Context-sensitive antibiotic optimization: a qualitative interviews study of a remote Australian hospital setting
Context-sensitive antibiotic optimization: a qualitative interviews study of a remote Australian hospital setting
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DOI：
10.1016/j.jhin.2018.06.002
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发表时间：
2018-11-01
影响因子：
6.9
通讯作者：
Kirby, E.
中科院分区：
文献类型：
--
作者：
Broom, J.;Broom, A.;Kirby, E.
背景：抗生素优化是一个紧迫的国际问题。监管框架，包括要求有一个有效的抗菌药物管理（AMS）计划，现在在国内和国际上的医院部门无处不在。然而，医疗保健最终是在各种机构环境和社会背景下提供的。有新的证据表明，抗生素优化策略的实施可能是不适当的，甚至适得其反的尝试，以优化在非典型的healthcare settings.Aim：记录的经验和观点的临床工作人员在澳大利亚的远程医疗设置方面的抗菌药物的使用，并在该环境中的优化策略。对来自澳大利亚昆士兰州一家偏远医院的30名医疗保健专业人员（包括医生、护士和药剂师）进行了半结构化定性访谈。结果：从分析中确定了四个主题，作为抗生素优化的关键挑战：（i）AMS是外部驱动的，当地知识被边缘化;（ii）对当地人口风险增加、治疗失败和随后过度使用抗菌药物的压力的看法;（iii）跨专业关系动态，包括被视为AMS障碍的医疗等级结构;（iv）由临时临时工作人员主导的临床工作队伍和其他流程问题被视为重大障碍。在这个网站的医疗保健专业人员的看法导致的结论是，抗菌法规和实践改进策略更普遍的是不太可能成功，如果他们不适应和尊重的背景下的护理，资源和结构的限制设置，和特殊人群的特殊性（和随后的临床“诀窍”）。(C)2018年，卫生保健感染协会。由爱思唯尔有限公司出版。保留所有权利。
Background: Antibiotic optimization is an urgent international issue. Regulatory frameworks, including the requirement to have a functioning antimicrobial stewardship (AMS) programme, are now ubiquitous across the hospital sector nationally and internationally. However, healthcare is ultimately delivered in a diverse range of institutional settings and social contexts. There is emerging evidence that implementation of antibiotic optimization strategies may be inappropriate or even counterproductive to attempts to optimize in atypical healthcare settings.Aim: To document the experiences and perspectives of clinical staff in a remote healthcare setting in Australia with respect to antimicrobial use, and strategies for optimization in that environment.Methods: Semi-structured qualitative interviews were conducted with 30 healthcare professionals, including doctors, nurses and pharmacists, from a remote hospital in Queensland, Australia.Findings: Four themes were identified from the analysis as key challenges to antibiotic optimization: (i) AMS as externally driven, and local knowledge sidelined; (ii) perceptions of heightened local population risks, treatment failure and the subsequent pressure to over-use of antimicrobials; (iii) interprofessional relationship dynamics including medical hierarchical structures perceived as a barrier to AMS; (iv) a clinical workforce dominated by transient locum staff and other process issues were perceived as significant barriers.Conclusion: The perceptions of healthcare professionals in this site lead to the conclusion that antimicrobial regulations and practice improvement strategies more generally are unlikely to succeed if they fail to accommodate and respect the context of care, the resource and structural constraints of the setting, and the specificities of particular populations (and subsequent clinical 'know-how'). (C) 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.