Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore, Singapore.
Saw Swee Hock School of Public Health and National University Health System, National University of Singapore, Singapore, Singapore.
Front Public Health. 2022 Sep 30;10:1001282. doi: 10.3389/fpubh.2022.1001282. eCollection 2022.
Shared decision-making (SDM) and trust building through continuity of care are known to play a pivotal role in improving appropriate antibiotic prescribing and use.
However, less is known about to effectively leverage these factors when present-or overcome them when not-to address community needs and improve patient liaison.
We addressed this question using a convergent parallel mixed-methods design. Focus group discussions ( = 13; August 2018-September 2020), were analyzed alongside a nationally-representative cross-sectional survey ( = 2004; November 2020-January 2021), in Singapore. Descriptive quantitative analyses and multivariable logistic regression were undertaken to examine antibiotic knowledge and factors associated with preference for SDM. Qualitative applied thematic analysis was integrated with these data to further explain the findings.
Poor knowledge and misbeliefs on appropriate antibiotic use and antimicrobial resistance (AMR) were identified. For example, only 9% of the surveyed population understood that AMR occurs when the bacteria, not the human body, become resistant to antibiotics. Qualitative data corroborated the survey findings and suggested a shared value was placed on public education to avoid the fallout from resistant bacterial strains on current and future generations. This study also identified the opportunity to harness community trust in primary care doctors, who were described as highly valued educators for antibiotic use and AMR. Those who had trust in doctors were 75% more likely to prefer SDM (aOR 1.75, 95% CI 1.10-2.77, = 0.017), especially adults aged ≥50 years who were receiving continued care with a regular doctor (aOR 1.83, 95% CI 1.18-2.86, = 0.007). Continuity of care was observed to value-add SDM by building trusting relationships, though it was often absent in younger populations.
This study highlights the long-term value-add of building on cultural capital pertaining to appropriate antibiotic use and AMR, by leveraging on the role of trust in doctors, desire for SDM and anchoring these in continuity of care when possible.
Using focused messaging and exploring alternative channels of communications such as annual check-ins or tele-consultations with a regular doctor, and emphasizing continuity of care across all age groups would help bridge the identified gaps.
共享决策（SDM）和通过连续性护理建立信任，被认为在改善抗生素的合理处方和使用方面发挥着关键作用。
然而，当涉及到满足社区需求和改善患者联络时，对于如何有效地利用这些因素，或者在这些因素不存在时克服这些因素，我们了解得较少。
我们使用收敛平行混合方法设计来解决这个问题。焦点小组讨论（= 13；2018 年 8 月至 2020 年 9 月）与全国代表性的横断面调查（= 2004；2020 年 11 月至 2021 年 1 月）一起进行了分析。进行了描述性定量分析和多变量逻辑回归，以检查抗生素知识和与 SDM 偏好相关的因素。定性应用主题分析与这些数据相结合，以进一步解释研究结果。
发现了抗生素使用和抗菌素耐药性（AMR）方面的知识不足和误解。例如，只有 9%的调查人群了解到，当细菌而不是人体对抗生素产生耐药性时，就会发生 AMR。定性数据证实了调查结果，并表明人们共同认为，开展公众教育对于避免当前和未来几代人受到耐药细菌株的影响非常重要。这项研究还发现了利用社区对初级保健医生的信任的机会，这些医生被描述为抗生素使用和 AMR 的高度受尊敬的教育者。那些信任医生的人更有可能偏好 SDM（优势比 1.75，95%置信区间 1.10-2.77，= 0.017），特别是正在接受常规医生持续护理的年龄≥50 岁的成年人（优势比 1.83，95%置信区间 1.18-2.86，= 0.007）。观察到连续性护理通过建立信任关系为 SDM 增值，尽管在年轻人群中，连续性护理往往不存在。
这项研究强调了通过利用医生信任、SDM 意愿以及在可能的情况下将这些意愿与连续性护理联系起来，长期增加与适当使用抗生素和 AMR 相关的文化资本的价值。
使用有针对性的信息传递，并探索其他沟通渠道，例如与常规医生进行年度检查或远程咨询，并强调所有年龄段的连续性护理，这将有助于弥合已确定的差距。
