初级保健机构实施抗微生物社会规范反馈(SNF)干预策略的障碍和促进因素:基于实施研究综合框架(CFIR)的定性研究。

IF 4.4 2区 医学 Q1 INFECTIOUS DISEASES
Yuxing Yan, Junli Yang, Yun Lu, Yutong Fu, Jiao Chen, Xinchen Li, Yue Chang
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引用次数: 0

摘要

背景:虽然目前的证据支持社会规范反馈(SNF)干预的有效性,但其持续融入初级保健仍然有限。通过基于delphi的证据适用性评估确定抗菌SNF干预策略的要素,本研究旨在探索其在初级保健机构实施的障碍和促进因素,从而为未来的优化提供信息。方法:基于实施研究综合框架(CFIR)的五个领域,我们开发了半结构化访谈和焦点小组讨论指南。采用有目的抽样,我们选择卫生管理人员、医院管理人员、医生和药剂师进行半结构化访谈,而在初级保健机构接受过抗菌药物治疗的患者则参加焦点小组讨论。数据收集一直持续到饱和,最终收集了来自中国西南部贵州省5个地点的5个卫生行政部门和7个初级保健机构的36名参与者的见解。使用NVivo 12对文本数据进行编码和分类。结果:我们确定了33个障碍,38个促进因素和1个混合决定因素,影响初级保健机构抗微生物SNF干预策略的持续实施。在内部设定领域中,影响实施的因素数量最多。主要障碍包括可用资源不足、知识和信息获取不足、缺乏相对优先权(指干预不如竞争性组织任务重要的看法)、优先考虑短期效率的组织文化、缺乏组织激励和奖励、执行气氛不足、执行准备不足、监督和领导参与不足。缺乏明确的目标和反馈,缺乏网络和沟通,组织结构中缺乏药剂师委员会。改善这些因素将促进持续执行。此外,这一领域的促进因素还包括变革的紧张局势(利益相关者认为当前的处方实践迫切需要改进)、良好的学习氛围、良好的兼容性和新成立的大型医院的组织结构。结论:抗菌SNF干预策略的长期实施需要干预特征、组织环境、个体特征、外部环境和动态实施过程的协同效应。该研究为具有可比社会经济背景的地区可持续实施抗微生物SNF干预策略和优化设计复杂干预措施提供了重要证据和参考。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Barriers and facilitators of the implementation for the antimicrobial Social Norm Feedback (SNF) intervention strategy in primary care institutions: a qualitative study based on the Consolidated Framework for Implementation Research (CFIR).

Barriers and facilitators of the implementation for the antimicrobial Social Norm Feedback (SNF) intervention strategy in primary care institutions: a qualitative study based on the Consolidated Framework for Implementation Research (CFIR).

Barriers and facilitators of the implementation for the antimicrobial Social Norm Feedback (SNF) intervention strategy in primary care institutions: a qualitative study based on the Consolidated Framework for Implementation Research (CFIR).

Background: Although current evidence supports the effectiveness of social norm feedback (SNF) interventions, their sustained integration into primary care remains limited. Drawing on the elements of the antimicrobial SNF intervention strategy identified through the Delphi-based evidence applicability evaluation, this study aims to explore the barriers and facilitators to its implementation in primary care institutions, thereby informing future optimization.

Methods: Based on the five domains of the Consolidated Framework for Implementation Research (CFIR), we developed semi-structured interview and focus group discussion guides. Employing purposive sampling, we selected health administrators, hospital managers, physicians, and pharmacists for semi-structured interviews, while patients who had received antimicrobial therapy in primary care institutions participated in focus group discussions. Data collection continued until saturation was achieved, ultimately gathering insights from 36 participants across 5 health administration departments and 7 primary care institutions in 5 locations of Guizhou Province, Southwest China. Textual data were coded and categorized using NVivo 12.

Results: We identified 33 barriers, 38 facilitators, and 1 mixed determinant influencing the persistent implementation of the antimicrobial SNF intervention strategy in primary care institutions. The highest number of factors influencing implementation was found in the inner setting domain. Key barriers included insufficient available resources, insufficient accessibility of knowledge and information, lack of relative priority (referring to the perception that the intervention was less important than competing organizational tasks), organizational culture that prioritizes short-term efficiency, lack of organizational incentives and rewards, inadequate implementation climate, insufficient readiness for implementation, insufficient oversight and leadership engagement, lack of clear goals and feedback, lack of networks and communications, and absence of Pharmacist Council in organizational structure. Improving these factors would promote continuous implementation. Furthermore, facilitators within this domain also included the tension for change (stakeholders' perception that current prescribing practices urgently need improvement), excellent learning climate, excellent compatibility, and organizational structure in newly established large-scale hospitals.

Conclusions: Long-term implementation of the antimicrobial SNF intervention strategy necessitates synergistic effects among intervention characteristics, organizational setting, characteristics of individuals, outer setting, and dynamic implementation process. The study provides critical evidence and references for the sustainable implementation of the antimicrobial SNF intervention strategy and the optimized design of complex interventions in regions with comparable socioeconomic contexts.

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来源期刊
Antimicrobial Resistance and Infection Control
Antimicrobial Resistance and Infection Control PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES
CiteScore
9.70
自引率
3.60%
发文量
140
审稿时长
13 weeks
期刊介绍: Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.
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