探索全科医生在管理无并发症尿路感染妇女时的决策:一项定性研究。

IF 2.5 Q2 PRIMARY HEALTH CARE
BJGP Open Pub Date : 2024-10-29 Print Date: 2024-10-01 DOI:10.3399/BJGPO.2023.0224
Peter K Kurotschka, Juliane Hemkeppler, David Gierszewski, Luca Ghirotto, Ildikó Gágyor
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引用次数: 0

摘要

背景:旨在提高基层医疗机构抗生素使用合理性的干预措施要想取得成效,就必须考虑开处方医生的观点:目的:探讨全科医生(GPs)在处理女性无并发症尿路感染(uUTIs)时的决策:对巴伐利亚州和巴登-符腾堡州(德国南部)的 22 名全科医生进行了半结构化访谈:方法:通过归纳定性内容分析对逐字记录进行分析:结果:我们得出了三个主题:促进决策的因素、使决策复杂化的因素和咨询方式。参与者认为,遵循循证建议可使处方决策更加顺利。全科医生和患者之前的经验和信念会引导他们做出使用某些抗生素的决定,即使这些经验和信念与循证建议相矛盾。患者的期望和需求也会影响抗生素处方的开具。组织上的限制,如时间压力、一周中的哪一天(如周末之前),以及对患者而言抗生素的费用低于其他治疗方法,都有利于做出开具抗生素处方的决定。诊断和预后的不确定性以及对循证建议的怀疑也使决策变得更加复杂。医患关系的不和谐也加剧了这种复杂性。关于咨询方式,更深入的咨询和共同决策被认为有助于这一过程:我们发现,在处理患有尿路感染的妇女时,有不同的因素会对直接的管理决策产生不利或有利的影响。这些因素揭示了全科医生决策背后的复杂性。为全科医生提供易于应用的指导,同时消除经济上的限制以分配足够的咨询时间,并支持共同决策,这可能有助于全科医生妥善处理女性尿路感染。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
General practitioners' decision making managing uncomplicated urinary tract infections in women: a qualitative study.

Background: To be effective, interventions aimed at increasing the appropriateness of antibiotic use in primary care should consider the perspectives of prescribing physicians.

Aim: To explore the decision making of general practitioners (GPs) when managing uncomplicated urinary tract infections (uUTIs) in women.

Design & setting: A qualitative study using semi-structured interviews with 22 GPs in Bavaria and Baden-Württemberg (southern Germany).

Method: Verbatim transcripts were analysed through inductive qualitative content analysis.

Results: We generated the following three main themes: factors facilitating the decision making; factors complicating the decision making; and consultation modalities. According to participants, following evidence-based recommendations makes the prescription decision smoother. GPs' and patients' prior experiences and beliefs guides decisions towards certain antibiotics, even if those experiences and beliefs contradict evidence-based recommendations. Patient expectations and demands also condition antibiotic prescribing, favouring it. Organisational constraints, such as time pressure, the day of the week (for example, before weekends), and a lower cost of antibiotics for patients than alternative treatments favour the decision to prescribe antibiotics. Diagnostic and prognostic uncertainty complicates decision making, as does scepticism towards evidence-based recommendations. Discordance within the patient-doctor relationship contributed to this complexity. Regarding consultation modalities, a more in-depth consultation and shared decision making were seen as helpful in this process.

Conclusion: We identified different factors as intervening against or for a straightforward management decision when dealing with women with uUTIs. They reveal the complexity behind the GPs' decision making. Providing GPs with easy-to-apply guidance while removing economic constraints to allocate sufficient consultation time, and supporting shared decision making may help GPs appropriately manage uUTIs in women.

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来源期刊
BJGP Open
BJGP Open Medicine-Family Practice
CiteScore
5.00
自引率
0.00%
发文量
181
审稿时长
22 weeks
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