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社会规范反馈减少临床医生抗生素处方行为干预效果meta分析

Behavioral intervention effect of social norm feedback on reducing clinicians′ antibiotic prescribing: a meta-analysis

  • 摘要:
      目的  评价社会规范反馈(SNF)减少临床医生抗生素处方行为的干预效果,为减缓抗菌药物的不合理使用提供参考依据。
      方法  检索中国期刊全文数据库、维普期刊全文数据库、万方数据库、PubMed数据库、Web of Science数据库、Scopus数据库和EMBASE数据库,并辅以文献追溯法收集各数据库从建库至2021年10月31日公开发表的关于SNF减少医生抗生素处方行为的相关文献,应用Stata16.0统计学软件对纳入的文献进行meta分析。
      结果  最终纳入9篇英文文献,累计样本量19528例;meta分析结果显示,SNF干预可使临床医生的抗生素处方率降低4 %(RD = – 0.04,95 % CI = – 0.06~ – 0.03);亚组分析结果显示,干预间隔 < 3个月和 ≥ 3个月、干预单元为医生和医疗机构、干预方式为信件和邮件/电子弹窗、排名方式以模糊排名的SNF干预均可降低临床医生的抗生素处方率(均P < 0.001);敏感性分析和发表偏倚检验结果显示,本次meta分析纳入的文献存在的发表偏倚较小,结果相对稳定。
      结论  SNF干预可减少临床医生的抗生素处方行为。

     

    Abstract:
      Objective  To evaluate intervention effect of social norm feedback (SNF) on reducing antibiotic prescribing behavior of clinicians and to provide a reference for decreasing irrational use of antibiotics.
      Methods  Literatures published relevant to intervention effect of SNF on doctors′ antibiotic prescribing behavior were retrieved through searching publications up to October 31, 2021 from China Journal Full-Text Database, VIP Journal Full-Text Database, WanFang Database, PubMed Database, Web of Science Database, Scopus Database, and EMBASE Database; the searching was supplemented using literature retrospective method. Stata 16.0 statistical software was adopted to perform meta-analysis.
      Results  Totally 9 English literatures with 19 528 pooled participants were included in the analysis. The results of meta-analysis showed that SNF intervention can reduce the number of clinicians′ antibiotic prescriptions by 4% (rate difference, RD = – 0.04, 95% confidence interval 95% CI: – 0.06 – – 0.03). Further subgroup analysis indicated that all SNF interventions being carried out through following approaches could significantly reduce antibiotic prescription rate of clinicians: with short interval (< 3 months) or long interval ( ≥ 3 months), targeted at doctors or medical institutions, disseminating intervening information by letters and emails/electronic pop-up windows, and adopting fuzzy ranking evaluation (all P < 0.001). Sensitivity analysis and publication bias test demonstrated that the literatures included in the analysis had less publication bias and the results were relatively stable.
      Conclusion   SNF intervention could restrain clinicians′ antibiotic prescribing behavior.

     

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