Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden.
Primary Care Research Group, University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
BMC Prim Care. 2023 Apr 10;24(1):93. doi: 10.1186/s12875-023-02047-z.
Antimicrobial resistance (AMR) is a major global health issue, bringing significant health burden and costs to societies. Increased antibiotic consumption (ABC) is linked to AMR emergence. Some of the known drivers of ABC are antibiotics over-prescription by physicians and their misuse by patients. Family doctors are recognised as important stakeholders in the control of ABC as they prescribe antibiotics and are considered a reliable source of medical information by patients. Therefore, it is important to explore their perceptions, especially in Romania, which has the highest ABC among European Union Member States. Furthermore, there is no published research exploring Romanian family doctors' perceptions regarding this phenomenon.
This was a qualitative study with data collection via semi-structured interviews among 12 family doctors. Manifest and latent content analysis was used to gain an in-depth understanding of their perceptions. Findings were mapped onto the domains of the Behaviour Change Wheel to facilitate a theory driven systematization and analysis.
Two main subthemes emerged: i) factors affecting ABC and prescribing and ii) potential interventions to tackle ABC and antibiotic resistance. The factors were further grouped in those that related to the perceived behaviour of family doctors or patients as well as those that had to do with the various systems, local contexts and the COVID-19 pandemic. An overarching theme: 'family doctors in Romania see their role differently when it comes to antibiotic resistance and perceive the lack of patient education or awareness as one of the major drivers of ABC' was articulated. The main findings suggested that the perceived factors span across the capability, opportunity and motivational domains of the behaviour change wheel and could be addressed through a variety of interventions - some identified by the participants. Findings can also be viewed through cultural lenses which shed further light on the family doctor- patient dynamic when it comes to antibiotics use.
Potential interventions to tackle identified factors emerged, revolving mostly on efforts to educate patients or the public. This exploratory research provides key perspectives and facilitates further research on potential interventions to successfully address AMR in Romania or similar settings.
抗菌药物耐药性（AMR）是一个主要的全球健康问题，给社会带来了巨大的健康负担和成本。抗生素消费（ABC）的增加与 AMR 的出现有关。一些已知的 ABC 驱动因素是医生过度开具抗生素处方以及患者的滥用。家庭医生被认为是控制 ABC 的重要利益相关者，因为他们开具抗生素，并被患者视为可靠的医疗信息来源。因此，了解他们的看法很重要，尤其是在罗马尼亚，该国是欧盟成员国中 ABC 最高的国家。此外，没有发表的研究探讨罗马尼亚家庭医生对这一现象的看法。
这是一项定性研究，通过对 12 名家庭医生进行半结构化访谈收集数据。采用显式和潜式内容分析方法深入了解他们的看法。研究结果被映射到行为改变轮的各个领域，以促进基于理论的系统分析。
出现了两个主要的子主题：i）影响 ABC 和处方的因素和 ii）解决 ABC 和抗生素耐药性的潜在干预措施。这些因素进一步分为与家庭医生或患者感知行为有关的因素，以及与各种系统、当地背景和 COVID-19 大流行有关的因素。一个总体主题是：“罗马尼亚的家庭医生在涉及抗生素耐药性时对自己的角色有不同的看法，并认为缺乏对患者的教育或意识是 ABC 的主要驱动因素之一”。主要发现表明，感知到的因素跨越行为改变轮的能力、机会和动机领域，可以通过各种干预措施来解决——其中一些是参与者确定的。研究结果还可以通过文化视角进行观察，这进一步阐明了家庭医生-患者在使用抗生素方面的动态。
针对已确定因素的潜在干预措施已经出现，主要围绕着对患者或公众进行教育的努力。这项探索性研究提供了关键的观点，并为在罗马尼亚或类似环境中成功解决 AMR 问题的潜在干预措施提供了进一步的研究。
