2019年冠状病毒病疫情对英格兰全科医疗抗菌药物管理支持的影响：一项定性访谈研究
Impact of the COVID-19 pandemic on antimicrobial stewardship support for general practices in England: a qualitative interview study.
作者信息
Campbell Anne, Borek Aleksandra J, McLeod Monsey, Tonkin-Crine Sarah, Pouwels Koen B, Roope Laurence Sj, Hayhoe Benedict Wj, Majeed Azeem, Walker A Sarah, Holmes Alison
机构信息
National Institute for Health Research (NIHR), Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
出版信息
BJGP Open. 2023 Sep 19;7(3). doi: 10.3399/BJGPO.2022.0193. Print 2023 Sep.
BACKGROUND
In England, clinical commissioning group (CCG; now replaced by Integrated Care Systems [ICSs]) and primary care network (PCN) professionals support primary care prescribers to optimise antimicrobial stewardship (AMS).
AIM
To explore views and experiences of CCG and PCN staff in supporting AMS, and the impact of COVID-19 on this support.
DESIGN & SETTING: Qualitative interview study in primary care in England.
METHOD
Semi-structured interviews with staff from CCG and PCNs responsible for AMS were conducted at two timepoints via telephone. These were audio-recorded, transcribed, and analysed thematically.
RESULTS
Twenty-seven interviews were conducted with 14 participants (nine CCG, five PCN) in December 2020-January 2021 and February-May 2021. The study found that AMS support was (1) deprioritised in order to keep general practice operational and deliver COVID-19 vaccines; (2) disrupted as social distancing made it harder to build relationships, conduct routine AMS activities, and challenge prescribing decisions; and (3) adapted, with opportunities identified for greater use of technology and changing patient and public perceptions of viruses and self-care. It was also found that resources to support AMS were valued if they were both novel, to counter AMS 'fatigue', and sufficiently familiar to fit with existing and/or future AMS.
CONCLUSION
AMS needs to be reprioritised in general practice in the post-pandemic era and within the new ICSs in England. This should include interventions and strategies that combine novel elements with already familiar strategies to refresh prescribers' motivation and opportunities for AMS. Behaviour change interventions should be aimed at improving the culture and processes for how PCN pharmacists voice concerns about AMS to prescribers in general practice and take advantage of the changed patient and public perceptions of viruses and self-care.
背景
在英格兰，临床委托小组（CCG；现由综合医疗系统[ICSs]取代）和基层医疗网络（PCN）的专业人员支持基层医疗开方者优化抗菌药物管理（AMS）。
目的
探讨CCG和PCN工作人员在支持AMS方面的观点和经验，以及新冠疫情对这种支持的影响。
设计与背景
英格兰基层医疗的定性访谈研究。
方法
在两个时间点通过电话对负责AMS的CCG和PCN工作人员进行半结构化访谈。访谈进行了录音、转录并进行主题分析。
结果
在2020年12月至2021年1月以及2021年2月至5月期间，对14名参与者（9名CCG人员，5名PCN人员）进行了27次访谈。研究发现，AMS支持工作：（1）为维持全科医疗运转和提供新冠疫苗而被置于次要地位；（2）因社交距离使得建立关系、开展常规AMS活动以及对开方决策提出质疑变得更加困难而受到干扰；（3）得到了调整，发现了更多利用技术的机会，以及改变患者和公众对病毒及自我护理的认知。还发现，如果支持AMS的资源既新颖以应对AMS“疲劳”，又足够熟悉以适应现有和/或未来的AMS，那么这些资源就会受到重视。
结论
在疫情后时代以及英格兰新的ICS框架内，全科医疗中需要重新重视AMS。这应包括将新颖元素与已熟悉的策略相结合的干预措施和策略，以恢复开方者进行AMS的积极性和机会。行为改变干预措施应旨在改善基层医疗网络药剂师向全科医疗开方者表达对AMS担忧的文化和流程，并利用患者和公众对病毒及自我护理认知上的变化。
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