PDF(Pubmed)
Abstract：
BACKGROUND: Previous studies have identified substantial regional variations in outpatient antibiotic prescribing in Germany, both in the paediatric and adult population. This indicates inappropriate antibiotic prescribing in some regions, which should be avoided to reduce antimicrobial resistance and potential side effects. The reasons for regional variations in outpatient antibiotic prescribing are not yet completely understood; socioeconomic and health care density differences between regions do not fully explain such differences. Here, we apply a behavioural perspective by adapting the Theoretical Domains Framework (TDF) to examine regional factors deemed relevant for outpatient antibiotic prescriptions by paediatricians and general practitioners.
METHODS: Qualitative study with guideline-based telephone interviews of 40 prescribers (paediatricians and general practitioners) in outpatient settings from regions with high and low rates of antibiotic prescriptions, stratified by urbanity. TDF domains formed the basis of an interview guide to assess region-level resources and barriers to rational antibiotic prescription behaviour. Interviews lasted 30-61 min (M = 45 min). Thematic analysis was used to identify thematic clusters, and relationships between themes were explored through proximity estimation.
RESULTS: Both paediatricians and general practitioners in low-prescribing regions reported supporting contextual factors (in particular good collegial networks, good collaboration with laboratories) and social factors (collegial support and low patient demand for antibiotics) as important resources. In high-prescribing regions, poor coordination between in-patient and ambulatory health services, lack of region-level information on antimicrobial resistance, few professional development opportunities, and regional variations in patient expectations were identified as barriers to rational prescribing behaviour.
CONCLUSIONS: Interventions targeting professional development, better collaboration structures with laboratories and clearer and user-friendly guidelines could potentially support rational antibiotic prescribing behaviour. In addition, better networking and social support among physicians could support lower prescription rates.
METHODS: Qualitative study with guideline-based telephone interviews of 40 prescribers (paediatricians and general practitioners) in outpatient settings from regions with high and low rates of antibiotic prescriptions, stratified by urbanity. TDF domains formed the basis of an interview guide to assess region-level resources and barriers to rational antibiotic prescription behaviour. Interviews lasted 30-61 min (M = 45 min). Thematic analysis was used to identify thematic clusters, and relationships between themes were explored through proximity estimation.
RESULTS: Both paediatricians and general practitioners in low-prescribing regions reported supporting contextual factors (in particular good collegial networks, good collaboration with laboratories) and social factors (collegial support and low patient demand for antibiotics) as important resources. In high-prescribing regions, poor coordination between in-patient and ambulatory health services, lack of region-level information on antimicrobial resistance, few professional development opportunities, and regional variations in patient expectations were identified as barriers to rational prescribing behaviour.
CONCLUSIONS: Interventions targeting professional development, better collaboration structures with laboratories and clearer and user-friendly guidelines could potentially support rational antibiotic prescribing behaviour. In addition, better networking and social support among physicians could support lower prescription rates.
摘要：
背景：先前的研究已经确定了德国门诊抗生素处方的实质性地区差异，在儿科和成人人群中。这表明某些地区的抗生素处方不当，应避免这种情况，以减少对抗菌药物的耐药性和潜在的副作用。门诊抗生素处方区域差异的原因尚未完全理解；地区之间的社会经济和医疗保健密度差异并不能完全解释这种差异。这里,我们通过调整理论域框架(TDF)来应用行为观点,以检查儿科医生和全科医生认为与门诊抗生素处方相关的区域因素.
方法：定性研究，以指南为基础，对40名门诊医生（儿科医生和全科医生）进行电话访谈，这些医生来自抗生素处方使用率高和低的地区，由城市化分层。TDF域构成了访谈指南的基础，以评估地区级资源和合理抗生素处方行为的障碍。面试持续30-61分钟（M=45分钟）。主题分析用于确定专题组，并通过邻近度估计探索主题之间的关系。
结果：低处方地区的儿科医生和全科医生都报告了支持背景因素（特别是良好的大学网络，与实验室的良好合作）和社会因素（大学支持和患者对抗生素的低需求）作为重要资源。在高处方地区，住院和门诊卫生服务之间的协调不力，缺乏地区层面的抗菌素耐药性信息，专业发展机会很少，患者期望的地区差异被认为是合理处方行为的障碍。
结论：针对专业发展的干预措施，更好的与实验室的合作结构以及更清晰和用户友好的指南可能会支持合理的抗生素处方行为.此外,医生之间更好的网络和社会支持可以支持较低的处方率.
方法：定性研究，以指南为基础，对40名门诊医生（儿科医生和全科医生）进行电话访谈，这些医生来自抗生素处方使用率高和低的地区，由城市化分层。TDF域构成了访谈指南的基础，以评估地区级资源和合理抗生素处方行为的障碍。面试持续30-61分钟（M=45分钟）。主题分析用于确定专题组，并通过邻近度估计探索主题之间的关系。
结果：低处方地区的儿科医生和全科医生都报告了支持背景因素（特别是良好的大学网络，与实验室的良好合作）和社会因素（大学支持和患者对抗生素的低需求）作为重要资源。在高处方地区，住院和门诊卫生服务之间的协调不力，缺乏地区层面的抗菌素耐药性信息，专业发展机会很少，患者期望的地区差异被认为是合理处方行为的障碍。
结论：针对专业发展的干预措施，更好的与实验室的合作结构以及更清晰和用户友好的指南可能会支持合理的抗生素处方行为.此外,医生之间更好的网络和社会支持可以支持较低的处方率.
