Boiko Olga, Burgess Caroline, Fox Robin, Ashworth Mark, Gulliford Martin C
School of Population Health and Environmental Sciences, King's College London, London, UK.
Bicester Health Centre, Bicester, Oxfordshire, UK.
BMJ Open. 2020 Oct 19;10(10):e038851. doi: 10.1136/bmjopen-2020-038851.
The emergence of antimicrobial resistance has led to increasing efforts to reduce unnecessary use of antibiotics in primary care, but potential hazards from bacterial infection continue to cause concern. This study investigated how primary care prescribers perceive risk and safety concerns associated with reduced antibiotic prescribing.
Qualitative study using semistructured interviews conducted with primary care prescribers from 10 general practices in an urban area and a shire town in England. A thematic analysis was conducted.
Thirty participants were recruited, including twenty-three general practitioners, five nurses and two pharmacists. Three main themes were identified: risk assessment, balancing treatment risks and negotiating decisions and risks. Respondents indicated that their decisions were grounded in clinical risk assessment, but this was informed by different approaches to antibiotic use, with most leaning towards reduced prescribing. Prescribers' perceptions of risk included the consequences of both inappropriate prescribing and inappropriate withholding of antibiotics. Sepsis was viewed as the most concerning potential outcome of non-prescribing, leading to possible patient harm and potential litigation. Risks of antibiotic prescribing included antibiotic resistant and infections, as well as side effects, such as rashes, that might lead to possible mislabelling as antibiotic allergy. Prescribers elicited patient preferences for use or avoidance of antibiotics to inform management strategies, which included educational advice, advice on self-management including warning signs, use of delayed prescriptions and safety netting.
Attitudes towards antibiotic prescribing are evolving, with reduced antibiotic prescribing now being approached more systematically. The safety trade-offs associated with either use or non-use of antibiotics present difficulties especially when prescribing decisions are inconsistent with patients' expectations.
抗菌药物耐药性的出现促使人们加大力度减少基层医疗中抗生素的不必要使用，但细菌感染带来的潜在危害仍令人担忧。本研究调查了基层医疗开处方者如何看待与减少抗生素处方相关的风险和安全问题。
采用定性研究方法，对来自英格兰一个市区和一个郡镇的10家普通诊所的基层医疗开处方者进行半结构式访谈。进行了主题分析。
招募了30名参与者，包括23名全科医生、5名护士和2名药剂师。确定了三个主要主题：风险评估、平衡治疗风险以及协商决策和风险。受访者表示，他们的决策基于临床风险评估，但这受到不同抗生素使用方法的影响，大多数人倾向于减少处方。开处方者对风险的认知包括不适当开处方和不适当停用抗生素的后果。脓毒症被视为不使用抗生素最令人担忧的潜在后果，可能导致患者伤害和潜在诉讼。抗生素处方的风险包括抗生素耐药性和感染，以及皮疹等副作用，可能导致被误标记为抗生素过敏。开处方者了解患者对抗生素使用或避免使用的偏好，以制定管理策略，包括教育建议、自我管理建议（包括警示信号）、使用延迟处方和安全网。
对抗生素处方的态度正在演变，现在减少抗生素处方的做法更加系统。使用或不使用抗生素所涉及的安全权衡存在困难，尤其是当开处方决策与患者期望不一致时。
