BACKGROUND Primary care networks in Germany are formalized regional collaborations of physicians and other healthcare providers. Common goals are optimized healthcare processes and services for patients, enhanced communication, agency for professional concerns and strengthened economic power. In the ARena study (Sustainable reduction of antibiotic-induced antimicrobial resistance), 14 primary care networks in two federal German states aimed to promote appropriate antibiotics use for acute non-complicated infections by fostering awareness and understanding. Factors related to the role of primary care networks were to be identified. METHODS For this study, audio-recorded telephone interviews were conducted with physicians, non-physician health professionals and stakeholder representatives. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was based on the inductive categories 'social support', 'social learning', 'social normative pressures' and 'social contagion' to reflect social influence processes. Data generated through a survey with physicians and non-physician health professionals were analyzed descriptively to foster understanding of the networks' potential impact on antibiotic prescribing. RESULTS Social influence processes proved to be relevant regarding knowledge transfer, manifestation of best-practice care and self-reflection. Peer communication was seen as a great asset, the main reason for membership and affirmative for own perspectives. All interviewed physicians (n = 27) considered their network to be a strong support factor for daily routines, introduction of new routines, and continuity of care. They utilized network-offered training programs focusing on best practice guideline-oriented use of antibiotics and considered their networks supportive in dealing with patient expectations. A shared attitude combined with ARena intervention components facilitated reflective management of antibiotic prescribing. Non-physician health professionals (n = 11) also valued network peer exchange. They assumed their employers joined networks to offer improved and continuous care. Stakeholders (n = 7) expected networks and their members to be drivers for care optimization. CONCLUSION Primary care networks play a crucial role in providing a platform for professional peer exchange, social support and reassurance. With regards to their impact on antibiotic prescribing for acute non-complicated infections, networks seem to facilitate and amplify quality improvement programs by providing a platform for refreshing awareness, knowledge and self-reflection among care providers. They are well suited to promote a rational use of antibiotics. TRIAL REGISTRATION ISRCTN, ISRCTN58150046. Registered 24 August 2017.

中文翻译：

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促进对非复杂感染的合理用药处方：了解德国初级保健网络中的社会影响。

背景技术德国的初级保健网络是医师和其他医疗保健提供者的正式区域合作。共同目标是为患者优化医疗流程和服务，加强沟通，解决专业问题并增强经济实力。在ARena研究中（可持续降低抗生素引起的抗菌素耐药性），德国两个联邦州的14个初级保健网络旨在通过提高认识和理解，促进对急性非复杂感染适当使用抗生素。需要确定与初级保健网络的作用有关的因素。方法在本研究中，与医生，非医师健康专业人员和利益相关者代表进行了录音电话访谈。使用主题分析对假名化的逐字记录进行编码。深入的分析基于归纳性类别“社会支持”，“社会学习”，“社会规范压力”和“社会传染”，以反映社会影响过程。描述性地分析了通过与医生和非医师卫生专业人员进行的调查所产生的数据，以增进对网络对抗生素处方的潜在影响的了解。结果事实证明，社会影响力过程与知识转移，最佳实践表现和自我反省有关。同行交流被视为一项重要资产，是成为会员的主要原因，并且对自己的观点持肯定态度。所有受访医生（n = 27）都认为，他们的网络是日常工作，新程序的引入和护理连续性的有力支持因素。他们利用网络提供的培训计划，侧重于以最佳实践指南为导向的抗生素使用，并认为其网络有助于满足患者的期望。共同的态度与ARena干预措施相结合，促进了抗生素处方的反思管理。非医师保健专业人员（n = 11）也重视网络对等交换。他们以为他们的雇主加入了网络，以提供持续改善的护理。利益相关者（n = 7）期望网络及其成员成为护理优化的驱动力。结论基层医疗网络在提供专业对等交流平台方面起着至关重要的作用，社会支持和保证。关于其对急性非并发症感染的抗生素处方的影响，网络似乎通过提供一个平台来提高护理人员之间的意识，知识和自我反思，从而促进和扩大了质量改进计划。它们非常适合促进合理使用抗生素。试用注册号ISRCTN，ISRCTN58150046。2017年8月24日注册。