'The Body Gets Used to Them': Patients' Interpretations of Antibiotic Resistance and the Implications for Containment Strategies
'The Body Gets Used to Them': Patients' Interpretations of Antibiotic Resistance and the Implications for Containment Strategies
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DOI：
10.1007/s11606-011-1916-1
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发表时间：
2012-07-01
影响因子：
5.7
通讯作者：
Butler, Christopher C.
中科院分区：
文献类型：
--
作者：
Brookes-Howell, Lucy;Elwyn, Glyn;Butler, Christopher C.
促进基于证据的抗生素处方和使用的干预措施经常建立在抗生素耐药性的概念上，但患者和临床医生可能对其含义有不同的假设。探讨患者对“抗生素耐药性”的解释，并考虑遏制抗生素耐药性策略的含义。多国定性访谈研究。120 - 2010年，一名来自欧洲9个国家初级保健研究网络的成年患者，最近因下呼吸道感染（LRTI）症状咨询了初级保健临床医生。咨询后，对患者进行了半结构化访谈，并进行了五阶段分析框架法（熟悉，根据访谈问题和数据中出现的主题开发主题框架，索引，图表和映射以搜索数据中的解释），当地网络促进者对初步报告进行评论。主要主题是抗生素耐药性作为“耐药人体”的一种属性，抗生素有效性的障碍是个体反应性的丧失。不太常见的是，患者正确地将抗生素耐药性概念化为细菌的一种特性。尽管如此，在几乎所有患者的解释中，抗生素的过度使用都是一个强烈的中心概念，无论他们认为耐药性位于体内还是细菌中。大多数患者都知道抗生素使用和抗生素耐药性之间的联系。将抗生素耐药性误解为人体而不是细菌细胞的属性，可以通过强调耐药性的可转移性，以及个人可以通过更适当的抗生素处方和使用做出的社会贡献，为更清晰的临床医生-患者讨论和公共卫生干预提供信息。
Interventions promoting evidence based antibiotic prescribing and use frequently build on the concept of antibiotic resistance but patients and clinicians may not share the same assumptions about its meaning.To explore patients' interpretations of 'antibiotic resistance' and to consider the implications for strategies to contain antibiotic resistance.Multi country qualitative interview study.One hundred and twenty-one adult patients from primary care research networks based in nine European countries who had recently consulted a primary care clinician with symptoms of Lower Respiratory Tract Infection (LRTI).Semi-structured interviews with patients following their consultation and subjected to a five-stage analytic framework approach (familiarization, developing a thematic framework from the interview questions and the themes emerging from the data, indexing, charting, and mapping to search for interpretations in the data), with local network facilitators commenting on preliminary reports.The dominant theme was antibiotic resistance as a property of a 'resistant human body', where the barrier to antibiotic effectiveness was individual loss of responsiveness. Less commonly, patients correctly conceptualized antibiotic resistance as a property of bacteria. Nevertheless, the over-use of antibiotics was a strong central concept in almost all patients' explanations, whether they viewed resistance as located in either the body or in bacteria.Most patients were aware of the link between antibiotic use and antibiotic resistance. The identification of the misinterpretation of antibiotic resistance as a property of the human body rather than bacterial cells could inform clearer clinician-patient discussions and public health interventions through emphasising the transferability of resistance, and the societal contribution individuals can make through more appropriate antibiotic prescribing and use.