Santillo Marta, Wanat Marta, Davoudianfar Mina, Bongard Emily, Savic Sinisa, Savic Louise, Porter Catherine, Fielding Joanne, Butler Christopher C, Pavitt Sue, Sandoe Jonathan, Tonkin-Crine Sarah
Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK.
BMJ Open. 2020 Oct 1;10(10):e035793. doi: 10.1136/bmjopen-2019-035793.
To develop a behavioural intervention package to support clinicians and patients to amend incorrect penicillin allergy records in general practice. The intervention aimed to: (1) support clinicians to refer patients for penicillin allergy testing (PAT), (2) support patients to attend for PAT and (3) support clinicians and patients to prescribe or consume penicillin, when indicated, following a negative PAT result.
Theory-based, evidence-based and person-based approaches were used in the intervention development. We used evidence from a rapid review, two qualitative studies, and expert consultations with the clinical research team to identify the intervention 'guiding principles' and develop an intervention plan. Barriers and facilitators to the target behaviours were mapped to behaviour change theory in order to describe the proposed mechanisms of change. In the final stage, think-aloud interviews were conducted to optimise intervention materials.
The collated evidence showed that the key barriers to referral of patients by clinicians were limited experience of referral and limited knowledge of referral criteria and PAT. Barriers for patients attending PAT were lack of knowledge of the benefits of testing and lack of motivation to get tested. The key barriers to the prescription and consumption of first-line penicillin following a negative test result were patient and clinician beliefs about the accuracy of PAT and whether taking penicillin was safe. Intervention materials were designed and developed to address these barriers.
We present a novel behavioural intervention package designed to address the multiple barriers to uptake of PAT in general practice by clinicians and patients. The intervention development details how behaviour change techniques have been incorporated to hypothesise how the intervention is likely to work to help amend incorrect penicillin allergy records. The intervention will go on to be tested in a feasibility trial and randomised controlled trial in England.
制定一套行为干预方案，以支持临床医生和患者修改全科医疗中不正确的青霉素过敏记录。该干预旨在：（1）支持临床医生将患者转诊进行青霉素过敏测试（PAT）；（2）支持患者接受PAT；（3）在PAT结果为阴性时，支持临床医生和患者在有指征时开具或使用青霉素。
在干预方案的制定过程中采用了基于理论、证据和个体的方法。我们利用了快速综述、两项定性研究以及与临床研究团队的专家咨询所获得的证据，来确定干预的“指导原则”并制定干预计划。将目标行为的障碍和促进因素映射到行为改变理论，以描述所提议的改变机制。在最后阶段，进行了出声思考访谈以优化干预材料。
汇总的证据表明，临床医生转诊患者的主要障碍是转诊经验有限以及对转诊标准和PAT的了解有限。患者接受PAT的障碍是对测试益处缺乏了解以及缺乏接受测试的动力。测试结果为阴性后，一线青霉素处方和使用的主要障碍是患者和临床医生对PAT准确性以及服用青霉素是否安全的看法。针对这些障碍设计并开发了干预材料。
我们提出了一套新颖的行为干预方案，旨在解决临床医生和患者在全科医疗中接受PAT的多重障碍。干预方案的制定详细说明了如何纳入行为改变技术，以推测干预可能如何发挥作用来帮助修改不正确的青霉素过敏记录。该干预方案将在英国进行可行性试验和随机对照试验。
