BACKGROUND In order to combat rising rates of antimicrobial resistant infections, it is vital that antimicrobial stewardship become embedded in primary health care (PHC). Despite the high use of antimicrobials in PHC settings, there is a lack of data regarding the integration of antimicrobial stewardship programs (ASP) in non-hospital settings. Our research aimed to determine which antimicrobial stewardship interventions are optimal to introduce into PHC clinics beginning to engage with an ASP, as well as how to optimize those interventions. This work became focused specifically around management of viral upper respiratory tract infections (URTIs), as these infections are one of the main sources of inappropriate antibiotic use. METHODS This mixed methods study of sequential explanatory design was developed through three research projects over 3 years in Regina, Saskatchewan, Canada. First, a survey of PHC providers was performed to determine their perceived needs from a PHC-based ASP. From this work, a "viral prescription pad" was developed to provide a tool to help PHC providers engage in patient education regarding appropriate antimicrobial use, specifically for URTIs. Next, interviews were performed with family physicians to discuss their perceived utility of this tool. Finally, we performed a public survey to determine preferences for the medium by which information is received regarding symptom management for viral URTIs. RESULTS The majority of PHC providers responding to the initial survey indicated they were improperly equipped with tools to aid in promoting conversations with patients and providing education about the appropriate use of antimicrobials. Following dissemination of the viral prescription pad and semi-structured interviews with family physicians, the viral prescription pad was deemed to be a useful educational tool. However, about half of the physicians interviewed indicated they did not actually provide a viral prescription to patients when providing advice on symptom management for viral URTIs. When asked about their preferences, 76% of respondents to the public survey indicated they would prefer to receive written or a combination of verbal and written information in this circumstance. CONCLUSIONS PHC providers indicated a need for educational tools to promote conversations with patients and provide education about the appropriate use of antimicrobials. Viral prescription pads were regarded by family physicians and patients as useful tools in facilitating discussion on the appropriate use of antimicrobials. PHC providers should exercise caution in opting out of providing written forms of information, as many respondents to the general public survey indicated their preference in receiving both verbal and written information.

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病毒处方垫-一项混合方法研究，以确定对初级卫生保健中抗菌管理的教育工具的需求和实用性。

背景技术为了应对抗微生物药耐药性感染的上升率，至关重要的是，将抗菌药管理纳入初级卫生保健（PHC）中。尽管在PHC场所大量使用抗菌药物，但缺乏有关在非医院环境中整合抗菌素管理计划（ASP）的数据。我们的研究旨在确定哪种抗菌药物干预措施最适合引入与ASP合作的PHC诊所，以及如何优化这些干预措施。这项工作专门针对病毒性上呼吸道感染（URTIs）的管理，因为这些感染是不当使用抗生素的主要来源之一。方法在加拿大萨斯喀彻温省里贾纳市，历时3年，通过三个研究项目进行了顺序说明设计的混合方法研究。首先，对PHC提供者进行了一项调查，以从基于PHC的ASP确定他们的感知需求。通过这项工作，开发了一种“病毒处方垫”，以提供一种工具，以帮助PHC提供者开展有关适当抗菌药物使用的患者教育，尤其是针对URTI的抗菌药物。接下来，与家庭医生进行了访谈，以讨论他们对该工具的实用性。最后，我们进行了一次公共调查，以确定对接收有关病毒性URTI症状管理信息的媒体的偏好。结果大多数对初始调查做出答复的PHC提供者表示，他们没有适当地配备工具来帮助促进与患者的对话并提供有关正确使用抗菌素的教育。在传播了病毒处方垫并与家庭医生进行了半结构式访谈之后，病毒处方垫被认为是一种有用的教育工具。但是，约有一半的接受采访的医生表示，他们在提供有关病毒性URTIs症状管理的建议时实际上并未向患者提供病毒处方。当被问及他们的偏好时，有76％的公众调查受访者表示，在这种情况下，他们希望接收书面或口头和书面信息的组合。结论PHC提供者表示需要一种教育工具来促进与患者的对话并提供有关正确使用抗菌素的教育。病毒处方垫被家庭医生和患者认为是促进讨论适当使用抗菌药物的有用工具。PHC提供者在选择不提供书面形式的信息时应谨慎行事，因为许多接受公众调查的受访者表示，他们倾向于同时接受口头和书面信息。