Impact of the COVID-19 pandemic on community antibiotic prescribing and stewardship: a qualitative interview study with general practitioners in England
Impact of the COVID-19 pandemic on community antibiotic prescribing and stewardship: a qualitative interview study with general practitioners in England
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COVID-19 大流行对社区抗生素处方和管理的影响：对英格兰全科医生的定性访谈研究
DOI：
10.1101/2021.11.19.21266529
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Borek A
中科院分区：
文献类型：
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作者：
Borek A
2019冠状病毒病大流行对初级保健服务的提供产生了深远影响。我们的目的是确定全科医生（gp）对COVID-19大流行如何影响英国全科医生的抗生素处方和抗菌药物管理（AMS）的看法和经验。在2020年秋季（14次访谈）和2021年春季（10次访谈）两个时间点对18名gp进行了24次半结构化访谈。采用纵向方法，对访谈进行了录音、抄写和专题分析。参与者报告说，在大流行早期，呼吸道感染和COVID-19症状的抗生素处方门槛较低（咨询次数较少），然后恢复到更常见的（大流行前）处方。他们认为，大流行对泌尿和皮肤感染的抗生素处方影响较小。参与者认为，工作和咨询方式的变化（例如，远程和面对面咨询的比例）以及患者就诊情况和全科医生工作量的变化影响了抗生素处方的波动。由于与covid -19相关的紧急优先事项，医疗辅助队的参与度和优先级都有所下降，这使情况更加复杂。需要重新参与辅助医疗系统，例如，通过恢复抗生素处方反馈和目标/激励措施。大流行扰乱了通常的工作方式和辅助医疗系统，并要求对其进行调整。现在重要的是确定机会，例如，在未来重新组织管理感染和AMS的方式。
The COVID-19 pandemic has had a profound impact on the delivery of primary care services. We aimed to identify general practitioners’ (GPs’) perceptions and experiences of how the COVID-19 pandemic influenced antibiotic prescribing and antimicrobial stewardship (AMS) in general practice in England. Twenty-four semi-structured interviews were conducted with 18 GPs at two time-points: autumn 2020 (14 interviews) and spring 2021 (10 interviews). Interviews were audio-recorded, transcribed and analysed thematically, taking a longitudinal approach. Participants reported a lower threshold for antibiotic prescribing (and fewer consultations) for respiratory infections and COVID-19 symptoms early in the pandemic, then returning to more usual (pre-pandemic) prescribing. They perceived the pandemic as having had less impact on antibiotic prescribing for urinary and skin infections. Participants perceived the changing ways of working and consulting (e.g., proportions of remote and in-person consultations) in addition to changing patient presentations and GP workloads as influencing the fluctuations in antibiotic prescribing. This was compounded by decreased engagement with, and priority of, AMS due to COVID-19-related urgent priorities. Re-engagement with AMS is needed, e.g., through reviving antibiotic prescribing feedback and targets/incentives. The pandemic disrupted, and required adaptations in, the usual ways of working and AMS. It is now important to identify opportunities, e.g., for re-organising ways of managing infections and AMS in the future.