General practitioners' perceptions of antimicrobial resistance: a qualitative study
General practitioners' perceptions of antimicrobial resistance: a qualitative study
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DOI：
10.1093/jac/dk1467
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发表时间：
2007-02-01
影响因子：
5.2
通讯作者：
Butler, Christopher C.
中科院分区：
文献类型：
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作者：
Simpson, Sharon A.;Wood, Fiona;Butler, Christopher C.
目的：旨在提高抗生素处方质量的干预措施往往突出了抗菌素耐药性的威胁。尽管大多数抗生素是由全科医生开出的，但人们对他们对这个问题的看法知之甚少。因此，本研究的目的是为了更深入地了解全科医生对抗生素耐药性的认知。方法：定性访谈，扎根理论研究。访问了40名全科医生，其中26名来自高氟喹诺酮类药物处方实践，14名来自普通氟喹诺酮类药物处方实践。结果：大多数全科医生关注广泛的耐药问题，并同意这是一个日益严重的问题。然而，许多人表示，他们在日常实践中很少遇到它的后果，一些人质疑将他们的处方决定与阻力和患者较差的结果联系起来的证据。他们感到矛盾的是，面对许多其他相互竞争的要求，他们显然无法影响这个问题。一些人表示，他们欢迎微生物同事提供更多有关当地耐药性模式的信息，并认为应该加强本科生和研究生关于抗菌药处方和耐药性的教育。然而，少数人提到，当地对抗生素耐药性认识的提高可能会导致他们开出更多的二线药物作为经验治疗。结论：抗生素耐药性只是影响全科医生决定是否开抗生素的一系列重要因素之一，而不是最直接的影响。在促进在初级保健中更谨慎地使用抗生素时，所有这些影响都需要考虑在内。来自微生物学家同事的更多关于局部耐药的信息将在临床上有用，但就其本身而言，可能会矛盾地影响一些全科医生更频繁地开出更新的、更广泛的药物。
Objectives: Interventions aimed at enhancing the quality of antibiotic prescribing often highlight the threat of antimicrobial resistance. Although most antibiotics are prescribed by general practitioners (GPs), little is known of their perceptions of this issue. The aim of this study was therefore to achieve a deeper understanding of GPs' perceptions of antimicrobial resistance.Methods: A qualitative interview, grounded theory study. Forty GPs were interviewed, 26 from high fluoroquinolone prescribing practices and 14 from average fluoroquinolone prescribing practices.Results: Most GPs were concerned about the broad issue of antimicrobial resistance and agreed that it was a growing problem. However, many said they infrequently encountered its consequences in their everyday practice and some questioned the evidence linking their prescribing decisions to resistance and poorer outcomes for their patients. They felt conflicted by their apparent inability to influence the problem in the face of many other competing demands. A number said they would welcome more information from their microbiological colleagues about resistance patterns locally, and felt that undergraduate and graduate education about antimicrobial prescribing and resistance should be enhanced. However, a few mentioned that a heightened awareness of antimicrobial resistance locally may cause them to prescribe more second line agents as empirical therapy.Conclusions: Antimicrobial resistance is only one of a range of important influences on GPs decisions whether or not to prescribe an antibiotic and is not the most immediate. These influences all need to be taken into account when promoting a more cautious use of antibiotics in primary care. More information from microbiologist colleagues about local resistance would be clinically useful, but on its own, may paradoxically influence some GPs to prescribe newer, broader spectrum agents more often.