Antibiotic prophylaxis in dentistry: part I. A qualitative study of professionals' views on the NICE guideline
Antibiotic prophylaxis in dentistry: part I. A qualitative study of professionals' views on the NICE guideline
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DOI：
10.1038/sj.bdj.2011.524
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发表时间：
2011-07-01
影响因子：
2.6
通讯作者：
Newton, J. T.
中科院分区：
文献类型：
--
作者：
Soheilipour, S.;Scambler, S.;Newton, J. T.
背景牙科治疗前抗生素预防的良好指南已经做出了实质性的改变，并从根本上偏离了以往的做法，这影响了人们长期以来的信念和实践模式。对于医疗专业人员来说，向长期以来认为他们必须在牙科治疗之前接受抗生素治疗的患者解释新的指导方针可能会有困难。目的了解临床医生对NICE抗生素预防指南的态度、在临床实践中对指南的使用、指南实施的障碍以及如何最好地克服任何感知到的障碍。方法对7名牙科护理专业人员、2名心脏病专家和1名心脏护理护士进行深入访谈。使用框架方法对数据进行分析，以提取中心主题和意见。结果临床医生普遍认为，最初患者不愿遵循良好的指导。人们认为，对于以前开过预防性抗生素的患者队列来说，情况尤其如此。他们发现很难向患有感染性心内膜炎的患者解释新的指南，这些患者长期以来一直认为他们必须在牙科治疗之前接受抗生素治疗。也有人对一名没有遵循指导的临床医生的法律地位表示担忧。临床医生普遍认为，以传单和有效网站的形式提供准确的信息将是向患者提供有关新指导的最佳方式。结论：临床医生预计很难向患者解释坚持NICE指南所需的临床实践变化，尤其是对于有感染性心内膜炎病史的患者或患者的心脏病医生不同意NICE指南的情况。他们特别强调提供准确的信息，以便让患者放心。
Background The NICE guideline for antibiotic prophylaxis before dental treatment has made a substantive change and fundamental departure from previous practice that affects long-standing beliefs and practice patterns. There is potential difficulty for healthcare professionals explaining the new guidance to patients who have long believed that they must receive antibiotics before their dental treatment. Aim To explore clinicians' attitudes towards the NICE guidance on antibiotic prophylaxis, their use of the guideline in clinical practice, barriers to the implementation of the guideline, and how best to overcome any perceived barriers. Methods In-depth interviews were conducted with seven dental care professionals, two cardiologists and a cardiac care nurse. The data were analysed using the framework method to extract central themes and opinions. Results Clinicians generally perceived that initially patients would be reluctant to follow the NICE guidance. This was felt to be particularly true of the patient cohort that had previously been prescribed prophylactic antibiotics. They found it difficult to explain the new guidance to patients who have had infective endocarditis and have long believed that they must receive antibiotics before their dental treatment. Concerns were also raised about the legal position of a clinician who did not follow the guidance. Clinicians generally suggested that the provision of accurate information in the form of leaflets and valid websites would be the best way to advise patients about the new guidance. Conclusions Clinicians anticipated difficulties in explaining to patients the change in clinical practice necessitated by adherence to the NICE guidance, most notably for patients with a history of infective endocarditis or where the patient's cardiologist did not agree with the NICE guidance. They placed particular emphasis on the provision of accurate information in order to reassure patients.