Understanding variation in primary medical care: a nine-country qualitative study of clinicians' accounts of the non-clinical factors that shape antibiotic prescribing decisions for lower respiratory tract infection.
Understanding variation in primary medical care: a nine-country qualitative study of clinicians' accounts of the non-clinical factors that shape antibiotic prescribing decisions for lower respiratory tract infection.
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DOI：
10.1136/bmjopen-2011-000796
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发表时间：
2012
期刊：
影响因子：
2.9
通讯作者：
Butler CC
中科院分区：
文献类型：
--
作者：
Brookes-Howell L;Hood K;Cooper L;Little P;Verheij T;Coenen S;Godycki-Cwirko M;Melbye H;Borras-Santos A;Worby P;Jakobsen K;Goossens H;Butler CC
欧洲国家在初级保健下呼吸道感染（LRTI）患者的抗生素处方方面存在很大差异，这不能仅用病例组合和临床因素来解释。在抗生素处方的变化，是不必要的疾病和临床表现的差异可能会增加耐药微生物的选择，有助于抗生素耐药性的问题。本研究旨在调查临床医生对影响LRTI患者抗生素处方决定的非临床因素的描述，以了解变异并确定解决可能的无益变异的机会。多国定性半结构化访谈研究，数据经过五个阶段的分析框架方法（熟悉，从访谈问题和新出现的主题，索引，图表和解释开发一个主题框架），并与访谈者评论初步分析主题。初级保健.从欧洲9个城市的初级保健研究网络中随机选择了80名初级保健临床医生。临床医生的叙述确定了在特定区域初级保健研究网络内运作的医疗保健系统所施加的非临床因素，包括患者在咨询医生之前获得抗生素（巴塞罗那和米兰），降低患者对抗生素期望的系统（南安普顿和安特卫普）以及缺乏一致的治疗指南（Balatonfüred和Balotódén）。其次，账户揭示了与临床医生的具体特征相关的因素，无论网络（专业精神，自我信念的决策和共同决策的承诺）。解决医疗保健系统因素（例如，在初级保健咨询之前限制患者使用抗生素的自我管理，提高公众意识和提供更一致的指南）可能有助于减少抗生素处方中的无益变化。促进临床医生对变化的接受能力，对决策的信心和投资解释处方决定的准备也可能是有益的。由于各网络强调的因素不同，干预措施的地方灵活性可能会最大限度地提高效力。
There is a wide variation between European countries in antibiotic prescribing for patients in primary care with lower respiratory tract infection (LRTI) that is not explained by case mix and clinical factors alone. Variation in antibiotic prescribing that is not warranted by differences in illness and clinical presentation may increase selection of resistant organisms, contributing to the problem of antibiotic resistance. This study aimed to investigate clinicians’ accounts of non-clinical factors that influence their antibiotic prescribing decision for patients with LRTI, to understand variation and identify opportunities for addressing possible unhelpful variation. Multicountry qualitative semistructured interview study, with data subjected to a five-stage analytic framework approach (familiarisation, developing a thematic framework from interview questions and emerging themes, indexing, charting and interpretation), and with interviewers commenting on preliminary analytic themes. Primary care. Eighty primary care clinicians randomly selected from primary care research networks based in nine European cities. Clinicians’ accounts identified non-clinical factors imposed by the healthcare system operating within specific regional primary care research networks, including patient access to antibiotics before consulting a doctor (Barcelona and Milan), systems to reduce patient expectations for antibiotics (Southampton and Antwerp) and lack of consistent treatment guidelines (Balatonfüred and Łódź). Secondly, accounts revealed factors related to specific characteristics of clinicians regardless of network (professional ethos, self-belief in decision-making and commitment to shared decision-making). Addressing healthcare system factors (eg, limiting patients’ self-management with antibiotics before consulting in primary care, increased public awareness and provision of more consistent guidelines) may assist in reducing unhelpful variation in antibiotic prescribing. Promoting clinicians’ receptivity to change, confidence in decision-making and readiness to invest in explaining prescribing decisions may also be beneficial. As factors were emphasised differently between networks, local flexibility in interventions is likely to maximise effectiveness.
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抗生素处方的变化及其对初级保健急性咳嗽患者恢复的影响：13个国家的前瞻性研究。
DOI：
10.1136/bmj.b2242
发表时间：
2009-06-23
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Butler CC;Hood K;Verheij T;Little P;Melbye H;Nuttall J;Kelly MJ;Mölstad S;Godycki-Cwirko M;Almirall J;Torres A;Gillespie D;Rautakorpi U;Coenen S;Goossens H
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Goossens H
影响因子：
--
作者：
FEINSTEIN, AR
通讯作者：
FEINSTEIN, AR
影响因子：
2.6
作者：
Akkerman, Annemiek E.;Kuyvenhoven, Mariike M.;van Dijk, Liset
通讯作者：
van Dijk, Liset
影响因子：
3.5
作者：
Cals, Jochen W. L.;Scheppers, Nicole A. M.;Butler, Christopher C.
通讯作者：
Butler, Christopher C.
影响因子：
2.2
作者：
Altiner, A;Knauf, A;Wilm, S
通讯作者：
Wilm, S