评估影响独立开处方护士开抗生素处方行为的因素

Alyson Green
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摘要

抗生素耐药性是一个紧迫的、加速发展的全球健康威胁,其原因在于感染预防和控制措施不当,以及抗生素处方未达到最佳水平。为减少抗生素耐药性的发生,卫生专业人员必须践行抗菌药物管理,其中包括优化处方行为。本研究旨在确定影响医疗处方者和独立护士处方者抗生素处方决定的因素,并比较不同实践环境下的反应。独立护士处方者受邀完成了一份包含 17 项抗生素处方声明的在线调查问卷。受访者按照五点李克特量表对其回答进行评分,从完全不同意到完全同意不等。共完成 115 份问卷并进行了分析。结果显示,独立护士处方者的抗生素处方决定可能会受到患者期望、诊断不确定性、与患者随访相关的挑战、时间压力和远程会诊的影响。与医疗处方者不同的是,她们并没有报告为与患者保持良好关系而开具抗生素处方的压力。抗生素处方决定受到临床指征以外的多种因素的影响,需要进一步的研究来详细探讨这些因素。独立护士处方者需要针对其具体需求和实践环境进行教育和培训。
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Evaluation of factors influencing antibiotic prescribing behaviour by independent nurse prescribers
Antibiotic resistance is an urgent, accelerating global health threat due to inadequate infection prevention and control practices, and sub-optimal prescribing of antibiotics. Health professionals are required to practise antimicrobial stewardship to reduce incidence of antibiotic resistance, and this includes optimal prescribing behaviours. This study aimed to establish factors influencing medical prescribers' and independent nurse prescribers' antibiotic prescribing decisions, and compare the responses between practice settings. Independent nurse prescribers were invited to complete an online questionnaire with 17 antibiotic prescribing statements. Respondents rated their responses on a five-point Likert-type scale ranging from totally disagree to totally agree. A total of 115 questionnaires were completed and analysed. The results showed independent nurse prescribers' antibiotic prescribing decisions may be influenced by patient expectations, diagnostic uncertainty, challenges related to patient follow-up, time pressures and remote consultations. Unlike medical prescribers, they do not report pressure to prescribe antibiotics to maintain a good relationship with the patient. Antibiotic prescribing decisions are influenced by a wide range of factors outside of clinical indication and further research is required to explore these in detail. Independent nurse prescribers require education and training tailored to their specific needs and practice settings.
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