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背景《何时需为之担忧?》互动手册,既适用于初级保健服务中呼吸道感染(RTIs)儿童的父母,又可用于临床医生的培训。某随机对照试验(EQUIP研究)表明,此干预方式减少了抗生素的使用和复诊意向。此定性评估的目的在于了解临床医生和父母对此项干预方法的接受程度、如何进行干预、所观察到的作用的机制及影响其效果的相关因素。方法与参与者中的20位父母和13名医生进行半结构化会谈。对会谈过程进行录音并逐字逐句抄录。使用框架法对数据进行分析,共分为5个阶段:熟悉数据、形成议题框架、索引体系化、图标化并做出解释。结果大多数父母和临床医生认为《何时需为之担忧?》手册(及临床医生在线培训)简便易行,有应用价值。严重病情体征辨识和一般病程时间长短的信息最为宝贵。虽然此互动手册对应诊而言非常重要,却很少使用。临床医生表示影响手册使用的因素包括:没时间、对手册不熟悉及难以对治疗计划和应诊咨询方式做出调整。此研究表明,就减少抗生素使用和复诊意向而言,增加临床医生和患者对手册的了解和信任是关键。由于病情复杂,而父母所接受的信息往往又自相矛盾,因而为了做好儿童RTIs管理的安全决策,这本手册的应用就显得倍加重要。结论《何时需为之担忧?》手册可减少抗生素的使用,临床医生和患者父母对其高度认同。使用该手册有助于增进了解,增强信心,提供连贯一致的信息。然而,此手册并未得到充分的利用。为了促进此项干预在卫生保健单位的推广实施,还需设法消除临床医生在本手册使用环节的相关影响因素。
The background “When do you need to worry?” The interactive handbook is intended for parents of children with RTIs in primary health care and for clinicians. A randomized controlled trial (EQUIP study) showed that this intervention reduced the use of antibiotics and the intent of referral. The purpose of this qualitative assessment is to understand how clinicians and parents are receptive to this intervention, how to intervene, what mechanisms are observed, and what factors influence their effectiveness. Semi-structured talks with 20 parents and 13 doctors in the method and participants. Record the progress of the talks and copy word by word. Using the framework method to analyze the data, is divided into five stages: familiar with the data to form the framework of the topic, the index system, iconic and explain. Results Most parents and clinicians consider the “when to worry about it?” Handbook (and clinician online training) that is simple and has application value. The most valuable information is the identification of serious illness and the duration of the general course of the disease. Although this interactive manual is very important for the consultation, it is rarely used. Clinicians said the factors that influence the use of the manual include: lack of time, unfamiliarity with the manual, and difficulty in making adjustments to the treatment plan and consultation. This study shows that increasing clinicians and patients’ understanding and trust in the handbook is key in reducing antibiotic use and referral intent. Due to the complexity of the condition and the often-conflicted information parents receive, the application of this handbook is paramount in order to make sound decisions about the management of children’s RTIs. Conclusion “When do you need to worry?” The manual reduces the use of antibiotics, which is highly recognized by clinicians and patients’ parents. Using this handbook helps to increase understanding, enhance confidence, and provide consistent information. However, this manual has not been fully utilized. In order to promote the implementation of this intervention in the health care unit, it is necessary to try to eliminate the relevant factors that clinicians use in this manual.