Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
BMC Health Serv Res. 2023 Apr 14;23(1):367. doi: 10.1186/s12913-023-09239-4.
Overprescribing of antibiotics is a major concern as it contributes to antimicrobial resistance. Research has found highly variable antibiotic prescribing in (UK) primary care, and to support more effective stewardship, the BRIT Project (Building Rapid Interventions to optimise prescribing) is implementing an eHealth Knowledge Support System. This will provide unique individualised analytics information to clinicians and patients at the point of care. The objective of the current study was to gauge the acceptability of the system to prescribing healthcare professionals and highlight factors to maximise intervention uptake.
Two mixed-method co-design workshops were held online with primary care prescribing healthcare professionals (n = 16). Usefulness ratings of example features were collected using online polls and online whiteboards. Verbal discussion and textual comments were analysed thematically using inductive (participant-centred) and deductive perspectives (using the Theoretical Framework of Acceptability).
Hierarchical thematic coding generated three overarching themes relevant to intervention use and development. Clinician concerns (focal issues) were safe prescribing, accessible information, autonomy, avoiding duplication, technical issues and time. Requirements were ease and efficiency of use, integration of systems, patient-centeredness, personalisation, and training. Important features of the system included extraction of pertinent information from patient records (such as antibiotic prescribing history), recommended actions, personalised treatment, risk indicators and electronic patient communication leaflets. Anticipated acceptability and intention to use the knowledge support system was moderate to high. Time was identified as a focal cost/ burden, but this would be outweighed if the system improved patient outcomes and increased prescribing confidence.
Clinicians anticipate that an eHealth knowledge support system will be a useful and acceptable way to optimise antibiotic prescribing at the point of care. The mixed method workshop highlighted issues to assist person-centred eHealth intervention development, such as the value of communicating patient outcomes. Important features were identified including the ability to efficiently extract and summarise pertinent information from the patient records, provide explainable and transparent risk information, and personalised information to support patient communication. The Theoretical Framework of Acceptability enabled structured, theoretically sound feedback and creation of a profile to benchmark future evaluations. This may encourage a consistent user-focused approach to guide future eHealth intervention development.
抗生素的过度处方是一个主要关注点，因为它会导致抗微生物药物耐药性。研究发现，（英国）初级保健中的抗生素处方存在高度差异，为了支持更有效的管理，BRIT 项目（快速干预以优化处方）正在实施电子健康知识支持系统。这将在护理点为临床医生和患者提供独特的个性化分析信息。本研究的目的是评估该系统对处方医疗保健专业人员的可接受性，并强调最大限度提高干预措施接受度的因素。
与初级保健处方医疗保健专业人员（n=16）在线举行了两次混合方法共同设计研讨会。使用在线民意调查和在线电子白板收集了示例功能的有用性评分。使用主题分析对口头讨论和文本评论进行了分析，主题分析采用了归纳（以参与者为中心）和演绎（使用可接受性理论框架）的观点。
分层主题编码生成了与干预使用和开发相关的三个总体主题。临床医生的关注点（焦点问题）包括安全处方、可访问的信息、自主权、避免重复、技术问题和时间。要求包括易用性和效率、系统集成、以患者为中心、个性化和培训。系统的重要功能包括从患者记录中提取相关信息（如抗生素处方史）、推荐操作、个性化治疗、风险指标和电子患者沟通传单。预计该知识支持系统的可接受性和使用意愿为中等至高度。时间被确定为一个焦点成本/负担，但如果系统改善患者结局并增加处方信心，这将是值得的。
临床医生预计电子健康知识支持系统将是一种优化护理点抗生素处方的有用且可接受的方法。混合方法研讨会强调了以患者为中心的电子健康干预措施发展的问题，例如沟通患者结局的价值。确定了重要的功能，包括能够从患者记录中高效地提取和总结相关信息、提供可解释和透明的风险信息以及个性化信息以支持患者沟通。可接受性理论框架使结构化、理论上合理的反馈成为可能，并创建了一个概况来为未来的评估提供基准。这可能会鼓励以用户为中心的一致方法来指导未来的电子健康干预措施的发展。
