Gashaw Enbiyale Kasse, Judy Humphries, Suzanne M. Cosh, Md Shahidul Islam
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We excluded editorials, opinions, systematic reviews and studies published in languages other than English. We searched studies from electronic databases: PubMed, ProQuest Health and Medicine, Web Science, and Scopus. The quality of the included studies was appraised using the Mixed Methods Appraisal Tool (Version 2018). Narrative synthesis was employed to synthesize the result and incorporate quantitative studies. Of the 1816 identified studies, 49 studies spanning 2000–2023 were eligible for review. The factors influencing antibiotic prescription practice and variability were grouped into physician-related, patient-related, and healthcare system-related factors. Clinical guidelines, previous patient experience, physician experience, colleagues’ prescribing practice, pharmaceutical pressure, time pressure, and financial considerations were found to be influencing factors of antibiotic prescribing practice. In addition, individual practice patterns, practice volume, and relationship with patients were also other factors for the variability of antibiotic prescription, especially for intra-physician prescription variability. Antibiotic prescription practice in primary health care is a complex practice, influenced by a combination of different factors and this may account for the variation. 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引用次数: 0
摘要
抗生素耐药性在全球范围内日益严重。医疗专业人员在初级医疗机构开具抗生素处方时的做法对抗生素耐药性有很大影响。抗生素处方是一个复杂的过程,受到各种内部和外部因素的影响。本系统综述旨在总结现有证据,说明导致初级医疗机构中医生开具抗生素处方差异的因素。本系统性综述依据 PRISMA 指南进行。我们纳入了定性、定量和混合方法研究,这些研究考察了影响基层医疗机构医生处方实践和处方差异的因素。我们排除了社论、观点、系统综述和以非英语语言发表的研究。我们检索了电子数据库中的研究:PubMed、ProQuest Health and Medicine、Web Science 和 Scopus。我们使用混合方法评估工具(2018 年版)对纳入研究的质量进行了评估。采用叙事综合法对结果进行综合,并纳入定量研究。在已确定的 1816 项研究中,有 49 项研究符合综述条件,时间跨度为 2000 年至 2023 年。影响抗生素处方实践和变异性的因素分为医生相关因素、患者相关因素和医疗系统相关因素。研究发现,临床指南、以往的患者经验、医生经验、同事的处方实践、药物压力、时间压力和经济因素是抗生素处方实践的影响因素。此外,个人执业模式、执业量以及与患者的关系也是影响抗生素处方变化的其他因素,尤其是医生内部的处方变化。初级卫生保健中的抗生素处方实践是一项复杂的实践,受到不同因素的综合影响,这可能是造成差异的原因。为解决影响抗生素处方变化的因素(医生内部和医生之间),干预措施应旨在减少诊断的不确定性,并提供持续的医学教育和培训,以促进以患者为中心的护理。
Factors contributing to the variation in antibiotic prescribing among primary health care physicians: a systematic review
Antibiotic resistance is growing globally. The practice of health professionals when prescribing antibiotics in primary health care settings significantly impacts antibiotic resistance. Antibiotic prescription is a complex process influenced by various internal and external factors. This systematic review aims to summarize the available evidence regarding factors contributing to the variation in antibiotic prescribing among physicians in primary healthcare settings. This systematic review was conducted based on PRISMA guidelines. We included qualitative, quantitative and mixed methods studies that examined factors influencing prescription practice and variability among primary healthcare physicians. We excluded editorials, opinions, systematic reviews and studies published in languages other than English. We searched studies from electronic databases: PubMed, ProQuest Health and Medicine, Web Science, and Scopus. The quality of the included studies was appraised using the Mixed Methods Appraisal Tool (Version 2018). Narrative synthesis was employed to synthesize the result and incorporate quantitative studies. Of the 1816 identified studies, 49 studies spanning 2000–2023 were eligible for review. The factors influencing antibiotic prescription practice and variability were grouped into physician-related, patient-related, and healthcare system-related factors. Clinical guidelines, previous patient experience, physician experience, colleagues’ prescribing practice, pharmaceutical pressure, time pressure, and financial considerations were found to be influencing factors of antibiotic prescribing practice. In addition, individual practice patterns, practice volume, and relationship with patients were also other factors for the variability of antibiotic prescription, especially for intra-physician prescription variability. Antibiotic prescription practice in primary health care is a complex practice, influenced by a combination of different factors and this may account for the variation. To address the factors that influence the variability of antibiotic prescription (intra- and inter-physician), interventions should aim to reduce diagnostic uncertainty and provide continuous medical education and training to promote patient-centred care.
期刊介绍:
BMC Family Practice is an open access, peer-reviewed journal that considers articles on all aspects of primary health care research. The journal has a special focus on clinical decision making and management, continuing professional education, service utilization, needs and demand, and the organization and delivery of primary care and care in the community.