Stemming the tide of antimicrobial resistance

抗生素耐药性是媒体高度关注的一大公共卫生威胁，这一问题引起了公民、临床医生、政策制定者和政界人士的极大关注。之前旨在消除耐药性驱动因素之一的干预措施，即初级保健中不适当的抗生素处方，效果令人失望。这些干预措施往往只是向临床医生提供有关问题严重程度的笼统信息，而不是提供机会来考虑与当地相关的数据，并获得以不同方式处理事情的新的、可行的技能。STAR计划建立在采访临床医生和患者所获得的见解的基础上，涉及这些群体的正在进行的定性研究将导致干预措施的改进。在STAR计划中获得的新技能提高了在常见感染会诊期间与患者的沟通质量。患者和公众可以发挥关键作用，干预措施旨在让患者了解他们对抗生素治疗的感受、想法和期望。临床医生不再猜测他们认为患者想要或期望什么，而是使用明确的策略来评估患者的知识和兴趣，并适当地满足这些要求。培训方案包括小组学习和使用在线学习和网站的自我指导学习。该网站将不断更新相关的新临床证据。该网站将有一个可供公众访问的缓和部分，其中将以可访问的方式概述关键的相关研究证据，关于适当自我管理的建议，以及有关疾病的临床过程和应引起重新会诊的事件的信息。STAR研究结果也将在该网站上公布。研究结果将发表在学术期刊上，并在科学会议上发表。此外，我们将通知主要参与者(卫生部、MRC、苏格兰行政卫生局、威尔士议会政府、卫生当局、PCOS、信托经理、皇家学院、BMA、本科生和研究生院长)研究结果。调查人员将利用其他创造性的机会来吸引专业人士和公众。例如，STAR研究的PI是全科医学呼吸道感染网络的创始成员，曾为各国政府机构提供咨询，并参与了世界卫生组织S战略的制定，以遏制抗菌素耐药性。其中一些工作对政策和公共活动产生了直接影响。所有调查人员都将利用类似的机会和论坛，让专业人员和公众都参与进来。

Antibiotic resistance is a major threat to public health with a high media profile, and the issue is of great concern to citizens, clinicians, policy makers and politicians. Previous interventions aimed at removing one of the drivers of resistance, inappropriate antibiotic prescribing in primary care, have had disappointing effects. These interventions have often simply bombarded clinicians with generalised information about the extent of the problem, rather than providing opportunities to consider locally relevant data and acquire new, feasible skills for doing things differently. The Star Program was built on insights gained from interviewing clinicians and patients and ongoing qualitative studies involving these groups will lead to refinements of the intervention. The new skills acquired in the STAR Program enhance the quality of communication with patients during the consultation for common infections. Patients and the public have a key role to play, and the intervention seeks to engage patients about their feelings, ideas and expectations about antibiotic treatment. Instead of clinicians second guessing what they think patients want or expect, explicit strategies are used to assess patients knowledge and interest and meet these appropriately. The training program includes group-learning and self-directed learning using on-line learning and a website. The site will be continuously updated with relevant emerging clinical evidence. There will be a moderated section of this web site that will be accessible to the general public which will outline key relevant research evidence in accessible ways, advice about appropriate self-management, and information about the clinical course of illnesses and events that should trigger re-consultation. STAR study findings will also be published on this website. Study findings will be published in academic journals and presented at scientific meetings. In addition, we will inform key players (DH, MRC, Scottish Executive Health Department, Welsh Assembly Government, Health Authorities, PCOs, Trust Managers, Royal Colleges, BMA, Undergraduate and Postgraduate Deans) of the study results. Other creative opportunities will be used by the investigators to engage professionals and public alike. For example, the PI of the STAR Study is a founding member of the General Practice Respiratory Infections Network, and has been consulted by agencies of national governments, and participated in the development of the World Health Organisation s strategy to contain antimicrobial resistance. Some of this work has had a direct impact on policy and public campaigns. Similar opportunities and forums will be used by all the investigators to engage both professionals and the public.