歐美醫生體驗：改善急性呼吸道感染抗生素處方質量的創新干預

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一項涉及六個國家的研究發現，提供給醫生的溝通技巧培訓和患者手冊，以及C反應蛋白（CRP）現場檢測，能有效提高處方抗生素的質量。醫生們表示，這些工具增強了他們應對患者期望和降低診斷不確定性的信心。這些干預措施不僅提升了醫生對疾病嚴重性和處方知識的了解，也增強了在不必要使用抗生素時作出非處方決策的自信。

臨床醫生對提高急性呼吸道感染抗生素處方質量干預的看法和經驗。

Clinicians’ views and experiences of interventions to enhance the quality of antibiotic prescribing for acute respiratory tract infections

Anthierens S, Tonkin-Crine S, Cals JW, et al. Clinicians’ views and experiences of interventions to enhance the quality of antibiotic prescribing for acute respiratory tract infections. J Gen Intern Med. 2015;30(4):408-416. doi:10.1007/s11606-014-3076-6

https://pubmed.ncbi.nlm.nih.gov/25373834/

Abstract

Evidence shows a high rate of unnecessary antibiotic prescriptions in primary care in Europe and the United States. Given the costs of widespread use and associated antibiotic resistance, reducing inappropriate use is a public health priority.

We aimed to explore clinicians’ experiences of training in communication skills and use of a patient booklet and/or a C-reactive protein (CRP) point-of-care test to reduce antibiotic prescribing for acute respiratory tract infections (RTIs).

We used a qualitative research approach, interviewing clinicians who participated in a randomised controlled trial (RCT) testing two contrasting interventions.

General practice clinicians in Belgium, England, The Netherlands, Poland, Spain and Wales participated in the study.

Key results

Clinicians from all countries attributed benefits for themselves and their patients to using both interventions. Clinicians reported that the communication skills training and use of the patient booklet gave them greater confidence in addressing patient expectations for an antibiotic by providing answers to common questions and supporting the clinician’s own explanations. Clinicians felt the booklet could be used for a variety of patients and for different types of infections. The CRP test was viewed as a tool to decrease diagnostic uncertainty, to support non-prescription decisions, and to reassure patients, but was only necessary when clinicians were uncertain about the need for antibiotics.

Providing clinicians with training and support tools for use in practice was received positively and was valued by clinicians across countries. Interventions seemed to have influenced behaviour by increasing clinician knowledge about illness severity and prescribing, increasing confidence in making non-prescribing decisions when antibiotics were unnecessary, and enabling clinicians to anticipate positive outcomes when making such decisions. Addressing such determinants of behaviour change enabled interventions to be relevant for clinicians working across different contexts.

摘要

證據顯示，在歐洲和美國的基層醫療中存在大量不必要的抗生素處方。鑑於廣泛使用的成本和相關的抗生素抗藥性，減少不恰當使用是公共衛生的優先事項。

我們旨在探索臨床醫生接受溝通技巧培訓以及使用患者手冊和/或C反應蛋白（CRP）即時診療測試來減少急性呼吸道感染（RTI）抗生素處方的經驗。

我們採用質性研究方法，訪問參與了兩種對比干預措施的隨機對照試驗（RCT）的臨床醫生。

比利時、英格蘭、荷蘭、波蘭、西班牙和威爾士的全科醫生參與了這項研究。

進行了六十六次半結構化訪談，將訪談內容逐字轉錄，必要時翻譯成英語，並使用主題和框架分析進行分析。

所有國家的臨床醫生都認為使用這兩種干預措施對他們自己和患者都有益。臨床醫生報告稱，溝通技巧培訓和使用患者手冊使他們更有信心應對患者

對抗生素的期望，通過提供常見問題的答案和支持醫生自己的解釋，更好地應對患者期望。臨床醫生認為這本手冊可以用於不同的患者和不同類型的感染。CRP測試被視為一種減少診斷不確定性、支持不開處方的決定和安慰患者的工具，但只有在臨床醫生對是否需要抗生素感到不確定時才是必要的。

為臨床醫生提供實踐中使用的培訓和支持工具受到了積極反饋，並受到各國臨床醫生的重視。干預措施似乎通過增加臨床醫生對疾病嚴重性和處方知識的了解、增強在不必要使用抗生素時做出非處方決定的信心，以及使臨床醫生在做出此類決定時能夠預期到積極結果，從而影響了行為。通過解決行為改變的這些決定因素，使得干預措施對在不同背景下工作的臨床醫生都具有相關性。

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