Improving the uptake and SusTainability of Effective interventions to promote Prudent antibiotic Use in Primary care (STEP-UP)

细菌对我们用来杀死它们的抗生素的抗药性越来越强。这对我们所有人来说都是一个大问题。我们使用抗生素的次数越多，细菌的抗药性就越强。在英格兰，全科医生开出的抗生素约占所用抗生素的四分之三。这些处方中的大多数(约80%)实际上对患者没有好处，但都会有助于增加抗生素耐药性。许多帮助全科医生给那些不太可能受益的患者开出更少抗生素的方法已经过测试。这些措施包括培训和“备份”处方等策略，以便患者在症状恶化时使用。许多药物效果良好，使用它们的全科医生开出的抗生素更少。问题是，没有参与研究的全科医生还没有开始使用抗生素，所以总体上没有什么变化。政府还出台了政策，如果医生给那些不太可能受益的患者开更少的抗生素，就会给全科医生更多的钱。这项研究花费了数百万英镑，减少了抗生素的使用，但尚不清楚额外的资金实际上能带来多大的变化。当研究人员测试新的诊断工具或培训包时，他们不仅问它是否有效，还问NHS要花多少钱才能广泛使用。计算“物有所值”将权衡现在的成本与未来的收益和风险。抗生素非常便宜(通常一个疗程低于GB1)，因此大多数分析表明，每个人都应该总是服用抗生素。问题是，我们没有好的方法将耐药性在未来构成的威胁包括在这些成本效益计算中。这意味着我们花费时间和金钱寻找新的“神奇子弹”来减少抗生素处方，而没有从我们已经知道有效、但没有使用的东西中获得最大限度的好处。我们需要知道为什么没有使用有效的策略，并改进它们，使它们在日常护理中定期使用。这个项目旨在首先更详细地了解以前的研究表明减少抗生素处方的策略是如何起作用的。我们之所以需要这样做，是因为“常识”的想法往往是错误的：不同的人对相同的情况有不同的反应，研究人员认为发生的事情往往不是这样的。这将帮助我们想出方法，让现有的策略更具吸引力，更容易每天使用。这将增加他们在整个英格兰的普及程度，这意味着我们可以继续减少不必要的抗生素使用和抗生素耐药性的威胁。我们将调查4个不同的、精心挑选的领域。-激励一般做法：评估全英格兰范围内的政策，支付一般做法以减少不必要的抗生素使用-对系统的改变：探索“延迟开药”，即全科医生开出处方，如果患者的症状恶化，可以“兑现”--提高全科医生的沟通技能：调查如何帮助全科医生向患者解释何时不需要抗生素--更好地为决策者提供信息：评估我们如何平衡现在使用抗生素和未来抗药性对健康和成本的影响。以及我们如何确定抗生素使用变化的成本效益在每个领域，我们将进行详细研究，以找出使用有效战略的障碍，并找出克服这些障碍的方法。这些研究将包括与临床调试小组、全科医生、护士处方医生、执业经理和患者一起进行的研究。然后，我们将与不同类型的医疗专业人员和患者合作，制定改进策略的方法。我们将在实施研究中测试这些增强功能。我们还将开发和应用新的经济评估研究方法来评估物有所值。我们的团队涵盖健康心理学、健康经济学、生物统计学、初级保健、药剂学和临床流行病学方面的专业知识。它还为年轻的研究人员提供了担任领导角色的机会，同时得到了更有经验的同事的支持。

Bacteria are increasingly resistant to the antibiotics we use to kill them. This is a major problem for us all. The more we use antibiotics, the more resistant the bacteria become. In England, GPs prescribe about 3/4 of antibiotics used. Most of these prescriptions (about 80%) will not actually benefit the patient but all will help to increase antibiotic resistance.Many ways to help GPs prescribe fewer antibiotics to patients who are unlikely to benefit have been tested. These have included training and strategies like 'back-up' prescriptions for patients to use if symptoms get worse. Many have worked well and GPs using them have prescribed fewer antibiotics. The problem is that GPs not taking part in the research have not started using them, so very little has changed overall.Government policies have also been introduced to give general practices more money if doctors prescribe fewer antibiotics to patients who are unlikely to benefit. This cost millions of pounds, and reduced antibiotic use, but it is not clear how promising extra money actually makes changes happen.When researchers test a new diagnostic tool or training package, they don't just ask whether it works, but how much it would cost the NHS to use widely. Working out 'value for money' balances costs now against benefits and risks in the future. Antibiotics are so cheap (usually under £1 for a course) that most analyses suggest everyone should always get antibiotics. The problem is that we don't have good ways to include the threat that resistance poses in the future in these cost-benefit calculations.This means that we spend time and money looking for new 'magic bullets' to reduce antibiotic prescribing, without getting the most from what we already know can work, but is not used. We need to know why effective strategies aren't used and improve them so they are used regularly in every-day care.This project aims first to understand in more detail how the strategies that previous studies have shown reduce antibiotic prescribing worked. We need to do this because 'common sense' ideas are often wrong: different people react in different ways to the same situation and what researchers think is going on is often not the case. This will help us come up with ways to make existing strategies more attractive and easier to use every day. These will increase their uptake across England, meaning we can continue to reduce unnecessary antibiotic use and the threat of antibiotic resistance.We will investigate 4 different, carefully chosen, areas.- Incentivising general practices: evaluating an England-wide policy to pay general practices to reduce unnecessary antibiotic use- Changes to the system: exploring 'delayed prescribing' where GPs give a prescription that patients can 'cash-in' if their symptoms get worse- Improving GPs communication skills: investigating ways to help GPs explain to patients when antibiotics are not needed- Better-informing decision-makers: assessing how we balance the health and cost impact of antibiotic use now vs resistance in the future, and how we determine cost-effectiveness of changes in antibiotic useIn each area, we will run detailed studies to find out what the barriers are to using effective strategies, and work out ways to overcome them. These will include studies with clinical commissioning groups, with GPs, nurse prescribers, practice managers and patients. We will then develop ways to improve strategies, in partnership with different types of healthcare professionals and patients. We will test these enhancements in an implementation study. We will also develop and apply new economic evaluation research methods to assess value for money.Our team covers expertise in health psychology, health economics, biostatistics, primary care, pharmacy and clinical epidemiology. It also provides the opportunity for younger researchers to take leadership roles whilst being supported by more experienced colleagues.