Antimicrobial resistance as a social dilemma: Approaches to reducing broad-spectrum antibiotic use in acute medical patients internationally

抗菌药物耐药性是21世纪世纪医学中最大和最广泛认识的问题之一。为了解决抗生素耐药性问题，试图改变抗生素的处方方式，取得了不同的成功。这部分是因为抗生素的处方受到许多社会，文化和组织因素的影响，处方抗生素的人在做出决定时必须平衡相互竞争的利益，价值观以及短期和长期利益。医疗服务提供者对患者个人和“整个社会”都负有责任，由于处方问题通常没有“技术”解决方案，因此决策通常基于道德价值观和医疗保健社区的习俗。因此，如果考虑到这些社会因素，改变抗生素处方方式的尝试将会更有效。这些社会因素，以及个人对抗生素处方的决定，受到当地和国家背景的强烈影响。通过比较在英国，斯里兰卡和南非处方抗生素的态度，本研究将考虑和预测不同的背景因素对各种尝试改变抗生素处方的影响。这将使人们更容易评估哪些尝试将取得成功，哪些尝试可以在不同的国际环境中重复。考虑到这些因素的模型可用于预测个人行为，社会，文化或经济因素的变化将如何影响处方抗生素的决定，以及更广泛的抗菌素耐药性问题。该项目有三个主要目标：1。建立一个由学者和临床医生组成的国际小组，他们将共同努力，利用社会科学理论和方法来研究抗生素在治疗重病患者中的使用。密切合作将确保该项目的工作与人们试图改善抗菌素耐药性的许多情况相关，特别是在非高收入国家。2.用理论建立一个模型，描述广谱抗生素在治疗重症患者中的应用。该模型将确定影响抗生素处方方式的风险，紧张局势以及社会和文化背景因素。寻找改善抗生素处方的方法，并考虑各种行动的潜力，以解决世界各地使用抗生素治疗重病患者的问题。3.开始研究一项未来提案，该提案将使用两种数学模型来预测在不同情况下尝试和改进抗生素使用的各种尝试的效果。在赠款范围内开发的一个或多个模型可用于提高影响抗生素处方的尝试的成功率，方法是使人们更清楚地了解在不同情况下，特别是在非高收入国家，哪些行动最有可能取得成功。这将减少在不成功的项目上投入资金、时间和精力的风险。这项工作将为未来的国际合作奠定基础，并为开发更大的项目，以研究和测试改善抗生素处方方式的尝试奠定基础。这可能涉及一项研究，该研究采访了患者，以探索他们在抗生素处方中的作用。这项研究还将涉及培训斯里兰卡和南非的当地研究人员的采访技巧

Antimicrobial resistance is one of the largest and most widely-acknowledged problems in 21st century medicine. Attempts to change the ways antibiotics are prescribed, in order to tackle the problem of antimicrobial resistance, have met with variable success. This is partly because the prescription of antibiotics is influenced by many social, cultural and organisational factors, and those prescribing antibiotics have to balance competing interests, values and short and long term benefits when making decisions. Healthcare providers have a responsibility both to individual patients and to "society at large", and since there is often not a "technical" solution to problems with prescribing, decisions are usually based on moral values and the customs of the healthcare community. Therefore attempts to change the ways antibiotics are prescribed will be more effective if they take these social factors into account. These social factors, and thus decisions made by individuals about prescribing antibiotics, are strongly influenced by the local and national context. By comparing attitudes to prescribing antibiotics in England, Sri Lanka, and South Africa this study will consider and predict the influence of different contextual factors on various attempts to change the ways antibiotics are prescribed. This will make it easier to assess which attempts will be successful and could be repeated in different international contexts. Models, which take these factors into account, can be used to predict how changes in individual behaviour, social, cultural, or economic factors will impact on decisions about prescribing antibiotics, and the broader problem of antimicrobial resistance. The project has three main aims:1. To develop an international group of academics and clinicians who will work together to use social science theory and methods to look at the use of antibiotics in treating seriously ill patients. Close collaboration will make sure that the work of the project will be relevant to many contexts in which people are trying to improve antimicrobial resistance, particularly in non-high income countries. 2. To use theory to build a model that describes the use of broad spectrum antibiotics in treating seriously ill patients. The model will identify the risks, tensions, and elements of social and cultural context that effect the way antibiotics are prescribed. To find ways to improve antibiotic prescribing, and to consider the potential of various actions to address problems with the use of antibiotics in treating seriously ill patients in different parts of the world. 3. To begin work on a future proposal which would use two types of mathematical models to predict the effect of various attempts to try and improve the use of antibiotics in different contexts. The model or models developed within the grant could be used to improve the success of attempts to influence antibiotic prescription, by making it clearer which actions have the best chance of success in different contexts, particularly in non-high income countries. This would reduce the risk of investing finances, time, and energy in unsuccessful projects. The work will lay the ground work for future international collaborations, and for the development of larger projects to research and test attempts to improve the way antibiotics are prescribed. This might involve a study which interviews patients to explore their role in the prescription of antibiotics. The study will also involve training local researchers in Sri Lanka and South Africa in interviewing skills