Sunde Marthe, Nygaard Marthe Marie, Høye Sigurd
Faculty of Medicine, University of Oslo, 0318 Oslo, Norway.
Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, 0318 Oslo, Norway.
Antibiotics (Basel). 2019 Aug 17;8(3):120. doi: 10.3390/antibiotics8030120.
Antimicrobial stewardship (AMS) interventions directed at general practitioners (GPs) contribute to an improved antibiotic prescribing. However, it is challenging to implement and maintain such interventions at a national level. Involving the municipalities' Chief Medical Officer (MCMO) in quality improvement activities may simplify the implementation and maintenance, but may also be perceived challenging for the GPs. In the ENORM (Educational intervention in NORwegian Municipalities for antibiotic treatment in line with guidelines) study, MCMOs acted as facilitators of an AMS intervention for GPs. We explored GPs' views on their own antibiotic prescribing, and their views on MCMO involvement in improving antibiotic prescribing in general practice. This is a mixed-methods study combining quantitative and qualitative data from two data sources: e-mail interviews with 15 GPs prior to the ENORM intervention, and online-form answers to closed and open-ended questions from 132 GPs participating in the ENORM intervention. The interviews and open-ended responses were analyzed using systematic text condensation. Many GPs admitted to occasionally prescribing antibiotics without medical indication, mainly due to pressure from patients. Too liberal treatment guidelines were also seen as a reason for overtreatment. The MCMO was considered a suitable and acceptable facilitator of quality improvement activities in general practice, and their involvement was regarded as unproblematic (scale 0 (very problematic) to 10 (not problematic at all): mean 8.2, median 10). GPs acknowledge the need and possibility to improve their own antibiotic prescribing, and in doing so, they welcome engagement from the municipality. MCMOs should be involved in quality improvement and AMS in general practice.
针对全科医生（GP）的抗菌药物管理（AMS）干预措施有助于改善抗生素处方。然而，在国家层面实施和维持此类干预措施具有挑战性。让市政首席医疗官（MCMO）参与质量改进活动可能会简化实施和维持工作，但对全科医生来说也可能被视为具有挑战性。在ENORM（挪威市政当局符合指南的抗生素治疗教育干预）研究中，MCMO充当了针对全科医生的AMS干预措施的促进者。我们探讨了全科医生对自己抗生素处方的看法，以及他们对MCMO参与改善全科医疗中抗生素处方的看法。这是一项混合方法研究，结合了来自两个数据源的定量和定性数据：在ENORM干预之前对15名全科医生进行电子邮件访谈，以及对参与ENORM干预的132名全科医生对封闭式和开放式问题的在线表格回答。使用系统文本浓缩法对访谈和开放式回答进行了分析。许多全科医生承认偶尔会在没有医学指征的情况下开具抗生素，主要是由于来自患者的压力。过于宽松的治疗指南也被视为过度治疗的一个原因。MCMO被认为是全科医疗质量改进活动的合适且可接受的促进者，他们的参与被认为没有问题（从0（非常有问题）到10（完全没有问题）的量表：平均8.2，中位数10）。全科医生认识到有必要且有可能改善自己的抗生素处方，并且在这样做的过程中，他们欢迎市政当局的参与。MCMO应参与全科医疗的质量改进和AMS。
