重症监护医生对快速多重分子诊断检测的信念及其在改善处方决策和抗菌药物管理方面的潜在作用：一项定性研究。
Intensivists' beliefs about rapid multiplex molecular diagnostic testing and its potential role in improving prescribing decisions and antimicrobial stewardship: a qualitative study.
机构信息
Centre for Behavioural Medicine, University College London, British Medical Association House, Tavistock Square, London, WC1H 9JP, UK.
UCLH-UCL Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK.
出版信息
Antimicrob Resist Infect Control. 2021 Jun 29;10(1):95. doi: 10.1186/s13756-021-00961-4.
BACKGROUND
Rapid molecular diagnostic tests to investigate the microbial aetiology of pneumonias may improve treatment and antimicrobial stewardship in intensive care units (ICUs). Clinicians' endorsement and uptake of these tests is crucial to maximise engagement; however, adoption may be impeded if users harbour unaddressed concerns or if device usage is incompatible with local practice. Accordingly, we strove to identify ICU clinicians' beliefs about molecular diagnostic tests for pneumonias before implementation at the point-of-care.
METHODS
We conducted semi-structured interviews with 35 critical care doctors working in four ICUs in the United Kingdom. A clinical vignette depicting a fictitious patient with signs of pneumonia was used to explore clinicians' beliefs about the importance of molecular diagnostics and their concerns. Data were analysed thematically.
RESULTS
Clinicians' beliefs about molecular tests could be grouped into two categories: perceived potential of molecular diagnostics to improve antibiotic prescribing (Molecular Diagnostic Necessity) and concerns about how the test results could be implemented into practice (Molecular Diagnostic Concerns). Molecular Diagnostic Necessity stemmed from beliefs that positive results would facilitate targeted antimicrobial therapy; that negative results would signal the absence of a pathogen, and consequently that having the molecular diagnostic results would bolster clinicians' prescribing confidence. Molecular Diagnostic Concerns included unfamiliarity with the device's capabilities, worry that it would detect non-pathogenic bacteria, uncertainty whether it would fail to detect pathogens, and discomfort with withholding antibiotics until receiving molecular test results.
CONCLUSIONS
Clinicians believed rapid molecular diagnostics for pneumonias were potentially important and were open to using them; however, they harboured concerns about the tests' capabilities and integration into clinical practice. Implementation strategies should bolster users' necessity beliefs while reducing their concerns; this can be accomplished by publicising the tests' purpose and benefits, identifying and addressing clinicians' misconceptions, establishing a trial period for first-hand familiarisation, and emphasising that, with a swift (e.g., 60-90 min) test, antibiotics can be started and refined after molecular diagnostic results become available.
背景
快速分子诊断测试可用于研究肺炎的微生物病因，这可能会改善重症监护病房（ICU）的治疗效果和抗菌药物管理。临床医生对这些测试的认可和采用对于最大程度地提高参与度至关重要；然而，如果用户存在未解决的问题，或者设备的使用与当地的做法不兼容，那么可能会阻碍采用。因此，我们努力在床边即时检测实施之前，确定 ICU 临床医生对肺炎分子诊断测试的看法。
方法
我们对英国 4 家 ICU 的 35 名重症监护医生进行了半结构化访谈。使用描述一个有肺炎迹象的虚构患者的临床案例来探讨临床医生对分子诊断的重要性的看法和他们的关注点。数据分析采用主题分析法。
结果
临床医生对分子检测的看法可以分为两类：认为分子诊断有提高抗生素处方的潜力（分子诊断必要性），以及对如何将检测结果付诸实践的担忧（分子诊断顾虑）。分子诊断必要性源于以下信念：阳性结果将有助于靶向抗菌治疗；阴性结果表明不存在病原体，因此获得分子诊断结果将增强临床医生的处方信心。分子诊断顾虑包括对设备功能的不熟悉，担心它会检测到非致病性细菌，不确定它是否会检测不到病原体，以及对在收到分子检测结果之前不使用抗生素感到不安。
结论
临床医生认为肺炎的快速分子诊断具有潜在的重要性，并且愿意使用它们；然而，他们对检测的能力和整合到临床实践中存在担忧。实施策略应增强用户的必要性信念，同时减少他们的担忧；这可以通过宣传检测的目的和好处，识别和解决临床医生的误解，建立一个试用阶段来进行第一手的熟悉，以及强调可以在获得分子诊断结果之前，通过快速（例如 60-90 分钟）的检测，开始并优化抗生素治疗。
Zotero 插件