Department of Health Management, School of Public Health, Fujian Medical University, Room 108 in the Building for School of Public Health, 1 Xuefubei Road, Minhou District, Fuzhou, 350122, Fujian, China.
BMC Med Inform Decis Mak. 2022 Oct 26;22(1):279. doi: 10.1186/s12911-022-02019-w.
To confront the serious challenge of antimicrobial resistance, using clinical practice guidelines (CPGs) standardizing the prescription behavior is vital. However, the overall mechanisms remains largely unknown as to how guidelines' use behavior can be improved. This study aimed to identify the determinants and investigate their relationship to bridge the knowledge gap of overall influencing mechanism of the use behavior of CPGs on antimicrobials.
By integrating theory of reasoned action (TRA) and organizational readiness for change (ORC), a structured questionnaire was developed to cover potential determinants that affect physicians' use behaviors of CPGs on antimicrobials at the individual-level (attitude, subjective norm, and behavioral intention) and organizational-level (top management support and organizational resource allocation). A multi-stage random sampling was implemented to collect data from physicians in secondary and tertiary hospitals from eastern, central and western China. Structural equation model (SEM) was used to test the proposed hypotheses, and to analyze the relationship and mechanism among the factors.
In total, 815 physicians were included. Most physicians demonstrated a positive tendency toward the use of CPGs on antimicrobials, with a mean score of 3.95 (SD = 0.70). The reliability and validity analysis showed the questionnaire constructed from the integrated theoretical model of TRA and ORC was acceptable. The SEM validation results also showed that the top management support (β = 0.688, P < 0.001), organizational resource allocation (β = 0.129, P < 0.001), individual attitudes (β = 0.164, P < 0.001), subjective norms (β = 0.322, P < 0.001), and behavioral intentions (β = 0.424, P < 0.001) were positively associated with physicians' use behaviors of CPGs on antimicrobials. Besides, top management support, organizational resource allocation, attitudes and subjective norms showed their mediating effects on regarding use behavior, which was 0.305, 0.129, 0.164 and 0.201, respectively.
This study revealed the influence mechanism of the use of CPGs on antimicrobials from the individual and organizational perspectives. These findings will not only help formulate future strategies to promote the use of CPGs on antimicrobials, but also provide clues for more effective prescription interventions.
为应对抗菌药物耐药性的严峻挑战，使用临床实践指南（CPGs）规范处方行为至关重要。然而，关于如何改善指南使用行为的总体机制在很大程度上仍不清楚。本研究旨在确定决定因素，并探讨它们之间的关系，以填补 CPGs 对抗菌药物使用行为总体影响机制的知识空白。
本研究通过整合理性行为理论（TRA）和变革准备度理论（ORC），开发了一份结构化问卷，涵盖了影响医生个人层面（态度、主观规范和行为意向）和组织层面（高层管理支持和组织资源分配）使用抗菌药物 CPGs 行为的潜在决定因素。采用多阶段随机抽样方法，从中国东部、中部和西部地区的二级和三级医院收集医生的数据。采用结构方程模型（SEM）检验假设，并分析各因素之间的关系和机制。
共纳入 815 名医生。大多数医生对抗菌药物 CPGs 的使用表现出积极倾向，平均得分为 3.95（SD=0.70）。可靠性和有效性分析表明，基于 TRA 和 ORC 综合理论模型构建的问卷是可以接受的。SEM 验证结果还表明，高层管理支持（β=0.688，P<0.001）、组织资源分配（β=0.129，P<0.001）、个体态度（β=0.164，P<0.001）、主观规范（β=0.322，P<0.001）和行为意向（β=0.424，P<0.001）与医生对抗菌药物 CPGs 的使用行为呈正相关。此外，高层管理支持、组织资源分配、态度和主观规范对使用行为具有中介作用，其中介效应分别为 0.305、0.129、0.164 和 0.201。
本研究从个体和组织角度揭示了抗菌药物 CPGs 使用的影响机制。这些发现不仅有助于制定未来促进抗菌药物 CPGs 使用的策略，还为更有效的处方干预提供线索。
