Poss-Doering Regina, Kühn Lukas, Kamradt Martina, Stürmlinger Anna, Glassen Katharina, Andres Edith, Kaufmann-Kolle Petra, Wambach Veit, Bader Lutz, Szecsenyi Joachim, Wensing Michel
Department 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.
Antibiotics (Basel). 2020 Dec 8;9(12):878. doi: 10.3390/antibiotics9120878.
The cluster randomized trial ARena (sustainable reduction of antibiotic-induced antimicrobial resistance, 2017-2020) promoted appropriate use of antibiotics for acute non-complicated infections in primary care networks (PCNs) in Germany. A process evaluation assessed determinants of practice and explored factors associated with antibiotic prescribing patterns. This work describes its findings on uptake and impacts of the complex intervention program and indicates potential implementation into routine care. In a nested mixed-methods approach, a three-wave study-specific survey for participating physicians and medical assistants assessed potential impacts and uptake of the complex intervention program. Stakeholders received a one-time online questionnaire to reflect on network-related aspects. Semi-structured, open-ended interviews, with a purposive sample of physicians, medical assistants and stakeholders, explored program component acceptance for daily practice and perceived sustainability of intervention component effects. Intervention components were perceived to be smoothly integrable into practice routines. The highest uptake was reported for educational components: feedback reports, background information, e-learning modules and disease-specific quality circles (QCs). Participation in PCNs was seen as the motivational factor for guideline-oriented patient care and adoption of new routines. Future approaches to fostering appropriate antibiotics use by targeting health literacy competencies and clinician's therapy decisions should combine evidence-based information sources, audit and feedback reports and QCs.
整群随机试验ARena（2017 - 2020年抗生素诱导的抗菌药物耐药性可持续降低）促进了德国基层医疗网络（PCN）中急性非复杂性感染抗生素的合理使用。一项过程评估确定了实践的决定因素，并探究了与抗生素处方模式相关的因素。这项工作描述了其关于复杂干预项目的接受情况和影响的研究结果，并指出了在常规护理中潜在的实施情况。采用嵌套式混合方法，针对参与研究的医生和医疗助理开展了一项三波次的特定研究调查，以评估复杂干预项目的潜在影响和接受情况。利益相关者收到一份一次性在线问卷，以反思与网络相关的方面。对医生、医疗助理和利益相关者进行了有目的抽样的半结构化开放式访谈，探讨了项目组成部分在日常实践中的接受情况以及干预组成部分效果的可持续性认知。干预组成部分被认为能够顺利融入实践流程。教育组成部分的接受度最高：反馈报告、背景信息、电子学习模块和特定疾病质量改进小组（QC）。参与基层医疗网络被视为以指南为导向的患者护理和采用新流程的激励因素。未来通过针对健康素养能力和临床医生的治疗决策来促进抗生素合理使用的方法，应结合基于证据的信息来源、审核和反馈报告以及质量改进小组。
