Clinicians' perceptions of the problem of antimicrobial resistance in health care facilities
Clinicians' perceptions of the problem of antimicrobial resistance in health care facilities
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DOI：
10.1001/archinte.164.15.1662
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发表时间：
2004-08-09
影响因子：
--
通讯作者：
Cardo, DM
中科院分区：
文献类型：
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作者：
Giblin, TB;Sinkowitz-Cochran, RL;Cardo, DM
背景：许多临床医生不遵守有关抗菌素耐药性 (AR) 的指南。为此，疾病控制和预防中心制定了一项全国性的预防医疗机构中抗生素耐药性的运动，提出了 4 项策略和 12 个循证步骤。 方法：为了评估临床医生对 AR 的看法、预防 AR 的障碍和促进因素，以及如何最好地接触临床医生，在 4 家匹兹堡地区医疗保健倡议医院开展该运动后，进行了一份调查问卷和 4 个焦点小组。结果：117 名临床医生完成了调查问卷； 28 人参加了焦点小组。临床医生明显更有可能认为 AR 在全国范围内是一个问题，而不是在自己的机构（95% vs 77%；P < .001）或实践中（95% vs 65%；P = .002），这与焦点小组结果一致（全国 93% vs 46% 机构或实践）。实施障碍最大的 3 个运动步骤是“治疗感染，而不是定植”(35%)、“感染治愈或不太可能时停止治疗”(35%) 和“实行抗菌药物控制”(33%)。焦点小组中的临床医生指出了医疗保健文化、知识缺乏和护理人员短缺等额外障碍；促进者包括教育、信息技术和咨询。建议使用计算机程序、海报和本地数据来让临床医生了解 AR。结论：临床医生认为 AR 是一个复杂的全国性问题，但与他们自己的机构或实践不太相关。正如该活动一样，向临床医生提供预防 AR 的信息和步骤可能会影响他们对问题的看法，并激励他们采取行动确保患者安全。
Background: Many clinicians do not comply with guidelines regarding antimicrobial resistance (AR). In response, the Centers for Disease Control and Prevention developed a national Campaign to Prevent Antimicrobial Resistance in Healthcare Settings that presents 4 strategies and 12 evidence-based steps.Methods: To assess clinicians' perceptions of AR, barriers and facilitators to preventing AR, and how best to reach clinicians, a questionnaire and 4 focus groups were conducted after presentation of the Campaign at 4 Pittsburgh Regional Healthcare Initiative hospitals.Results: One hundred seventeen clinicians completed the questionnaire; 28 participated in the focus groups. Clinicians were significantly more likely to perceive that AR was a problem nationally than in their own institution (95% vs 77%; P < .001) or practice (95% vs 65%; P = .002), consistent with focus group results (93% nationally vs 46% institution or practice). The 3 Campaign steps with the most barriers to implementation were "Treat infection, not colonization" (35%), "Stop treatment when infection is cured or unlikely" (35%), and "Practice antimicrobial control" (33%). Clinicians in the focus groups cited the additional barriers of the health care culture, lack of knowledge, and the nursing shortage; facilitators included education, information technology, and consults. Computer programs, posters, and local data were suggested for reaching clinicians about AR.Conclusions: Clinicians perceive AR to be a complex national problem but less relevant to their own institution or practice. Providing clinicians with information and steps for preventing AR, as in the Campaign, may affect their perceptions of the problem and motivate them to take actions to ensure patient safety.