Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
Clemson University, Clemson, South Carolina, United States.
Appl Clin Inform. 2021 Jan;12(1):34-40. doi: 10.1055/s-0040-1718757. Epub 2021 Jan 20.
Antibiotic prescribing in ambulatory care centers is increasing. Previous research suggests that 20 to 50% of antibiotic prescriptions are either unnecessary or inappropriate. Unnecessary antibiotic consumption can harm patients by increasing antibiotic resistance and drug-associated toxicities, and the reasons for such use are multifactorial. Antimicrobial Stewardship Programs (ASP) were developed to guide better use of antibiotics. A core element of ASP is to provide feedback to clinical providers. To create clinically meaningful feedback, user-center design (UCD) is a robust approach to include end-users in the design process to improve systems.
The study aimed to take a UCD approach to developing antibiotic prescribing feedback through input from clinicians in two ambulatory care settings.
We conducted two group prototyping sessions with pediatric clinicians who practice in the emergency department and urgent care settings at a tertiary care children's hospital. Participants received background on the problem of antibiotic prescribing and then were interviewed about their information needs, perceived value, and desired incentives for a prescribing feedback system. Sessions concluded with their response and recommendations to sample sections of an antibiotic feedback report including orienting material, report detail, targeted education, and resources.
A UCD approach was found to be highly valuable in the development of a feedback mechanism that is viewed as desirable by clinicians. Clinicians preferred interpreting the data themselves with aids such as diagrams and charts over the researcher concluded statements about the clinician's behavior. Specific feedback that clinicians considered redundant were removed from the model if preexisting alerts were established.
Integrating a UCD approach in developing ASP feedback identified desirable report characteristics that substantially modified preliminary wireframes for feedback. Future research will evaluate the clinical effectiveness of our feedback reports in outpatient settings.
在门诊护理中心，抗生素的处方量正在增加。先前的研究表明，20% 到 50%的抗生素处方要么是不必要的，要么是不恰当的。不必要的抗生素使用会通过增加抗生素耐药性和与药物相关的毒性来危害患者，而这种使用的原因是多方面的。抗生素管理计划 (Antimicrobial Stewardship Programs，ASP) 的开发是为了指导更好地使用抗生素。ASP 的一个核心要素是向临床医生提供反馈。为了提供有临床意义的反馈，用户中心设计 (User-Center Design，UCD) 是一种强大的方法，可以让最终用户参与设计过程，从而改进系统。
本研究旨在通过来自两家门诊护理环境的临床医生的投入，采用 UCD 方法开发抗生素处方反馈。
我们在一家三级儿童医院的急诊室和紧急护理环境中进行了两次小组原型设计会议，参与者接受了抗生素处方问题的背景介绍，然后对他们的信息需求、感知价值和对处方反馈系统的期望激励因素进行了访谈。会议结束时，他们对包括导向材料、报告详细信息、有针对性的教育和资源在内的抗生素反馈报告的样本部分做出了回应和建议。
UCD 方法在开发反馈机制方面非常有价值，该机制被临床医生认为是理想的。临床医生更喜欢自己解释数据，辅以图表等辅助工具，而不是研究人员对医生行为的总结性陈述。如果已经建立了预先存在的警报，则从模型中删除临床医生认为冗余的特定反馈。
在开发 ASP 反馈时整合 UCD 方法，确定了理想的报告特征，这些特征大大修改了反馈的初步线框。未来的研究将评估我们在门诊环境中反馈报告的临床效果。
