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一项关于电子学习干预对支持基层医疗环境中非医学开处方者针对上呼吸道感染进行合理抗生素处方行为影响的可行性研究。

The impact of an electronic learning intervention to support appropriate antibiotic prescribing behaviour by non-medical prescribers for upper respiratory tract infections in the primary care setting: a feasibility study.

作者信息

Hawker Clare, Courtenay Molly, Chater Angel, Gallagher Rose, Lim Rosemary, Reid Nicholas, Thomas Neil, Williams Adam Dn

机构信息

School of Healthcare Sciences, Cardiff University, Cardiff, UK.

Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Luton, UK.

出版信息

BMC Health Serv Res. 2025 Aug 4;25(1):1022. doi: 10.1186/s12913-025-13260-0.


DOI:10.1186/s12913-025-13260-0
PMID:40759917
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12323022/
Abstract

BACKGROUND: Interventions are available for general practitioners to support appropriate antibiotic prescribing behaviour for common, acute, uncomplicated, self-limiting upper respiratory tract infections (URTIs). Non-medical prescribers frequently manage these conditions, but no such interventions exist for these groups. This study aimed to assess the feasibility and perceived impact of a theory-based electronic learning intervention designed to support appropriate antibiotic prescribing by non-medical prescribers for URTIs in primary care settings. METHODS: A repeated measures, electronic survey design was used, with data collection occurring pre-intervention (stage 1), post-intervention (stage 3), and at a 3-month follow-up (stage 4). The intervention's usefulness was assessed by analysing prescribers' self-reported confidence and knowledge in treating patients with URTIs, as well as their views on the relevance of the intervention to their work. The influence of the intervention on prescribing behaviour was evaluated by examining prescribers' perceived capabilities, opportunities, and motivations (COM) in the pre-intervention questionnaire and at follow-up. Feasibility outcome measures included recruitment, retention, and engagement with the intervention. RESULTS: Twenty-one participants (n = 18 nurses, n = 1 pharmacist, and n = 2 paramedics) responded to the recruitment materials, followed the weblink to the survey, and completed the intervention over the 2-month recruitment period. Outcome data for 21 participants were available for pre- and post intervention (stage 1 & 3) and 11 (52%) participants completed follow-up (stage 4). Behavioural practice (information and support for self-management of URTIs) and perceived COM in relation to prescribing for patients with URTIs all increased at follow-up. Mean confidence scores were high at pre- and post-intervention stages but showed a slight decrease at follow-up. The intervention was reported to be useful and applicable to participants' practice. CONCLUSION: It was feasible to recruit the target sample, and participants engaged well with the intervention. However, further consideration is needed for recruiting pharmacists and paramedics and developing a retention strategy for the follow-up survey. Behaviour and COM influences on behaviour changed positively from before to after the intervention. Future work should consider using the intervention in nursing and pharmacy undergraduate programmes, with students on prescribing programmes, and with other non-medical prescribers such as paramedic and physiotherapist prescribers.

摘要

背景:有多种干预措施可供全科医生采用,以支持其针对常见、急性、非复杂性、自限性上呼吸道感染(URTIs)进行恰当的抗生素处方行为。非医学处方者经常处理这些病症,但针对这些群体不存在此类干预措施。本研究旨在评估一种基于理论的电子学习干预措施的可行性及其可感知的影响,该干预措施旨在支持非医学处方者在基层医疗环境中针对URTIs进行恰当的抗生素处方。 方法:采用重复测量电子调查设计,在干预前(第1阶段)、干预后(第3阶段)以及3个月随访时(第4阶段)收集数据。通过分析处方者自我报告的治疗URTIs患者的信心和知识,以及他们对干预措施与自身工作相关性的看法,来评估干预措施的有用性。通过在干预前问卷和随访时检查处方者的感知能力、机会和动机(COM),来评估干预措施对处方行为的影响。可行性结果指标包括招募、留存率以及对干预措施的参与度。 结果:21名参与者(n = 18名护士、n = 1名药剂师和n = 2名护理人员)回应了招募材料,点击调查链接并在为期2个月的招募期内完成了干预。21名参与者的干预前和干预后(第1阶段和第3阶段)结果数据可得,11名(52%)参与者完成了随访(第4阶段)。随访时,行为实践(URTIs自我管理的信息和支持)以及与为URTIs患者开处方相关的感知COM均有所增加。干预前和干预后阶段的平均信心得分较高,但随访时略有下降。据报告,该干预措施有用且适用于参与者的实践。 结论:招募目标样本是可行的,参与者对干预措施的参与度良好。然而,在招募药剂师和护理人员以及制定随访调查的留存策略方面,还需要进一步考虑。干预前后,行为和COM对行为的影响发生了积极变化。未来的工作应考虑在护理和药学本科课程、参与处方课程的学生以及其他非医学处方者(如护理人员和物理治疗师处方者)中使用该干预措施。

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本文引用的文献

[1]
Antibiotics for acute otitis media in children.

Cochrane Database Syst Rev. 2023-11-15

[2]
Patterns of GP and nurse independent prescriber prescriptions for antibiotics dispensed in the community in England: a retrospective analysis.

J Antimicrob Chemother. 2023-10-3

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Influences on nurses' engagement in antimicrobial stewardship behaviours: a multi-country survey using the Theoretical Domains Framework.

J Hosp Infect. 2022-11

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Lancet. 2022-2-12

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JAC Antimicrob Resist. 2019-11-12

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Influences on antibiotic prescribing by non-medical prescribers for respiratory tract infections: a systematic review using the theoretical domains framework.

J Antimicrob Chemother. 2020-12-1

[7]
Theory-based electronic learning intervention to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers: an acceptability and feasibility experimental study using mixed methods.

BMJ Open. 2020-6-30

[8]
Acceptability, reliability, and validity of a brief measure of capabilities, opportunities, and motivations ("COM-B").

Br J Health Psychol. 2020-4-20

[9]
Theory-based electronic learning intervention to support appropriate antibiotic prescribing by nurses and pharmacists: intervention development and feasibility study protocol.

BMJ Open. 2019-8-18

[10]
Community nursing and antibiotic stewardship: the importance of communication and training.

Br J Community Nurs. 2019-7-2

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