背景:抗真菌药物管理(AFS)计划被认为有助于优化抗真菌药物的治疗和预防处方。然而,只有少数这样的程序被实施。因此,有关此类计划的行为驱动因素和障碍以及从现有成功的AFS计划中学到的证据有限。这项研究旨在利用英国的大型AFS计划并从中汲取教训。目的是(a)调查AFS计划对处方习惯的影响,(A)使用基于COM-B的理论域框架(TDF)(能力,机会,和行为动机),以定性地识别多个专业的抗真菌处方行为的驱动因素和障碍,(c)半定量调查过去5年抗真菌处方习惯的趋势。
方法:对血液学进行了定性访谈和半定量在线调查,重症监护,呼吸,剑桥大学医院的实体器官移植临床医生。开发了讨论指南和调查,以确定处方行为的驱动因素,基于TDF。
结果:来自21/25临床医生的反应。定性结果表明,AFS计划在支持最佳抗真菌处方实践方面是有效的。我们发现了七个影响抗真菌处方决策的TDF域-五个驱动因素和两个障碍。主要驱动因素是多学科团队(MDT)之间的集体决策,而主要障碍是缺乏某些治疗方法和真菌诊断能力。此外,在过去的5年里,跨专业,我们观察到处方集中在更有针对性而非广谱抗真菌药物上的趋势越来越明显.
结论:了解相关临床医生对已确定的驱动因素和障碍的处方行为的基础,可以为AFS计划的干预措施提供信息,并有助于持续改善抗真菌药物处方。可以利用MDT之间的集体决策来改善临床医生的抗真菌处方。这些发现可能会在专科护理环境中推广。
BACKGROUND: Antifungal stewardship (AFS) programs are recognized to contribute to optimizing antifungal prescribing for treatment and prophylaxis. However, only a small number of such programs are implemented. Consequently, evidence on behavioral drivers and barriers of such programs and learnings from existing successful AFS programs is limited. This study aimed to leverage a large AFS program in the UK and derive learnings from it. The objective was to (a) investigate the impact of the AFS program on prescribing habits, (a) use a Theoretical Domains Framework (TDF) based on the COM-B (Capability, Opportunity, and Motivation for Behavior) to qualitatively identify drivers and barriers for antifungal prescribing behaviors across multiple specialties, and (c) semiquantitatively investigate trends in antifungal prescribing habits over the last 5 years.
METHODS: Qualitative interviews and a semiquantitative online survey were conducted across hematology, intensive care, respiratory, and solid organ transplant clinicians at Cambridge University Hospital. The discussion guide and survey used were developed to identify drivers of prescribing behavior, based on the TDF.
RESULTS: Responses were received from 21/25 clinicians. Qualitative outcomes demonstrated that the AFS program was effective in supporting optimal antifungal prescribing practices. We found seven TDF domains influencing antifungal prescribing decisions-five drivers and two barriers. The key driver was collective decision-making among the multidisciplinary team (MDT) while key barriers were lack of access to certain therapies and fungal diagnostic capabilities. Furthermore, over the last 5 years and across specialties, we observed an increasing tendency for prescribing to focus on more targeted rather than broad-spectrum antifungals.
CONCLUSIONS: Understanding the basis for linked clinicians\' prescribing behaviors for identified drivers and barriers may inform interventions on AFS programs and contribute to consistently improving antifungal prescribing. Collective decision-making among the MDT may be leveraged to improve clinicians\' antifungal prescribing. These findings may be generalized across specialty care settings.