Antibiotic Resistance Project, The Pew Charitable Trusts, Washington, District of Columbia, USA
Antibiotic Resistance Project, The Pew Charitable Trusts, Washington, District of Columbia, USA.
BMJ Open. 2020 Jul 14;10(7):e034983. doi: 10.1136/bmjopen-2019-034983.
At least 30% of outpatient antibiotic prescriptions are unnecessary. Outpatient antibiotic stewardship is needed to improve prescribing and address the threat of antibiotic resistance. A better understanding of primary care physicians (PCPs) attitudes towards antibiotic prescribing and outpatient antibiotic stewardship is needed to identify barriers to stewardship implementation and help tailor stewardship strategies. The aim of this study was to assess PCPs current attitudes towards antibiotic resistance, inappropriate antibiotic prescribing and the feasibility of outpatient stewardship efforts.
Eight focus groups with PCPs were conducted by an independent moderator using a moderator guide. Focus groups were audio recorded, transcribed and coded for major themes using deductive and inductive content analysis methods.
Focus groups were conducted in four US cities: Philadelphia, Birmingham, Chicago and Los Angeles.
Two focus groups were conducted in each city-one with family medicine and internal medicine physicians and one with paediatricians. A total of 26 family medicine/internal medicine physicians and 26 paediatricians participated.
Participants acknowledged that resistance is an important public health issue, but not as important as other pressing problems (eg, obesity, opioids). Many considered resistance to be more of a hospital issue. While participants recognised inappropriate prescribing as a problem in outpatient settings, many felt that the key drivers were non-primary care settings (eg, urgent care clinics, retail clinics) and patient demand. Participants reacted positively to stewardship efforts aimed at educating patients and clinicians. They questioned the validity of antibiotic prescribing metrics. This scepticism was due to a number of factors, including the feasibility of capturing prescribing quality, a belief that physicians will 'game the system' to improve their measures, and dissatisfaction and distrust of quality measurement in general.
Stakeholders will need to consider physician attitudes and beliefs about antibiotic stewardship when implementing interventions aimed at improving prescribing.
至少有 30%的门诊抗生素处方是不必要的。需要开展门诊抗生素管理，以改善处方行为，应对抗生素耐药的威胁。为了确定实施管理措施的障碍，并帮助制定管理策略，有必要深入了解初级保健医生（PCP）对抗生素处方和门诊抗生素管理的态度。本研究旨在评估 PCP 目前对抗生素耐药性、不适当的抗生素处方以及开展门诊管理工作的可行性的态度。
由独立主持人采用主持人指南，对 PCP 进行了 8 组焦点小组讨论。使用演绎和归纳内容分析方法对焦点小组进行录音、转录和主要主题编码。
在四个美国城市（费城、伯明翰、芝加哥和洛杉矶）进行了焦点小组讨论。
在每个城市进行了两组焦点小组讨论，一组是家庭医学和内科医生，一组是儿科医生。共有 26 名家庭医学/内科医生和 26 名儿科医生参加了讨论。
参与者承认耐药性是一个重要的公共卫生问题，但不如其他紧迫问题（如肥胖、阿片类药物）重要。许多人认为耐药性更多是医院的问题。尽管参与者认为在门诊环境中存在不适当的处方问题，但许多人认为主要驱动因素是非初级保健机构（如急诊诊所、零售诊所）和患者需求。参与者对旨在教育患者和临床医生的管理措施反应积极。他们对抗生素处方指标的有效性提出了质疑。这种怀疑态度源于许多因素，包括捕捉处方质量的可行性、医生将“操纵系统”以改善其措施的信念，以及对质量衡量的不满和不信任。
在实施旨在改善处方行为的干预措施时，利益相关者将需要考虑医生对抗生素管理的态度和信念。
