在家庭初级保健中诊断不确定性和决策:对抗生素处方的定性研究
Rupak Datta1,2, Eliza Kiwak2, Terri R Fried1,2
1Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA.
Journal of the American Geriatrics Society
|January 19, 2024
概括
由于诊断不确定性和患者因素,在家庭初级保健中处方抗生素是复杂的. 了解临床医生的决策是改善家庭护理机构抗生素管理的关键.
科学领域:
- 老年病的医生 老年病的医生
- 传染性疾病 传染性疾病
- 初级医疗保健医学 一级医疗保健医学
背景情况:
- 基于家庭的初级保健在评估感染方面提出了独特的挑战.
- 这些挑战可以显著影响抗生素处方实践.
- 了解临床医生的决策对于在这种环境中有效的抗生素管理至关重要.
研究的目的:
- 调查影响家庭初级保健临床医生的抗生素决策的因素.
- 探讨医疗保健提供者的观点,关于感染诊断和治疗在住院患者.
主要方法:
- 与退伍军人事务部家庭基础初级保健计划的22名临床医生进行了半结构面试.
- 基于理论和常数比较方法被用于转录分析.
- 这项研究探讨了2022年6月至9月的临床医生经验.
主要成果:
- 临床医生报告说,由于患者特征 (不典型的表现,并发症,认知障碍) 和家庭护理限制 (测试访问,样本质量,EHR访问) 的诊断不确定性.
- 影响抗生素处方的因素包括避免住院,护理人员压力和不可靠的随访.
- 抑制因素包括对抗生素危害的担忧和愿意尝试非药物干预的意愿.
结论:
- 在家庭初级保健中,临床医生必须在治疗感染时平衡诊断不确定性和竞争考虑.
- 识别这些复杂的决策过程可以为提高家庭护理中的抗生素管理策略提供信息.
- 更好的理解可以导致更明智的抗生素使用在脆弱的家庭人口.
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