Department of Internal Medicine, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran.
Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Science, Isfahan, Iran.
Antimicrob Resist Infect Control. 2022 Aug 29;11(1):109. doi: 10.1186/s13756-022-01151-6.
Rational antibiotic prescription (RAP) refers to the purposeful and appropriate antibiotic prescription with correct dose and course to produce the most possible benefits and less possible side effects. Identification and management of the barriers to RAP can help promote RAP. The aim of the study was to explore the barriers to RAP in Iran.
This descriptive qualitative study was conducted in 2021 on 46 physicians (including general physicians, specialists, and subspecialists), pharmacologists, microbiologists, and nurses. Participants were purposefully selected from five specialty and subspecialty hospitals in Isfahan, Iran, and the Treatment Administration of Isfahan University of Medical Sciences, Isfahan, Iran. Data were collected via semi-structured interviews and were analyzed via conventional content analysis.
The barriers to RAP in Iran came into sixteen subcategories and four main categories, namely physicians' limited professional competence (with six subcategories), poor informational and functional resources (with four subcategories), ineffective supervision of RAP (with three subcategories), and inappropriate context for RAP (with three subcategories). The subcategories of these categories were physicians' limited professional knowledge, physicians' poor attitude towards RAP, physicians' routine-based practice instead of evidence-based practice, physicians' limited accountability, physicians' fear over the legal consequences of not prescribing antibiotics, physicians' financial motives, limited access to quality educational materials, poor in-service training for physicians, lack of culturally appropriate guidelines, inefficiency of the stewardship committee, limited supervision of physicians' performance, ineffective managerial supervision, limited supervision of sampling for antimicrobial susceptibility testing, sociocultural factors contributing to irrational antibiotic prescription, poor adherence of insurance companies to their financial commitments, and financial incentives of pharmaceutical companies for physicians.
The barriers to RAP are different and complex and include physician-related, resource-related, supervision-related, and contextual factors. Physicians with limited professional competence, limited access to resources, and limited supervision will have problems in RAP. Effective management of the barriers to RAP can promote RAP and minimize irrational antibiotic prescription and its consequences, chiefly antimicrobial resistance.
合理使用抗生素（RAP）是指目的明确、使用恰当的抗生素，剂量和疗程合适，使可能获得的益处最大化，同时使可能出现的副作用最小化。识别和管理 RAP 的障碍有助于促进 RAP。本研究旨在探讨伊朗 RAP 的障碍因素。
这是一项 2021 年进行的描述性定性研究，对象为 46 名医生（包括全科医生、专科医生和亚专科医生）、药理学家、微生物学家和护士。参与者是从伊朗伊斯法罕的五家专科医院和伊朗伊斯法罕医科大学治疗管理处有目的地选择的。通过半结构式访谈收集数据，并采用常规内容分析法进行分析。
伊朗 RAP 的障碍因素分为十六个子类别和四个主要类别，即医生专业能力有限（六个子类别）、信息和功能资源不足（四个子类别）、RAP 监督不力（三个子类别）和 RAP 环境不合适（三个子类别）。这些类别的子类别包括医生专业知识有限、医生对 RAP 的态度不佳、医生基于常规而不是基于证据的实践、医生的责任有限、医生担心不使用抗生素开具处方的法律后果、医生的经济动机、获取高质量教育材料的途径有限、医生在职培训不足、缺乏文化适宜性指南、管理委员会效率低下、医生绩效监督有限、管理层监督不力、抗菌药物敏感性试验采样监督有限、导致不合理抗生素处方的社会文化因素、保险公司对其财务承诺的遵守情况不佳以及制药公司对医生的经济激励。
RAP 的障碍因素不同且复杂，包括与医生相关、与资源相关、与监督相关以及与环境相关的因素。专业能力有限、资源获取有限和监督有限的医生在 RAP 方面会遇到问题。有效管理 RAP 的障碍因素可以促进 RAP，最大限度地减少不合理的抗生素处方及其后果，主要是抗生素耐药性。
