PDF(Pubmed)
Abstract：
OBJECTIVE: Blood culture (BC) sampling is recommended for all suspected sepsis patients prior to antibiotic administration. We examine barriers and enablers to BC sampling in three Southeast Asian countries.
METHODS: A Theoretical Domains Framework (TDF)-based survey, comprising a case scenario of a patient presenting with community-acquired sepsis and all 14 TDF domains of barriers/enablers to BC sampling.
METHODS: Hospitals in Indonesia, Thailand and Viet Nam, December 2021 to 30 April 2022.
METHODS: 1070 medical doctors and 238 final-year medical students were participated in this study. Half of the respondents were women (n=680, 52%) and most worked in governmental hospitals (n=980, 75.4%).
METHODS: Barriers and enablers to BC sampling.
RESULTS: The proportion of respondents who answered that they would definitely take BC in the case scenario was highest at 89.8% (273/304) in Thailand, followed by 50.5% (252/499) in Viet Nam and 31.3% (157/501) in Indonesia (p<0.001). Barriers/enablers in nine TDF domains were considered key in influencing BC sampling, including \'priority of BC (TDF-goals)\', \'perception about their role to order or initiate an order for BC (TDF-social professional role and identity)\', \'perception that BC is helpful (TDF-beliefs about consequences)\', \'intention to follow guidelines (TDF-intention)\', \'awareness of guidelines (TDF-knowledge)\', \'norms of BC sampling (TDF-social influence)\', \'consequences that discourage BC sampling (TDF-reinforcement)\', \'perceived cost-effectiveness of BC (TDF-environmental context and resources)\' and \'regulation on cost reimbursement (TDF-behavioural regulation)\'. There was substantial heterogeneity between the countries. In most domains, the lower (higher) proportion of Thai respondents experienced the barriers (enablers) compared with that of Indonesian and Vietnamese respondents. A range of suggested intervention types and policy options was identified.
CONCLUSIONS: Barriers and enablers to BC sampling are varied and heterogenous. Cost-related barriers are more common in more resource-limited countries, while many barriers are not directly related to cost. Context-specific multifaceted interventions at both hospital and policy levels are required to improve diagnostic stewardship practices.
METHODS: A Theoretical Domains Framework (TDF)-based survey, comprising a case scenario of a patient presenting with community-acquired sepsis and all 14 TDF domains of barriers/enablers to BC sampling.
METHODS: Hospitals in Indonesia, Thailand and Viet Nam, December 2021 to 30 April 2022.
METHODS: 1070 medical doctors and 238 final-year medical students were participated in this study. Half of the respondents were women (n=680, 52%) and most worked in governmental hospitals (n=980, 75.4%).
METHODS: Barriers and enablers to BC sampling.
RESULTS: The proportion of respondents who answered that they would definitely take BC in the case scenario was highest at 89.8% (273/304) in Thailand, followed by 50.5% (252/499) in Viet Nam and 31.3% (157/501) in Indonesia (p<0.001). Barriers/enablers in nine TDF domains were considered key in influencing BC sampling, including \'priority of BC (TDF-goals)\', \'perception about their role to order or initiate an order for BC (TDF-social professional role and identity)\', \'perception that BC is helpful (TDF-beliefs about consequences)\', \'intention to follow guidelines (TDF-intention)\', \'awareness of guidelines (TDF-knowledge)\', \'norms of BC sampling (TDF-social influence)\', \'consequences that discourage BC sampling (TDF-reinforcement)\', \'perceived cost-effectiveness of BC (TDF-environmental context and resources)\' and \'regulation on cost reimbursement (TDF-behavioural regulation)\'. There was substantial heterogeneity between the countries. In most domains, the lower (higher) proportion of Thai respondents experienced the barriers (enablers) compared with that of Indonesian and Vietnamese respondents. A range of suggested intervention types and policy options was identified.
CONCLUSIONS: Barriers and enablers to BC sampling are varied and heterogenous. Cost-related barriers are more common in more resource-limited countries, while many barriers are not directly related to cost. Context-specific multifaceted interventions at both hospital and policy levels are required to improve diagnostic stewardship practices.
摘要：
目的：建议对所有疑似脓毒症患者在使用抗生素前进行血培养（BC）采样。我们研究了三个东南亚国家BC采样的障碍和促成因素。
方法：基于理论域框架(TDF)的调查，包括患者出现社区获得性败血症和所有14个TDF领域的障碍/促成因素BC采样的病例情景。
方法：印度尼西亚的医院，泰国和越南，2021年12月至2022年4月30日。
方法：1070名医生和238名最后一年的医学生参加了这项研究。一半的受访者是女性（n=680，52％），大多数在政府医院工作（n=980，75.4％）。
方法：BC采样的障碍和促成因素。
结果：在泰国，回答肯定会服用BC的受访者比例最高，为89.8％（273/304），其次是越南的50.5%(252/499)和印度尼西亚的31.3%(157/501)(p<0.001)。九个TDF领域的障碍/推动者被认为是影响BC采样的关键，包括“BC的优先级（TDF目标）”，\'感知他们的角色来订购或启动BC的订单（TDF-社交专业角色和身份）\'，“认为BC是有帮助的（TDF-关于后果的信念）”，\'遵循指南的意图（TDF意图）\'，“指南意识(TDF-知识)”，“BC抽样规范(TDF-社会影响)”，“阻碍BC采样的后果(TDF强化)”，“BC的感知成本效益（TDF-环境背景和资源）”和“成本报销法规（TDF-行为法规）”。各国之间存在很大的异质性。在大多数领域，与印尼和越南受访者相比，泰国受访者中遇到障碍（推动者）的比例较低（较高）。确定了一系列建议的干预类型和政策选择。
结论：BC采样的障碍和推动者是多种多样和异质的。与成本相关的障碍在资源有限的国家更为普遍，虽然许多障碍与成本没有直接关系。需要在医院和政策层面采取针对具体情况的多方面干预措施，以改善诊断管理实践。
方法：基于理论域框架(TDF)的调查，包括患者出现社区获得性败血症和所有14个TDF领域的障碍/促成因素BC采样的病例情景。
方法：印度尼西亚的医院，泰国和越南，2021年12月至2022年4月30日。
方法：1070名医生和238名最后一年的医学生参加了这项研究。一半的受访者是女性（n=680，52％），大多数在政府医院工作（n=980，75.4％）。
方法：BC采样的障碍和促成因素。
结果：在泰国，回答肯定会服用BC的受访者比例最高，为89.8％（273/304），其次是越南的50.5%(252/499)和印度尼西亚的31.3%(157/501)(p<0.001)。九个TDF领域的障碍/推动者被认为是影响BC采样的关键，包括“BC的优先级（TDF目标）”，\'感知他们的角色来订购或启动BC的订单（TDF-社交专业角色和身份）\'，“认为BC是有帮助的（TDF-关于后果的信念）”，\'遵循指南的意图（TDF意图）\'，“指南意识(TDF-知识)”，“BC抽样规范(TDF-社会影响)”，“阻碍BC采样的后果(TDF强化)”，“BC的感知成本效益（TDF-环境背景和资源）”和“成本报销法规（TDF-行为法规）”。各国之间存在很大的异质性。在大多数领域，与印尼和越南受访者相比，泰国受访者中遇到障碍（推动者）的比例较低（较高）。确定了一系列建议的干预类型和政策选择。
结论：BC采样的障碍和推动者是多种多样和异质的。与成本相关的障碍在资源有限的国家更为普遍，虽然许多障碍与成本没有直接关系。需要在医院和政策层面采取针对具体情况的多方面干预措施，以改善诊断管理实践。
