Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
BMJ Open. 2021 Dec 20;11(12):e051561. doi: 10.1136/bmjopen-2021-051561.
Exploration of the factors that influence hospital doctors' antibiotic prescribing decisions when treating children with respiratory symptoms in UK emergency departments.
A qualitative study using semistructured interviews based on a critical incident technique with 21 physicians of different grades and specialties that treat children in the UK. Interviews were audio-recorded then transcribed verbatim and analysed using thematic analysis.
Four themes were identified. These themes illustrate factors which influence clinician prescribing. The three principal themes were authorities, pressures and risk. The fourth transcending theme that ran through all themes was clinician awareness and complicity ('knowing but still doing').
Hospital doctors prescribe antibiotics even when they know they should not. This appears to be due to the influence of those in charge or external pressures experienced while weighing up the immediate and longer term risks but clinicians do this with full insight into their actions. These findings have implications for invested parties seeking to develop future antimicrobial stewardship programmes. It is recommended that stewardship interventions acknowledge and target these themes which may in turn facilitate behaviour change and antimicrobial prescribing practice in emergency departments.
探索影响英国急诊科医生治疗呼吸系统症状儿童时开具抗生素处方决策的因素。
采用基于关键事件技术的定性研究，对 21 名不同级别和专业的英国儿科医生进行半结构式访谈。访谈进行录音，然后逐字转录，并使用主题分析进行分析。
确定了四个主题。这些主题说明了影响临床医生处方的因素。三个主要主题是权威、压力和风险。贯穿所有主题的第四个主题是临床医生的意识和共谋（“明知故犯”）。
医院医生即使知道不应该开抗生素，也会开抗生素。这似乎是由于负责人的影响或在权衡短期和长期风险时所经历的外部压力所致，但临床医生对自己的行为有充分的了解。这些发现对寻求制定未来抗菌药物管理计划的相关方具有重要意义。建议管理干预措施承认和针对这些主题，这反过来可能有助于改变行为和急诊部门的抗生素处方实践。
