Tarrant Carolyn, Colman Andrew M, Jenkins David R, Chattoe-Brown Edmund, Perera Nelun, Mehtar Shaheen, Nakkawita W M I Dilini, Bolscher Michele, Krockow Eva M
Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK.
Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7RH, UK.
Antibiotics (Basel). 2021 Jan 19;10(1):94. doi: 10.3390/antibiotics10010094.
Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions.
抗菌药物管理计划主要通过干预措施来改变处方行为，致力于减少广谱抗生素（BSAs）的过度使用。本研究旨在确定在不同的高收入和低收入以及公立和私立医疗环境中，对BSAs过度使用的多层次影响。对来自英国、斯里兰卡和南非医院的46名开处方者进行了半结构化访谈，包括公立和私立医疗机构的人员。访谈探讨了开具BSAs的决策过程、使用BSAs的驱动因素以及BSAs对不同利益相关者的益处，并采用持续比较法进行分析。分析确定了个体、社会和结构层面上BSAs过度使用的驱动因素。过度使用的结构驱动因素在不同环境中差异很大，包括：与管理目标产生冲突的系统层面因素；医院内部物质资源有限；以及患者贫困、当地社区缺乏基础设施和资源。抗菌药物管理需要努力减少对BSAs的依赖，以此作为应对特定环境结构条件的解决方案。
