Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany.
Department of Clinical Epidemiology, Leibniz Institute of Prevention Research and Epidemiology - BIPS, Bremen, Germany.
BMC Health Serv Res. 2024 May 6;24(1):589. doi: 10.1186/s12913-024-11059-z.
Previous studies have identified substantial regional variations in outpatient antibiotic prescribing in Germany, both in the paediatric and adult population. This indicates inappropriate antibiotic prescribing in some regions, which should be avoided to reduce antimicrobial resistance and potential side effects. The reasons for regional variations in outpatient antibiotic prescribing are not yet completely understood; socioeconomic and health care density differences between regions do not fully explain such differences. Here, we apply a behavioural perspective by adapting the Theoretical Domains Framework (TDF) to examine regional factors deemed relevant for outpatient antibiotic prescriptions by paediatricians and general practitioners.
Qualitative study with guideline-based telephone interviews of 40 prescribers (paediatricians and general practitioners) in outpatient settings from regions with high and low rates of antibiotic prescriptions, stratified by urbanity. TDF domains formed the basis of an interview guide to assess region-level resources and barriers to rational antibiotic prescription behaviour. Interviews lasted 30-61 min (M = 45 min). Thematic analysis was used to identify thematic clusters, and relationships between themes were explored through proximity estimation.
Both paediatricians and general practitioners in low-prescribing regions reported supporting contextual factors (in particular good collegial networks, good collaboration with laboratories) and social factors (collegial support and low patient demand for antibiotics) as important resources. In high-prescribing regions, poor coordination between in-patient and ambulatory health services, lack of region-level information on antimicrobial resistance, few professional development opportunities, and regional variations in patient expectations were identified as barriers to rational prescribing behaviour.
Interventions targeting professional development, better collaboration structures with laboratories and clearer and user-friendly guidelines could potentially support rational antibiotic prescribing behaviour. In addition, better networking and social support among physicians could support lower prescription rates.
先前的研究表明，德国儿科和成人患者的门诊抗生素处方存在显著的地区差异，这表明一些地区的抗生素处方存在不合理现象，应避免这种情况以降低抗菌药物耐药性和潜在的副作用。导致门诊抗生素处方地区差异的原因尚不完全清楚；地区间的社会经济和医疗保健密度差异并不能完全解释这种差异。在这里，我们采用行为视角，通过改编理论领域框架（TDF）来检查被儿科医生和全科医生认为与门诊抗生素处方相关的区域因素。
这是一项定性研究，采用基于指南的电话访谈，对来自抗生素处方率较高和较低地区的 40 名门诊医生（儿科医生和全科医生）进行访谈，按城市程度进行分层。TDF 领域构成了访谈指南的基础，以评估对合理抗生素处方行为有影响的区域资源和障碍。访谈持续 30-61 分钟（M=45 分钟）。采用主题分析法识别主题集群，并通过接近度估计探索主题之间的关系。
低处方率地区的儿科医生和全科医生都报告了支持情境因素（特别是良好的同事关系网络、与实验室的良好合作）和社会因素（同事支持和患者对抗生素的低需求）是重要资源。在高处方率地区，发现了住院和门诊卫生服务之间协调不佳、缺乏区域层面的抗生素耐药信息、专业发展机会少以及患者期望的区域差异等影响合理处方行为的障碍。
针对专业发展、与实验室更好的协作结构以及更清晰和用户友好的指南的干预措施可能会支持合理的抗生素处方行为。此外，医生之间更好的网络和社会支持可以支持较低的处方率。
