Anyanwu Philip Emeka, Borek Aleksandra J, Tonkin-Crine Sarah, Beech Elizabeth, Costelloe Céire
Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK.
Antibiotics (Basel). 2020 Jan 23;9(2):44. doi: 10.3390/antibiotics9020044.
In order to tackle the public health threat of antimicrobial resistance, improvement in antibiotic prescribing in primary care was included as one of the priorities of the Quality Premium (QP) financial incentive scheme for Clinical Commissioning Groups (CCGs) in England. This paper briefly reports the outcome of a workshop exploring the experiences of antimicrobial stewardship (AMS) leads within CCGs in selecting and adopting strategies to help achieve the QP antibiotic targets. We conducted a thematic analysis of the notes on discussions and observations from the workshop to identify key themes. Practice visits, needs assessment, peer feedback and audits were identified as strategies integrated in increasing engagement with practices towards the QP antibiotic targets. The conceptual model developed by AMS leads demonstrated possible pathways for the impact of the QP on antibiotic prescribing. Participants raised a concern that the constant targeting of high prescribing practices for AMS interventions might lead to disengagement by these practices. Most of the participants suggested that the effect of the QP might be less about the financial incentive and more about having national targets and guidelines that promote antibiotic prudency. Our results suggest that national targets, rather than financial incentives are key for engaging stakeholders in quality improvement in antibiotic prescribing.
为应对抗菌药物耐药性对公共卫生构成的威胁，改善基层医疗中的抗生素处方行为被纳入了英格兰临床委托小组（CCG）的质量提升（QP）财政激励计划的优先事项之中。本文简要报告了一场研讨会的成果，该研讨会探讨了CCG内部抗菌药物管理（AMS）负责人在选择和采用策略以帮助实现QP抗生素目标方面的经验。我们对研讨会上的讨论记录和观察笔记进行了主题分析，以确定关键主题。实践访问、需求评估、同行反馈和审核被确定为有助于提高各医疗机构为实现QP抗生素目标而参与度的综合策略。AMS负责人开发的概念模型展示了QP对抗生素处方产生影响的可能途径。参与者担心，持续将高处方量的医疗机构作为AMS干预的目标可能会导致这些机构产生抵触情绪。大多数参与者认为，QP的效果可能与其财政激励作用关系不大，而更多地在于拥有促进审慎使用抗生素的国家目标和指南。我们的结果表明，国家目标而非财政激励措施才是促使利益相关者参与抗生素处方质量改进的关键。
