Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada.
BMJ Open Qual. 2021 Feb;10(1). doi: 10.1136/bmjoq-2020-001088.
In nursing homes, 25%-75% of antibiotic days of treatment are inappropriate or unnecessary and are often continued for longer durations than necessary. In Ontario, physicians can receive a provincial audit and feedback report that provides individualised, confidential, data about their antibiotic prescribing. Objectives of this study were to explore antibiotic prescribing of nursing home physicians and the influence of the report.
All physicians who received a personalised report from Ontario Health (Quality) (OH(Q)) in January 2019 (n=361) were eligible to participate in semistructured telephone interviews that were recorded then transcribed verbatim. Recruitment emails were sent from OH(Q) until saturation of ideas. Analysis was conducted by two team members inductively, then deductively using the theoretical domains framework, a comprehensive, theory-informed framework to classify determinants of specific behaviours.
Interviews were conducted with n=18 physicians; 78% (n=14) were men, practising for an average of 27 years, with 18 years of experience working in nursing homes. Physicians worked in a median of 2 facilities (range 1-6), with 72% (n=13) in an urban setting. 56% (n=10) were medical directors for at least one home. impacted all aspects of antibiotic prescribing. Key roles included being an 'Appropriate prescriber', an 'Educator' and a 'Change driver'. For antibiotic initiation, these roles interacted with , , , and to determine the resulting prescribing behaviour. When considering the impact of interacting with the report, participants' perceived roles interacted with , and was an overarching domain.
This theory-informed approach is being used to inform upcoming versions of existing audit and feedback initiatives. Appealing to the role that prescribers see themselves offers a unique opportunity to encourage desired changes, such as providing tools for physicians to be Educators and facilitating, particularly medical directors, to be Change drivers.
在养老院中，25%-75%的抗生素治疗天数是不适当或不必要的，并且经常持续使用的时间超过必要的时间。在安大略省，医生可以收到一份省级审计和反馈报告，该报告提供有关其抗生素处方的个体化、机密、数据。本研究的目的是探讨养老院医生的抗生素处方情况以及报告的影响。
所有在 2019 年 1 月收到安大略省卫生（质量）（OH(Q)）个性化报告的医生（n=361）均有资格参加半结构化电话访谈，访谈内容会被记录下来并逐字转录。OH(Q)会发送招募电子邮件，直到想法达到饱和。两名团队成员使用理论领域框架（一种全面的、基于理论的框架，用于对特定行为的决定因素进行分类）进行了归纳和演绎分析。
对 n=18 名医生进行了访谈；78%（n=14）为男性，平均从业 27 年，在养老院工作 18 年。医生在中位数为 2 家机构（范围 1-6 家）工作，72%（n=13）在城市地区工作。56%（n=10）至少担任过一家养老院的医疗主任。 对抗生素处方的各个方面都有影响。主要角色包括“适当的处方者”、“教育者”和“变革推动者”。在抗生素的起始治疗方面，这些角色与 、 、 和 相互作用，决定了最终的处方行为。当考虑与报告相互作用的影响时，参与者认为自己的角色与 、 和 相互作用， 是一个总体的领域。
这种基于理论的方法正在被用于为现有的审计和反馈举措的未来版本提供信息。针对开处方者认为自己的角色提供了一个独特的机会，可以鼓励他们做出期望的改变，例如为医生提供成为教育者的工具，并促进特别是医疗主任成为变革推动者。
