摘要
目的了解减少抗生素滥用行为的社会规范反馈(SNF)干预方法,为中国开展SNF干预减少抗生素滥用行为提供参考依据。方法检索PubMed数据库、Embase数据库、Web of Science数据库和Scopus数据库,并辅以文献追溯法收集各数据库2000年1月—2021年10月公开发表的关于减少抗生素滥用行为SNF干预的相关英文文献,对减少抗生素滥用行为的SNF干预方法进行系统文献综述法分析。结果SNF干预的机构主要为基层医疗卫生机构,还包括三级医院、专科医院及研究纳入当地所有医院的某个部门;信息反馈的排名单位包括以机构为单位、以医生个体为单位和以医生群体为单位;同行比较时抗生素处方名次信息的展示方式主要为以模糊同行排名值进行展示、以精确同行排名值进行展示和以同行抗生素处方均数比较值进行展示;相邻2次反馈干预间隔大多为每月或每季度;医生的同行比较反馈信息可通过纸质邮寄信件、电子邮件或当地开发的可用于信息反馈的系统3种方式获得;SNF处方行为干预配套的干预包主要包括患者宣传教育、处方开药指导和处方沟通策略;SNF干预效果的评价指标包括评价干预前后抗生素处方的相关指标和评价干预前后成本效益的相关指标,其中评价抗生素处方的主要指标为干预前后标准化抗生素处方率的变化、标准化抗生素处方总量的变化、限定日剂量(DDD)和根据特定病种计算不恰当抗生素处方率,评价成本效益的相关指标主要评估干预后节约的处方费用、干预材料的成本和患者的收益指标。结论减少抗生素滥用行为的SNF干预主要在基层医疗卫生机构开展,多针对总抗生素处方指标高或抗生素处方不恰当指标高的医生进行干预,中国可借鉴国际社会开展SNF干预的经验为减少我国抗生素滥用寻求新路径。
Objective To comprehend the method and effect of social norm feedback(SNF)intervention on reducing antibiotic abuse for offering a reference to implementation of relevant SNF intervention in China.Methods Studies on SNF intervention on reducing antibiotic abuse published in English from January 2000 through October 2021 were systematically retrieved via searching databases of PubMed,Embase,Web of Science and Scopus and literatures tracing was also conducted for auxiliary retrieval.Results Totally 14 English literatures were included in the analysis.The reported SNF interventions were conducted mainly among primary health care institutions;some of the interventions were conducted in tertiary hospitals,specialized hospitals and in departments of local medical institutions.The unit-specific SNF was ranked by institution,individual doctor or doctor group.The ranking of prescription number was mainly displayed by fuzzy or accurate peer ranking value or mean value of antibiotic prescriptions.For most of the SNF interventions,the information feedbacks were conducted monthly or quarterly and the comparative information among the intervention-covered physicians were disseminated by paper mail,e-mail or locally-developed specific information system.The three most commonly utilized auxiliary packages within the interventions were patient educational materials,clinical practice guidelines and communication strategy.The effects of the interventions were evaluated with the changes in indicators of antibiotic prescription and cost-benefit analysis before and after the interventions,including changes in antibiotic prescription behavior evaluated with the indicators of standardized antibiotic prescription rate,total standardized antibiotic prescription,defined daily dose(DDD),the inappropriate antibiotic prescription rate according to specific diseases,the total cost of prescriptions saved after intervention,the cost of intervention materials and the benefits of patients.Conclusion The reported SNF interventions on reducing antibiotic abuse were conducted mainly among primary health care institutions and the target population were doctors with higher number of antibiotic prescriptions or inappropriate antibiotic prescriptions.The performance and outcome of the interventions may provide references for reducing antibiotic abuse in China.
作者
曾颖超
石林
李伟彬
刘立
刘雨晨
黄绮娴
刘朝杰
杨廉平
ZENG Ying-chao;SHI Lin;LI Wei-bin(School of Public Health,Sun Yat-sen University,Guangzhou,Guangdong Province 510080,China;不详)
出处
《中国公共卫生》
CAS
CSCD
北大核心
2023年第2期267-272,共6页
Chinese Journal of Public Health
基金
国家自然科学基金(72074234)
美国中华医学基金会(CMB-OC19-337)
广东省自然科学基金(2022A1515011338)。