Authors' Reply to Hays: "A Multinational European Study of Patient Preferences for Novel Diagnostics to Manage Antimicrobial Resistance".
Authors' Reply to Hays: "A Multinational European Study of Patient Preferences for Novel Diagnostics to Manage Antimicrobial Resistance".
复制标题
作者对海斯的回复：“欧洲多国研究患者对管理抗菌素耐药性的新型诊断方法的偏好”。
DOI：
10.1007/s40258-020-00573-w
复制
发表时间：
2020
影响因子：
3.6
通讯作者：
Mott DJ
中科院分区：
文献类型：
--
作者：
Mott DJ
我们感谢Hays博士对我们题为“欧洲多国患者偏好新诊断方法管理抗菌素耐药性”的文章的回应[1][2]。我们的文章提供了患者对诊断试验属性的偏好的经验证据，旨在对抗菌素耐药性(AMR)的管理有用。调查结果来自对七个欧洲国家988名受访者的调查。过去两年内在社区(即非医院)环境中服用抗生素的受访者，被邀请在一系列假设性测试中进行选择，这些测试在三个属性上的表现不同：提供结果的速度；对测试结果的信心；以及测试程序的便利性。调查结果表明，速度对受访者来说是最不重要的属性，而德国和荷兰的受访者表示，相对于其他属性，他们更倾向于自信。在其他有明显偏好的国家(法国、意大利、西班牙和英国)，便利性比其他属性更受青睐。我们感到欣慰的是，海斯博士认为我们的文章的发现是对他经常通过自己的研究做出贡献的文献的宝贵贡献。我们还感谢有机会谈到他提出的几点，目的是提高我们成果的清晰度，也许还能提高其适用性。我们在这里以Hays博士所指出的标题逐点作出回应。医疗点(PoC)Hays博士对PoC测试和其他形式的测试进行了区分，PoC测试包括患者可以自我管理的测试。他认为，患者在选择前者时可能比后者有更大的影响力。在我们的研究中，我们选择不将重点限制在PoC测试上，因为我们希望在社区环境中找到服务提供的混合，我们希望提供一项具有广泛相关性的调查。我们没有命名PoC或实验室测试模式，而是询问患者他们将如何权衡速度以获得与其他属性(便利性和信心)的测试结果。我们可能希望PoC的结果更快，或者实验室测试的结果更慢，但这是我们没有向受访者提供的详细程度。正如海斯博士建议的那样，目前的情况很可能是，患者对特定测试模式的偏好与医疗保健提供者的总体选择几乎没有相关性。然而，对于本文的目的，我们的假设是，如果咨询了患者，如果所提供的测试从他们的角度来看是更理想的，那么这可能有助于诊断技术的采用。海斯博士认为，咨询时间的限制和患者的期望可能意味着，使用诊断性测试来应对患者对抗生素的需求是不可行的。我们同意，这是具有挑战性的。归根结底，医疗保健提供者需要投资于干预措施，以对抗AMR的威胁，并应根据成本和收益的证据确定这样做的最佳战略。我们的期望是，诊断学在这里发挥一定的作用，即使需要进一步的创新才能最大限度地适应这些因素。例如，数字健康领域的进步可能会通过将处方验证与诊断测试结果联系起来而有所帮助。当然，可以探索替代方案，导致在不使用诊断方法的情况下停用抗生素，但必须给予应有的安全性
We thank Dr Hays for responding [1] to our article entitled “A Multinational European Study of Patient Preferences for Novel Diagnostics to Manage Antimicrobial Resistance”[2]. Our article provides empirical evidence on patients’ preferences for the attributes of diagnostic tests intended to be useful in the management of antimicrobial resistance (AMR). Results are derived from a survey of 988 respondents in seven European countries. Respondents, who had been prescribed antibiotics in the community (ie nonhospital) setting within the last two years, were invited to choose between a series of hypothetical tests that differed in their performance across three attributes: speed that results are available; confidence in test results; and convenience of the testing procedure. Findings indicate that speed was the least important attribute to respondents, while respondents in Germany and The Netherlands expressed a preference for confidence over other attributes. In other countries where there was a clear preference (France, Italy, Spain, and the UK), convenience was favoured over other attributes. We are gratified that Dr Hays identifies our article’s findings as a valuable contribution to a literature that he has often contributed to through his own research. We are also grateful for the opportunity to address several points that he raises, with the aim of improving the clarity and perhaps the applicability of our results. We respond here point-by-point under the headings indicated by Dr Hays. Point-of-Care (PoC) Dr Hays draws a distinction between PoC testing, including tests that patients can self-administer, and other forms of testing. He suggests that patients may have more influence in the selection of the former than the latter. In our study we chose not to limit our focus to PoC testing because we expect to find a mixture of service provision in the community setting and we wanted to provide a survey of broad relevance. Instead of naming PoC or laboratory testing modes, we asked patients about how they would trade off speed to get test results against other attributes (convenience and confidence). We might expect faster results with PoC or slower results from laboratory tests, but this was a level of detail that we did not provide to respondents. It may well be the case at present, as Dr Hays suggests, that patient preferences for specific modes of testing are of little relevance to the choices that healthcare providers make in general. However, for the purpose of the article our supposition is that if patients were consulted, and if the tests offered were more optimal from their perspective as a result, then this could aid the uptake of diagnostic technologies. Expectations Dr Hays suggests that consultation time constraints and patients’ expectations may mean that it is not feasible to use a diagnostic test to counter patients’ demands for antibiotics. We agree that this is challenging. Ultimately, healthcare providers need to invest in interventions to counter the threat of AMR and should determine the best strategy to do so on the basis of evidence on the costs and benefits. Our expectation is that diagnostics have some role to play here, even if further innovation is required for optimal accommodation of these. For example, advances in digital health may help by linking validation of prescriptions to a diagnostic test result. Of course, alternatives may be explored that result in withholding antibiotics without the use of diagnostics, but safety must be given due