Acceptability, appropriateness, and feasibility of antimicrobial stewardship interventions among Swiss primary care physicians, a national, cross-sectional survey - Switzerland

Abstract
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Background
Appropriate use of antibiotics is crucial to limit the worldwide growth of antimicrobial resistance. With most of the antibiotic prescriptions taking place in primary care, antimicrobial stewardship (AMS) interventions must be known, welcomed, and used by Primary Care Physicians (PCPs) to fully deploy their effects. This is the first nationwide study assessing Swiss PCPs’ views on a broad range of AMS interventions. This might help to design and promote interventions to their targeted population, increase their uptake by PCPs and ultimately impact prescription. The main objective of this study was to evaluate the use, awareness, acceptability, appropriateness, and feasibility of a broad range of AMS interventions available for Swiss PCPs.
Methods
A cross-sectional survey targeted PCPs throughout Switzerland, distributed through Family Medicine Departments’ mailing lists (University of Lausanne, University of Luzern), professional newsletters, and medical education events from December 2023 to March 2024. The survey assessed the use of 16 sources of information about appropriate antibiotic use, considered as AMS interventions. Second, the survey assessed specifically the perceived acceptability, appropriateness, and feasibility of 8 AMS interventions targeting the use of antimicrobials in the management of respiratory tract infections (RTIs), using five-level Likert scales.
Results
Out of the 355 PCPs that took part in the survey, 218 evaluated at least one AMS intervention targeting RTIs. PCPs were most aware of biomarkers to guide antibiotic prescription in RTIs, such as point-of-care procalcitonin (POC-PCT, 67.6%) and C- reactive protein (POC-CRP, 61.1%), and the Federal Office of Public Health’s (FOPH) awareness campaign (57.3%). The national guidelines website was familiar to 52.7% of PCPs. Awareness was lower regarding antibiotic prescription audit and feedback (36.0%), shared decision-making tools (27.0%), factsheets for physicians (22.5%), and communication skills training (17.1%). The national guidelines website emerged as the most acceptable, appropriate, and feasible AMS intervention among Swiss PCPs, scoring 4.20, 4.25, and 4.21 out of 5, respectively. In comparison, the mean scores for all other interventions was 3.84 for acceptability, 3.85 for appropriateness, and 3.76 for feasibility, respectively.
Conclusion
Despite the high perceived acceptability, appropriateness, and feasibility of certain AMS interventions available for respiratory tract infections, their real-life impact may be hindered by low awareness.

Geographic coverage
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Switzerland

Analysis unit
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The unit of the study is the individual. The total number of participants is 355.

Universe
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Primary care physicians

Kind of data
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Sample survey data [ssd], free-text fields omitted

Sampling procedure
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Self-selected, self-administered, anonymous online questionnaire

Mode of data collection
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Self-selected, self-administered, anonymous online questionnaire

Research instrument
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Unisanté’s hosted Limesurvey

摘要
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背景
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抗生素的合理使用对于限制全球抗菌素耐药性的增长至关重要。鉴于大多数抗生素处方发生在初级保健中，抗菌素 stewardship (AMS) 干预措施必须被初级保健医师 (PCPs) 所了解、欢迎并使用，以充分发挥其效果。本研究为瑞士首次全国性研究，旨在评估瑞士 PCPs 对 AMS 干预措施的广泛看法。这有助于针对目标人群设计并推广干预措施，提高 PCPs 的采用率，并最终影响处方。本研究的主要目标是评估瑞士 PCPs 可用的各种 AMS 干预措施的使用、认知、可接受性、适宜性和可行性。
方法
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一项横断面调查针对瑞士全境的 PCPs 进行，通过家庭医学部门的邮寄名单（洛桑大学，卢塞恩大学）、专业通讯和医学教育活动，于 2023 年 12 月至 2024 年 3 月期间进行。调查评估了 16 个关于适当抗生素使用的信源的使用情况，这些信源被视为 AMS 干预措施。其次，调查特别评估了针对呼吸道感染 (RTIs) 管理中使用抗菌素的 8 种 AMS 干预措施的感知可接受性、适宜性和可行性，使用五级李克特量表。
结果
在参与调查的 355 名 PCPs 中，有 218 名评估了至少一种针对 RTIs 的 AMS 干预措施。PCPs 对指导 RTIs 抗生素处方的生物标志物最为熟悉，例如床旁前降钙素 (POC-PCT，67.6%) 和 C-反应蛋白 (POC-CRP，61.1%)，以及联邦公共卫生办公室 (FOPH) 的认知宣传活动（57.3%）。52.7% 的 PCPs 熟悉国家指南网站。对抗生素处方审计和反馈（36.0%）、共同决策工具（27.0%）、医师信息手册（22.5%）和沟通技巧培训（17.1%）的认知较低。在国家指南网站被视为瑞士 PCPs 中最可接受、最适宜和最可行的 AMS 干预措施，分别得分为 4.20、4.25 和 4.21（满分 5 分）。相比之下，所有其他干预措施的平均得分分别为可接受性 3.84、适宜性 3.85 和可行性 3.76。
结论
尽管某些 AMS 干预措施在呼吸道感染中的感知可接受性、适宜性和可行性较高，但其在现实生活中的影响可能因认知度低而受限。
地理覆盖范围
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瑞士
分析单元
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研究的分析单元为个人。参与者的总数为 355。
总体
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初级保健医师
数据类型
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样本调查数据 [ssd]，省略了自由文本字段
抽样程序
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自选、自我管理的匿名在线问卷
数据收集方式
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自选、自我管理的匿名在线问卷
研究工具
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Unisanté 托管的 Limesurvey