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.
BMC Fam Pract. 2020 Dec 19;21(1):274. doi: 10.1186/s12875-020-01351-2.
Antimicrobial resistance remains a global challenge. In Germany, the national health agenda supports measures that enhance the appropriate, guideline-oriented use of antibiotics. The study "Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care (CHANGE-3)" aimed at a sustainable reduction of antimicrobial resistance through converting patterns of prescribing practice and use of antibiotics and an increase in health literacy in primary care patients, practice teams, and in the general public. Embedded in a cluster-randomized trial of a multifaceted implementation program, a process evaluation focused on the uptake of program components to assess the fidelity of the implementation program in the CHANGE-3 study and to understand utilization of its educational components.
A mix of qualitative and quantitative methods was used. Semi-structured telephone interviews were conducted with General Practitioners, Medical Assistants, patients treated for respiratory tract infection and outreach visitors who had carried out individual outreach visits. A two-wave written survey (T1: 5 months after start, T2: 16 months after start) was conducted in general practitioners and medical assistants. Qualitative data were analyzed using thematic framework analysis. Descriptive statistics were used to analyze survey data.
Uptake of intervention components was heterogenous. Across all components, the uptake reported by General Practitioners varied from 20 to 88% at T1 and 31 to 63% at T2. Medical Assistants reported uptake from 22 to 70% at T1 and 6 to 69% at T2. Paper-based components could by and large be integrated in daily practice (64 to 90% in T1; 41 to 93% in T2), but uptake of digital components was low. A one-time outreach visit provided thematic information and feedback regarding actual prescribing, but due to time constraints were received with reluctance by practice teams. Patients were largely unaware of program components, but assumed that information and education could promote health literacy regarding antibiotics use.
The process evaluation contributed to understanding the applicability of the delivered educational components with regards to the appropriate use of antibiotics. Future research efforts need to identify the best mode of delivery to reach the targeted population.
ISRCTN, ISRCTN15061174 . Registered 13 July 2018 - Retrospectively registered.
抗菌药物耐药性仍是全球面临的挑战。在德国，国家卫生议程支持采取措施，增强抗生素的合理使用，以指导临床实践。“在德国初级保健中转换治疗呼吸道感染的抗生素使用习惯（CHANGE-3）”研究旨在通过转换处方实践模式和抗生素使用模式以及提高初级保健患者、实践团队和公众的健康素养，来实现可持续减少抗菌药物耐药性。该研究将实施计划的多方面内容纳入一项集群随机试验中，同时开展一项过程评估，重点关注实施计划各项内容的采用情况，以评估 CHANGE-3 研究中实施计划的保真度，并了解其教育内容的使用情况。
采用定性和定量相结合的方法。对全科医生、医疗助理、接受呼吸道感染治疗的患者和进行个别上门访问的外展访问者进行半结构式电话访谈。在全科医生和医疗助理中开展了两次书面调查（T1：开始后 5 个月，T2：开始后 16 个月）。使用主题框架分析法对定性数据进行分析。采用描述性统计分析方法对调查数据进行分析。
干预措施各项内容的采用情况存在差异。所有内容中，全科医生报告的 T1 采用率为 20%至 88%，T2 采用率为 31%至 63%。医疗助理报告的 T1 采用率为 22%至 70%，T2 采用率为 6%至 69%。纸质内容在很大程度上可以整合到日常实践中（T1 采用率为 64%至 90%；T2 采用率为 41%至 93%），但数字内容的采用率较低。一次性上门访问提供了关于实际处方的主题信息和反馈，但由于时间限制，受到了实践团队的抵触。患者对项目内容大多不知情，但认为信息和教育可以提高抗生素使用方面的健康素养。
该过程评估有助于了解所提供的教育内容在抗生素合理使用方面的适用性。未来的研究工作需要确定向目标人群提供最佳交付模式。
ISRCTN，ISRCTN83441506. 注册于 2018 年 7 月 13 日-事后注册。
