Balea Lavinia Bianca, Glasdam Stinne
Faculty of Medicine, Lund University, Malmö, Sweden.
Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
Front Antibiot. 2024 Sep 4;3:1439688. doi: 10.3389/frabi.2024.1439688. eCollection 2024.
Antimicrobial resistance (AMR) represents a persistent and ascensive global threat influenced by antibiotic misuse and overuse. In the Romanian context, patterns of antibiotic consumption and resistance within the healthcare system are marked in the red scenario on the European map. General practitioners and pharmacists, among others, play a major role in stewardship towards AMR.
To explore the practices, strategies, and challenges in antibiotic treatment and prevention of antimicrobial resistance from the perspectives of Romanian community pharmacists and general practitioners.
Semi-structured interviews were conducted with six general practitioners and five community pharmacists in Romania from January to March 2024. An inductive, Goffman theory-inspired thematic analysis was conducted, inspired by Braun and Clarke's thematic analysis method, consisting of familiarization with the data, iterative coding guided by theoretically inspired questions, and identification and refinement of (sub)themes. Goffman's theory of social interaction, focusing on the concepts of front stage, backstage, and roles, guided the analytical questions.
The results were presented in three overarching themes: 'Knowledge acquired backstage to support challenges and performance on front stage', 'Adapting roles and performances on the front stage: A mix of structured and twisted acts', and 'Interprofessional Collaboration: A latent part in the play's roles and performances'. Professionals prepared their understandings of AMR and antibiotics backstage, with an awareness of the challenges rooted in the Romanian context. The front stage scenario evolved from structured antibiotic performances led by AMR strategies with compliant actors to challenging performances influenced by actors which changed the course of performances and intended AMR strategies. The revealed competition between general practitioners and pharmacists further complicated antibiotic use and AMR-related performances.
The Romanian socio-political system influenced the course of antibiotic treatment and the professionals' intended antibiotic related practices and AMR strategies. The study showed a theory-practice gap in health professionals' practices, leading to limited strategy integration towards AMR and increased antibiotic use. The study underscores the need for context-specific policies and interventions to minimize identified gaps.
抗菌药物耐药性（AMR）是一个持续且日益严重的全球威胁，受到抗生素滥用和过度使用的影响。在罗马尼亚的背景下，医疗系统内抗生素消费和耐药模式在欧洲地图上处于红色警示状态。全科医生和药剂师等在应对AMR方面发挥着重要作用。
从罗马尼亚社区药剂师和全科医生的角度探讨抗生素治疗及抗菌药物耐药性预防中的实践、策略和挑战。
2024年1月至3月，对罗马尼亚的六名全科医生和五名社区药剂师进行了半结构化访谈。采用了受戈夫曼理论启发的归纳式主题分析方法，该方法受布劳恩和克拉克的主题分析方法启发，包括熟悉数据、由理论启发的问题引导的迭代编码，以及（子）主题的识别和完善。戈夫曼的社会互动理论，聚焦于前台、后台和角色的概念，指导了分析问题。
结果呈现为三个总体主题：“在后台获取知识以应对前台的挑战和表现”、“在前台调整角色和表现：结构化与扭曲行为的混合”以及“跨专业协作：戏剧角色和表现中的潜在部分”。专业人员在后台准备他们对抗菌药物耐药性和抗生素的理解，同时意识到罗马尼亚背景中存在的挑战。前台场景从由抗菌药物耐药性策略主导、有合规参与者的结构化抗生素表现，演变为受改变表现进程和预期抗菌药物耐药性策略的参与者影响的具有挑战性的表现。全科医生和药剂师之间所揭示的竞争使抗生素使用和与抗菌药物耐药性相关的表现进一步复杂化。
罗马尼亚的社会政治体系影响了抗生素治疗的进程以及专业人员预期的抗生素相关实践和抗菌药物耐药性策略。该研究表明卫生专业人员的实践存在理论与实践的差距，导致对抗菌药物耐药性的策略整合有限且抗生素使用增加。该研究强调需要制定针对具体情况的政策和干预措施，以尽量减少已发现的差距。
