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Enhancing the quality of antibiotic prescribing in Primary Care: Qualitative evaluation of a blended learning intervention

机译：提高基层医疗中抗生素处方的质量：混合学习干预措施的定性评估

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Background The Stemming the Tide of Antibiotic Resistance (STAR) Educational Program aims to enhance the quality of antibiotic prescribing and raise awareness about antibiotic resistance among general medical practitioners. It consists of a seven part, theory-based blended learning program that includes online reflection on clinicians' own practice, presentation of research evidence and guidelines, a practice-based seminar focusing on participants' own antibiotic prescribing and resistance rates in urine samples sent from their practice, communication skills training using videos of simulated patients in routine surgeries, and participation in a web forum. Effectiveness was evaluated in a randomised controlled trial in which 244 GPs and Nurse Practitioners and 68 general practices participated. This paper reports part of the process evaluation of that trial. Methods Semi-structured, digitally recorded, and transcribed telephone interviews with 31 purposively sampled trial participants analysed using thematic content analysis. Results The majority of participants reported increased awareness of antibiotic resistance, greater self-confidence in reducing antibiotic prescribing and at least some change in consultation style and antibiotic prescribing behaviour. Reported practical changes included adopting a practice-wide policy of antibiotic prescription reduction. Many GPs also reported increased insight into patients' expectations, ultimately contributing to improved doctor-patient rapport. The components of the intervention put forward as having the greatest influence on changing clinician behaviour were the up-to-date research evidence resources, simple and effective communication skills presented in on-line videos, and presentation of the practice's own antibiotic prescribing levels combined with an overview of local resistance data. Conclusion Participants regarded this complex blended learning intervention acceptable and feasible, and reported wide-ranging, positive changes in attitudes and clinical practice as a result of participating in the STAR Educational Program. Trial registration Current Controlled Trials ISRCTN63355948
机译：背景技术遏制抗生素抗药性（STAR）教育计划旨在提高抗生素处方的质量，并提高普通从业者对抗生素抗药性的认识。它由七个部分组成，基于理论的混合学习程序，包括对临床医生自身实践的在线反思，研究证据和指南的介绍，基于实践的研讨会，重点是参与者自己处方的抗生素处方和从他们的实践，使用常规手术中模拟患者的视频进行沟通技能培训，以及参加网络论坛。在一项随机对照试验中评估了有效性，其中包括244名全科医生和护士从业人员以及68名普通医生。本文报告了该试验过程评估的一部分。方法采用主题内容分析法，对31位有意抽样的试验参与者进行了半结构化，数字记录和转录的电话采访。结果大多数参与者报告了对抗生素耐药性的意识增强，在减少抗生素处方方面的自信心增强以及至少在咨询风格和抗生素处方行为方面有所改变。报告的实际变化包括采用全行业减少抗生素处方的政策。许多全科医生也报告说，对患者期望的了解增加，最终有助于改善医患关系。提出的对改变临床医生行为影响最大的干预措施包括：最新的研究证据资源，在线视频中展示的简单有效的沟通技巧，与实践相结合的抗生素处方水平介绍以及局部电阻数据概述。结论参与者认为这种复杂的混合学习干预措施是可接受和可行的，并且由于参加STAR教育计划，他们报告了态度和临床实践发生了广泛的积极变化。试用注册电流对照试验ISRCTN63355948

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