How can guidelines be optimised to help achieve the rational use of antibiotics after the Covid-19 pandemic?

该博士项目旨在使用混合方法来了解如何优化指南以改善Covid-19后的抗生素使用，为指南制定者和实施者提供新的见解。全球抗菌素耐药性（AMR）一直在增加，部分原因是卫生保健机构抗生素使用率高。指南在影响抗生素使用方面发挥着关键作用，特别是在基于临床判断而不是精确诊断测试开处方的初级保健机构。有可能影响抗生素使用的一项指南是AWaRe指数。AWaRe由世界卫生组织（世卫组织）于2017年创建，旨在将《基本药物清单》中的抗生素分为三组：获取（治疗最常见感染的第一和第二选择抗生素）、观察（产生耐药性可能性较高的抗生素）和储备（最后的治疗手段）。这些类别的目的是指导管理方案，作为系统、设施和规定者的措施和目标的基础。在英国，AWaRe是2019-2024年抗微生物药物耐药性国家行动计划（NAP）的一部分，用于英格兰公共卫生部（PHE）的监测以及初级和二级保健机构的研究。然而，目前尚不清楚AWaRe是否或如何转化为初级保健临床实践。该研究项目将利用流行病学和人类学方法的互补优势，了解如何优化指南，以改善英国Covid-19后的抗生素使用，为指南制定者和实施者提供新的见解。该项目的流行病学（定量）方面将使用电子健康记录中的抗生素处方数据。我将比较英格兰和爱尔兰的处方模式，以量化AWaRe指数的影响。AWaRe已在英国的2019-2024年AMR国家行动计划中实施，但尚未在爱尔兰的国家行动计划中实施，因此我将能够通过评估抗生素使用随时间的变化（在英国实施之前和之后）来确定AWaRe是否对英格兰的处方产生了影响，并与对照国家（爱尔兰）进行比较。这个项目的人类学（定性）方面将涉及关键信息提供者访谈和民族志实地调查。将对参与国家抗生素使用政策制定的3名个人进行关键举报人访谈，并将在整个项目中重复访谈，以使本研究能够共同开展。人种学的实地考察将在英国的两个全科诊所进行，我将在那里观察药物管理团队（他们一直是英国抗菌素耐药性管理干预的焦点）、临床工作人员和药剂师之间的会议。定性和定量的研究结果将合并成一个最终的解释，在这个解释中，我将确定本研究的不同元素之间的一致和不一致的领域。

This PhD project aims to use a mixed-methods approach to understand how guidelines can be optimised for improving antibiotic use after Covid-19, providing new insights to be used by guideline setters and implementers.Antimicrobial resistance (AMR) has been increasing globally, in part due to high rates on antibiotic use in healthcare settings. Guidelines play a pivotal role in influencing antibiotic use, particularly in primary care settings where prescribing is based on clinical judgement rather than a precise diagnostic test. One guideline that has potential to influence antibiotic use is the AWaRe Index. AWaRe was created by the World Health Organization (WHO) in 2017 as a way of categorising antibiotics in the Essential Medicines List into three groups: Access (first- and second-choice antibiotics for treating most common infections), Watch (antibiotics with a higher potential for developing resistance) and Reserve (last resort treatments). These categories are intended to guide stewardship programmes by being the basis of measures and targets for systems, facilities and prescribers. In the UK, AWaRe is part of the 2019-2024 AMR National Action Plan (NAP), is used for monitoring by Public Health England (PHE) and in research in both primary and secondary care settings. However, it is not yet clear if or how AWaRe is translated into primary care clinical practice.This research project will draw on the complementary strengths of epidemiological and anthropological methods to understand how guidelines can be optimised for improving antibiotic use after Covid-19 in the UK, providing new insights to be used by guideline setters and implementers.The epidemiological (quantitative) aspect of this project will use antibiotic prescribing data from electronic health records. I will compare patterns in prescribing between England and Ireland in order to quantify the effects of the AWaRe Index. AWaRe was implemented in the UK's 2019-2024 AMR National Action Plan, but is not yet in Ireland's National Action Plan, so I will be able to determine if AWaRe has had an impact on prescribing in England by assessing changes in antibiotic use over time (before and after it was implemented in England), and compared to a control country (Ireland). The anthropological (qualitative) aspects of this project will involve key informant interviews and ethnographic fieldwork. Key informant interviews will be conducted with 3 individuals who are involved in national antibiotic use policy settings and will be repeated throughout the project to enable the co-production of this research. The ethnographic fieldwork will be conducted at 2 general practices in the UK and where I will observe meetings between Medicine Management Teams (who have been the focal points for UK AMR stewardship interventions), clinical staff and pharmacists.The qualitative and quantitative findings will be merged into one final interpretation, where I will identify areas of agreement and disagreement between the different elements of this research.