Public Health and Primary Care, Campus The Hague, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
Public Health and Primary Care, Campus The Hague, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.
BMJ Open. 2023 May 17;13(5):e065006. doi: 10.1136/bmjopen-2022-065006.
This study aimed to identify determinants of inappropriate antibiotic prescription in primary care in developed countries and to construct a framework with the determinants to help understand which actions can best be targeted to counteract development of antimicrobial resistance (AMR).
A systematic review of peer-reviewed studies reporting determinants of inappropriate antibiotic prescription published through 9 September 2021 in PubMed, Embase, Web of Science and the Cochrane Library was performed.
All studies focusing on primary care in developed countries where general practitioners (GPs) act as gatekeepers for referral to medical specialists and hospital care were included.
Seventeen studies fulfilled the inclusion criteria and were used for the analysis which identified 45 determinants of inappropriate antibiotic prescription. Important determinants for inappropriate antibiotic prescription were comorbidity, primary care not considered to be responsible for development of AMR and GP perception of patient desire for antibiotics. A framework was constructed with the determinants and provides a broad overview of several domains. The framework can be used to identify several reasons for inappropriate antibiotic prescription in a specific primary care setting and from there, choose the most suitable intervention(s) and assist in implementing them for combatting AMR.
The type of infection, comorbidity and the GPs perception of a patient's desire for antibiotics are consistently identified as factors driving inappropriate antibiotic prescription in primary care. A framework with determinants of inappropriate antibiotic prescription may be useful after validation for effective implementation of interventions for decreasing these inappropriate prescriptions.
CRD42023396225.
本研究旨在确定发达国家初级保健中不合理使用抗生素的决定因素，并构建一个包含这些决定因素的框架，以帮助理解哪些措施最能有效对抗抗菌药物耐药性（AMR）的发展。
对截至 2021 年 9 月 9 日在 PubMed、Embase、Web of Science 和 Cochrane 图书馆发表的关于发达国家初级保健中不合理使用抗生素的决定因素的同行评议研究进行了系统回顾。
所有研究均纳入以全科医生（GP）作为转诊至医学专家和住院治疗的把关者的发达国家的初级保健为重点的研究。
17 项研究符合纳入标准，并用于分析，确定了 45 个不合理使用抗生素的决定因素。不合理使用抗生素的重要决定因素包括合并症、初级保健不被认为对 AMR 的发展负责以及 GP 对患者使用抗生素意愿的看法。该框架包含了这些决定因素，并提供了几个领域的广泛概述。该框架可用于确定特定初级保健环境中不合理使用抗生素的几个原因，并由此选择最合适的干预措施，并协助实施这些措施以对抗 AMR。
感染类型、合并症以及 GP 对患者使用抗生素意愿的看法一直被认为是导致初级保健中不合理使用抗生素的因素。在经过验证后，一个包含不合理使用抗生素决定因素的框架可能有助于有效实施减少这些不合理处方的干预措施。
PROSPERO 注册号：CRD42023396225。
