PDF(Pubmed)
Abstract：
BACKGROUND: Antimicrobial resistance (AMR) represents a growing concern for public health.
OBJECTIVE: We sought to explore the challenges associated with development and implementation of a complex intervention designed to improve AMS in hospitals.
METHODS: We conducted a qualitative evaluation of a complex AMS intervention with educational, behavioral, and technological components in 5 wards of an English hospital. At 2 weeks and 7 weeks after initiating the intervention, we interviewed 25 users of the intervention, including senior and junior prescribers, a senior nurse, a pharmacist, and a microbiologist. Topics discussed included perceived impacts of different elements of the intervention and facilitators and barriers to effective use. Interviews were supplemented by 2 observations of ward rounds to gain insights into AMS practices. Data were audio-recorded, transcribed, and inductively and deductively analyzed thematically using NVivo12.
RESULTS: Tracing the adoption and impact of the various components of the intervention was difficult, as it had been introduced into a setting with competing pressures. These particularly affected behavioral and educational components (eg, training, awareness-building activities), which were often delivered ad hoc. We found that the participatory intervention design had addressed typical use cases but had not catered for edge cases that only became visible when the intervention was delivered in real-world settings (eg, variations in prescribing workflows across different specialties and conditions).
CONCLUSIONS: Effective user-focused design of complex interventions to promote AMS can support acceptance and use. However, not all requirements and potential barriers to use can be fully anticipated or tested in advance of full implementation in real-world settings.
OBJECTIVE: We sought to explore the challenges associated with development and implementation of a complex intervention designed to improve AMS in hospitals.
METHODS: We conducted a qualitative evaluation of a complex AMS intervention with educational, behavioral, and technological components in 5 wards of an English hospital. At 2 weeks and 7 weeks after initiating the intervention, we interviewed 25 users of the intervention, including senior and junior prescribers, a senior nurse, a pharmacist, and a microbiologist. Topics discussed included perceived impacts of different elements of the intervention and facilitators and barriers to effective use. Interviews were supplemented by 2 observations of ward rounds to gain insights into AMS practices. Data were audio-recorded, transcribed, and inductively and deductively analyzed thematically using NVivo12.
RESULTS: Tracing the adoption and impact of the various components of the intervention was difficult, as it had been introduced into a setting with competing pressures. These particularly affected behavioral and educational components (eg, training, awareness-building activities), which were often delivered ad hoc. We found that the participatory intervention design had addressed typical use cases but had not catered for edge cases that only became visible when the intervention was delivered in real-world settings (eg, variations in prescribing workflows across different specialties and conditions).
CONCLUSIONS: Effective user-focused design of complex interventions to promote AMS can support acceptance and use. However, not all requirements and potential barriers to use can be fully anticipated or tested in advance of full implementation in real-world settings.
摘要：
背景：抗菌素耐药性（AMR）代表了公众健康日益关注的问题。
目的：我们试图探索与开发和实施旨在改善医院AMS的复杂干预措施相关的挑战。
方法：我们对复杂的AMS干预进行了定性评估，行为，以及英国医院5个病房的技术组件。在开始干预后2周和7周，我们采访了25位干预用户，包括高级和初级开药者，一位高级护士,药剂师,和微生物学家。讨论的主题包括干预措施和促进者的不同要素的影响以及有效使用的障碍。访谈得到了2次病房观察的补充，以了解AMS实践。数据是音频记录的，转录，并使用NVivo12进行归纳和演绎分析。
结果：追踪干预措施的各个组成部分的采用和影响是困难的，因为它被引入了一个充满竞争压力的环境。这些特别受影响的行为和教育成分(例如，培训,提高认识活动)，通常是临时交付的。我们发现，参与式干预设计已经解决了典型的用例，但没有满足边缘案例，只有在现实世界的环境中进行干预时才变得可见（例如，不同专业和条件下处方工作流程的差异)。
结论：以用户为中心的复杂干预措施的有效设计可以促进AMS的接受和使用。然而,并非所有的要求和潜在的使用障碍都可以在现实环境中全面实施之前完全预期或测试。
目的：我们试图探索与开发和实施旨在改善医院AMS的复杂干预措施相关的挑战。
方法：我们对复杂的AMS干预进行了定性评估，行为，以及英国医院5个病房的技术组件。在开始干预后2周和7周，我们采访了25位干预用户，包括高级和初级开药者，一位高级护士,药剂师,和微生物学家。讨论的主题包括干预措施和促进者的不同要素的影响以及有效使用的障碍。访谈得到了2次病房观察的补充，以了解AMS实践。数据是音频记录的，转录，并使用NVivo12进行归纳和演绎分析。
结果：追踪干预措施的各个组成部分的采用和影响是困难的，因为它被引入了一个充满竞争压力的环境。这些特别受影响的行为和教育成分(例如，培训,提高认识活动)，通常是临时交付的。我们发现，参与式干预设计已经解决了典型的用例，但没有满足边缘案例，只有在现实世界的环境中进行干预时才变得可见（例如，不同专业和条件下处方工作流程的差异)。
结论：以用户为中心的复杂干预措施的有效设计可以促进AMS的接受和使用。然而,并非所有的要求和潜在的使用障碍都可以在现实环境中全面实施之前完全预期或测试。
