From the Division of Infectious Diseases, Department of Medicine.
Department of Pharmacy, Johns Hopkins Hospital, Baltimore.
J Patient Saf. 2022 Apr 1;18(3):e633-e639. doi: 10.1097/PTS.0000000000000899.
Our objective was to characterize tasks required for patient-performed antibiotic medication management (MM) at the hospital-to-home transition, as well as barriers to and strategies for patient-led antibiotic MM. Our overall goal was to understand patients' role in managing antibiotics at the hospital-to-home transition.
We performed a qualitative study including semistructured interviews with health care workers and contextual inquiry with patients discharged home on oral antibiotics. The setting was one academic medical center and one community hospital. Participants included 37 health care workers and 16 patients. We coded interview transcripts and notes from contextual inquiry and developed themes.
We identified 6 themes involving barriers or strategies for antibiotic MM. We identified dissonance between participant descriptions of the ease of antibiotic MM at the hospital-to-home transition and their experience of barriers. Similarly, patients did not always recognize when they were experiencing side effects. Lack of access to follow-up care led to unnecessarily long antibiotic courses. Instructions about completing antibiotics were not routinely provided. However, patients typically did not question the need for the prescribed antibiotic.
There are many opportunities to improve patient-led antibiotic MM at the hospital-to-home transition. Mismatches between patient perceptions and patient experiences around antibiotic MM at the hospital-to-home transition provide opportunities for health system improvement.
我们的目的是描述患者在医院到家庭过渡期间进行抗生素药物管理（MM）所需的任务，以及患者主导的抗生素 MM 的障碍和策略。我们的总体目标是了解患者在医院到家庭过渡期间管理抗生素的角色。
我们进行了一项定性研究，包括与医护人员进行半结构化访谈和对口服抗生素出院的患者进行情境调查。研究地点是一家学术医疗中心和一家社区医院。参与者包括 37 名医护人员和 16 名患者。我们对访谈记录和情境调查的笔记进行了编码，并开发了主题。
我们确定了 6 个主题，涉及抗生素 MM 的障碍或策略。我们发现参与者对医院到家庭过渡期间抗生素 MM 的容易程度的描述与他们遇到的障碍之间存在矛盾。同样，患者并不总是意识到自己正在经历副作用。由于无法获得后续护理，导致抗生素疗程不必要地延长。关于完成抗生素治疗的说明通常没有提供。然而，患者通常不会质疑所开抗生素的必要性。
在医院到家庭过渡期间，有许多机会可以改善患者主导的抗生素 MM。患者对医院到家庭过渡期间抗生素 MM 的认知与实际体验之间的不匹配为改善医疗系统提供了机会。
