Dept. of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
aQua Institut, Maschmuehlenweg 8-10, 37073, Goettingen, Germany.
BMC Fam Pract. 2020 Mar 14;21(1):51. doi: 10.1186/s12875-020-01119-8.
Primary care networks in Germany are formalized regional collaborations of physicians and other healthcare providers. Common goals are optimized healthcare processes and services for patients, enhanced communication, agency for professional concerns and strengthened economic power. In the ARena study (Sustainable reduction of antibiotic-induced antimicrobial resistance), 14 primary care networks in two federal German states aimed to promote appropriate antibiotics use for acute non-complicated infections by fostering awareness and understanding. Factors related to the role of primary care networks were to be identified.
For this study, audio-recorded telephone interviews were conducted with physicians, non-physician health professionals and stakeholder representatives. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was based on the inductive categories 'social support', 'social learning', 'social normative pressures' and 'social contagion' to reflect social influence processes. Data generated through a survey with physicians and non-physician health professionals were analyzed descriptively to foster understanding of the networks' potential impact on antibiotic prescribing.
Social influence processes proved to be relevant regarding knowledge transfer, manifestation of best-practice care and self-reflection. Peer communication was seen as a great asset, the main reason for membership and affirmative for own perspectives. All interviewed physicians (n = 27) considered their network to be a strong support factor for daily routines, introduction of new routines, and continuity of care. They utilized network-offered training programs focusing on best practice guideline-oriented use of antibiotics and considered their networks supportive in dealing with patient expectations. A shared attitude combined with ARena intervention components facilitated reflective management of antibiotic prescribing. Non-physician health professionals (n = 11) also valued network peer exchange. They assumed their employers joined networks to offer improved and continuous care. Stakeholders (n = 7) expected networks and their members to be drivers for care optimization.
Primary care networks play a crucial role in providing a platform for professional peer exchange, social support and reassurance. With regards to their impact on antibiotic prescribing for acute non-complicated infections, networks seem to facilitate and amplify quality improvement programs by providing a platform for refreshing awareness, knowledge and self-reflection among care providers. They are well suited to promote a rational use of antibiotics.
ISRCTN, ISRCTN58150046. Registered 24 August 2017.
德国的初级保健网络是医生和其他医疗保健提供者的正式区域合作。共同目标是优化患者的医疗流程和服务，加强沟通，为专业问题提供代理，并增强经济实力。在 ARena 研究（可持续减少抗生素诱导的抗菌耐药性）中，德国两个联邦州的 14 个初级保健网络旨在通过提高认识和理解来促进急性非复杂性感染的合理使用抗生素。目的是确定与初级保健网络作用相关的因素。
为此项研究，对医生、非医师卫生专业人员和利益相关者代表进行了录音电话访谈。对匿名化的逐字记录进行了主题分析编码。深入分析基于“社会支持”、“社会学习”、“社会规范压力”和“社会传染”这几个归纳类别，以反映社会影响过程。通过对医生和非医师卫生专业人员进行的调查进行描述性分析，以了解网络对抗生素处方的潜在影响。
社会影响过程在知识转移、最佳实践护理的表现和自我反思方面被证明是相关的。同行间的交流被视为一项巨大的优势，是加入网络的主要原因，并且对自己的观点也持肯定态度。所有接受访谈的医生（n=27）都认为他们的网络是日常工作、新常规引入和护理连续性的强有力支持因素。他们利用网络提供的培训计划，重点是抗生素的最佳实践指南导向使用，并认为网络在处理患者期望方面提供了支持。共同的态度加上 ARena 干预措施，促进了对抗生素处方的反思性管理。非医师卫生专业人员（n=11）也重视网络同行交流。他们认为自己的雇主加入网络是为了提供更好的持续护理。利益相关者（n=7）期望网络及其成员成为优化护理的驱动力。
初级保健网络在提供专业同行交流、社会支持和保证方面发挥着至关重要的作用。就其对急性非复杂性感染抗生素使用的影响而言，网络似乎通过为医疗服务提供者提供更新意识、知识和自我反思的平台，促进和放大质量改进计划。它们非常适合促进抗生素的合理使用。
ISRCTN，ISRCTN58150046。于 2017 年 8 月 24 日注册。
