Abstract：
This study aimed to identify modifiable determinants (facilitators and barriers) related to the choice of prescribing antibiotics in human medicine across clinical settings. Enhanced management of antibiotics can help slow the spread of resistant bacteria. A qualitative meta-synthesis approach was used, according to Sandelowski and Barroso\'s method. Included studies were evaluated using the Critical Appraisal Skills Programme. Findings were extracted and organized to form a qualitative meta-summary. The Theoretical Domains Framework, the Capabilities-Opportunities-Motivation (COM-B) model and the Behaviour Change Wheel were used as a coding matrix for data interpretation. The analysis of 63 included studies revealed barriers and facilitators in 12 of 14 domains specified by the Theoretical Domains Framework. Prescribers\' capabilities, motivation and opportunities were found to be the main drivers of antibiotic prescribing behaviour. Knowledge, skills, beliefs, expectations, the influence of patients and colleagues, organizational culture and infrastructure characteristics have a significant impact on prescribing behaviours. A comprehensive inventory of factors related to antibiotic prescribing has been compiled. Interventions to promote appropriate antibiotic prescribing should take a systemic approach rather than focusing solely on individual-level variables. Furthermore, the adoption of co-design approaches for such interventions is desirable to ensure greater applicability and sustainability in the real-world context of organizations.
摘要：
这项研究旨在确定与临床环境中人类医学中抗生素处方选择相关的可修改的决定因素（促进因素和障碍）。加强抗生素管理可以帮助减缓耐药细菌的传播。采用了定性的元综合方法，根据Sandelowski和Barroso的方法.使用关键评估技能计划对纳入的研究进行了评估。对研究结果进行提取和组织，以形成定性的荟萃总结。理论领域框架，能力-机会-动机（COM-B）模型和行为变化轮被用作数据解释的编码矩阵。对63项研究的分析揭示了理论域框架指定的14个领域中的12个领域中的障碍和促进者。处方者的能力，研究发现,动机和机会是抗生素处方行为的主要驱动因素.知识,技能,信仰,期望,患者和同事的影响，组织文化和基础设施特征对处方行为有重大影响。已编制了与抗生素处方有关的因素的综合清单。促进适当抗生素处方的干预措施应采取系统性方法，而不是仅关注个体水平的变量。此外，为此类干预措施采用共同设计方法是可取的，以确保在组织的现实世界环境中具有更大的适用性和可持续性。
