几乎没有发现家长沟通行为与抗生素处方之间的关系。相反，在开抗生素的情况下，这与临床医生对症状和体征的表达担忧有关。
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