Barriers and facilitators of evidence-based management of patients with bacterial infections among general dental practitioners: a theory-informed interview study
Barriers and facilitators of evidence-based management of patients with bacterial infections among general dental practitioners: a theory-informed interview study
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DOI：
10.1186/s13012-016-0372-z
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发表时间：
2016-01-29
影响因子：
7.2
通讯作者：
Ramsay, Craig R.
中科院分区：
文献类型：
--
作者：
Newlands, Rumana;Duncan, Eilidh M.;Ramsay, Craig R.
背景：尽管大多数感染可以通过当地措施成功治疗，但普通牙科医生（GDPs）经常开抗生素来管理牙齿感染。支持国内生产总值做出适当处方决定的出版指南已经存在，但牙科抗生素处方仍然存在很大差异。作为减少牙科抗生素处方（RAPiD）试验的一部分，进行了一项访谈研究，以了解使用当地措施而不是处方抗生素来管理细菌感染的障碍和促进因素。方法：采用理论领域框架（TDF）进行30次半结构化一对一电话访谈。回答被编码到TDF和子主题的领域中。与行为改变相关的优先领域（高频：>= 50%受访者讨论）被确定为未来干预努力的目标，并映射到行为改变轮系统的“干预功能”上。结果：五个领域（行为调节、社会影响、强化、环境背景和资源以及对后果的信念）和七个子主题被确定为未来干预的目标。所有参与者都有关于细菌感染循证管理的知识，但由于患者因素和时间管理，他们报告了遵循这一知识的困难。研究发现，缺乏时间严重影响了它们在执行当地措施方面的决策过程。他们还认为自己有能力克服病人的影响，认为采取当地措施会影响到随后的预约时间，以及没有采取当地措施的激励措施。虽然没有发现知识或基本技能方面的问题，但与会者建议了一些持续的专业发展计划（例如时间管理、出版指南概述）来解决一些障碍。该领域的结果表明，未来的干预措施可以改变gdp对细菌感染的抗生素处方的一些干预功能：通过培训传授技能，为gdp提供模仿的例子（即建模）或创造奖励的期望（即激励）。结论：这是第一个理论上有依据的研究，旨在确定gdp中细菌感染患者的循证管理的障碍和促进因素。需要一种务实的方法来解决未来干预措施中旨在改变牙医不当处方行为的可修改障碍。
Background: General dental practitioners (GDPs) regularly prescribe antibiotics to manage dental infections although most infections can be treated successfully by local measures. Published guidance to support GDPs to make appropriate prescribing decisions exists but there continues to be wide variation in dental antibiotic prescribing. An interview study was conducted as part of the Reducing Antibiotic Prescribing in Dentistry (RAPiD) trial to understand the barriers and facilitators of using local measures instead of prescribing antibiotics to manage bacterial infections.Methods: Thirty semi-structured one-to-one telephone interviews were conducted using the Theoretical Domains Framework (TDF). Responses were coded into domains of the TDF and sub-themes. Priority domains (high frequency: >= 50 % interviewees discussed) relevant to behaviour change were identified as targets for future intervention efforts and mapped onto 'intervention functions' of the Behaviour Change Wheel system.Results: Five domains (behavioural regulation, social influences, reinforcement, environmental context and resources, and beliefs about consequences) with seven sub-themes were identified as targets for future intervention. All participants had knowledge about the evidence-based management of bacterial infections, but they reported difficulties in following this due to patient factors and time management. Lack of time was found to significantly influence their decision processes with regard to performing local measures. Beliefs about their capabilities to overcome patient influence, beliefs that performing local measures would impact on subsequent appointment times as well as there being no incentives for performing local measures were also featured. Though no knowledge or basic skills issues were identified, the participants suggested some continuous professional development programmes (e.g. time management, an overview of published guidance) to address some of the barriers. The domain results suggest a number of intervention functions through which future interventions could change GDPs' antibiotic prescribing for bacterial infections: imparting skills through training, providing an example for GDPs to imitate (i.e. modelling) or creating the expectation of a reward (i.e. incentivisation).Conclusions: This is the first theoretically informed study to identify barriers and facilitators of evidence-based management of patients with bacterial infections among GDPs. A pragmatic approach is needed to address the modifiable barriers in future interventions intended to change dentists' inappropriate prescribing behaviour.