PDF(Pubmed)
Abstract：
Antibiotic resistance is growing globally. The practice of health professionals when prescribing antibiotics in primary health care settings significantly impacts antibiotic resistance. Antibiotic prescription is a complex process influenced by various internal and external factors. This systematic review aims to summarize the available evidence regarding factors contributing to the variation in antibiotic prescribing among physicians in primary healthcare settings.
This systematic review was conducted based on PRISMA guidelines. We included qualitative, quantitative and mixed methods studies that examined factors influencing prescription practice and variability among primary healthcare physicians. We excluded editorials, opinions, systematic reviews and studies published in languages other than English. We searched studies from electronic databases: PubMed, ProQuest Health and Medicine, Web Science, and Scopus. The quality of the included studies was appraised using the Mixed Methods Appraisal Tool (Version 2018). Narrative synthesis was employed to synthesize the result and incorporate quantitative studies.
Of the 1816 identified studies, 49 studies spanning 2000-2023 were eligible for review. The factors influencing antibiotic prescription practice and variability were grouped into physician-related, patient-related, and healthcare system-related factors. Clinical guidelines, previous patient experience, physician experience, colleagues\' prescribing practice, pharmaceutical pressure, time pressure, and financial considerations were found to be influencing factors of antibiotic prescribing practice. In addition, individual practice patterns, practice volume, and relationship with patients were also other factors for the variability of antibiotic prescription, especially for intra-physician prescription variability.
Antibiotic prescription practice in primary health care is a complex practice, influenced by a combination of different factors and this may account for the variation. To address the factors that influence the variability of antibiotic prescription (intra- and inter-physician), interventions should aim to reduce diagnostic uncertainty and provide continuous medical education and training to promote patient-centred care.
This systematic review was conducted based on PRISMA guidelines. We included qualitative, quantitative and mixed methods studies that examined factors influencing prescription practice and variability among primary healthcare physicians. We excluded editorials, opinions, systematic reviews and studies published in languages other than English. We searched studies from electronic databases: PubMed, ProQuest Health and Medicine, Web Science, and Scopus. The quality of the included studies was appraised using the Mixed Methods Appraisal Tool (Version 2018). Narrative synthesis was employed to synthesize the result and incorporate quantitative studies.
Of the 1816 identified studies, 49 studies spanning 2000-2023 were eligible for review. The factors influencing antibiotic prescription practice and variability were grouped into physician-related, patient-related, and healthcare system-related factors. Clinical guidelines, previous patient experience, physician experience, colleagues\' prescribing practice, pharmaceutical pressure, time pressure, and financial considerations were found to be influencing factors of antibiotic prescribing practice. In addition, individual practice patterns, practice volume, and relationship with patients were also other factors for the variability of antibiotic prescription, especially for intra-physician prescription variability.
Antibiotic prescription practice in primary health care is a complex practice, influenced by a combination of different factors and this may account for the variation. To address the factors that influence the variability of antibiotic prescription (intra- and inter-physician), interventions should aim to reduce diagnostic uncertainty and provide continuous medical education and training to promote patient-centred care.
摘要：
背景：抗生素耐药性在全球范围内增长。卫生专业人员在初级卫生保健机构开具抗生素处方时的做法会显著影响抗生素耐药性。抗生素处方是一个复杂的过程，受各种内部和外部因素的影响。本系统综述旨在总结有关导致初级医疗机构中医生抗生素处方变化的因素的可用证据。
方法：本系统综述是根据PRISMA指南进行的。我们包括定性，定量和混合方法研究，研究影响初级保健医生处方实践和变异性的因素。我们排除了社论，意见,以英语以外的语言发表的系统评论和研究。我们从电子数据库中搜索了研究：PubMed，ProQuest健康与医学,网络科学,还有Scopus.使用混合方法评估工具(2018年版)评估纳入研究的质量。采用叙事综合来综合结果并纳入定量研究。
结果：在1816项确定的研究中，2000-2023年的49项研究符合审查条件。影响抗生素处方实践和变异性的因素分为医生相关，患者相关,和医疗保健系统相关因素。临床指南,以前的病人经验，医师经验,同事处方练习，药物压力,时间压力,和财务因素被发现是抗生素处方实践的影响因素。此外,个人实践模式，练习卷,与患者的关系也是抗生素处方变异性的其他因素，特别是对于医生内的处方变异性。
结论：初级卫生保健中的抗生素处方实践是一个复杂的实践，受不同因素组合的影响，这可能是造成这种变化的原因。为了解决影响抗生素处方变异性的因素（医师内部和医师之间），干预措施应旨在减少诊断的不确定性，并提供持续的医学教育和培训，以促进以患者为中心的护理。
方法：本系统综述是根据PRISMA指南进行的。我们包括定性，定量和混合方法研究，研究影响初级保健医生处方实践和变异性的因素。我们排除了社论，意见,以英语以外的语言发表的系统评论和研究。我们从电子数据库中搜索了研究：PubMed，ProQuest健康与医学,网络科学,还有Scopus.使用混合方法评估工具(2018年版)评估纳入研究的质量。采用叙事综合来综合结果并纳入定量研究。
结果：在1816项确定的研究中，2000-2023年的49项研究符合审查条件。影响抗生素处方实践和变异性的因素分为医生相关，患者相关,和医疗保健系统相关因素。临床指南,以前的病人经验，医师经验,同事处方练习，药物压力,时间压力,和财务因素被发现是抗生素处方实践的影响因素。此外,个人实践模式，练习卷,与患者的关系也是抗生素处方变异性的其他因素，特别是对于医生内的处方变异性。
结论：初级卫生保健中的抗生素处方实践是一个复杂的实践，受不同因素组合的影响，这可能是造成这种变化的原因。为了解决影响抗生素处方变异性的因素（医师内部和医师之间），干预措施应旨在减少诊断的不确定性，并提供持续的医学教育和培训，以促进以患者为中心的护理。
