BACKGROUND Many studies have investigated the ways in which physicians decide whether to prescribe antibiotics, but very few studies have focused on the reasons for which general practitioners (GPs) choose to prescribe a particular antibiotic in a specific clinical situation. Improvements in our understanding of the rationale behind GPs' decisions would provide insight into the reasons for which GPs do not always prescribe the antibiotic recommended in clinical practice guidelines and facilitate the development of appropriate interventions to improve antibiotic prescription. The objective of the study was to understand the rationale used by GPs to decide which antibiotic to prescribe in a specific clinical situation, and to propose a model representing this rationale. METHODS We used a three-step process. First, data were collected from interviews with 20 GPs, and analysed according to the grounded theory approach. Second, data were collected from publications exploring the factors used by GPs to choose an antibiotic. Third, data were used to develop a comprehensive model of the rationale used by GPs to decide which antibiotic to prescribe. RESULTS The GPs considered various factors when choosing antibiotics: factors relating to microbiology (bacterial resistance), pharmacology (adverse effects, efficacy, practicality of the administration protocol, antibiotic class, drug cost), clinical conditions (patient profile and comorbid conditions, symptoms, progression of infection, history of antibiotic treatment, preference), and personal factors (GP's experience, knowledge, emotion, preference). CONCLUSIONS Various interventions, targeting all the factors underlying antibiotic choice, are required to improve antibiotic prescription. GP-related factors could be improved through interventions aiming to improve the GPs' knowledge of antibiotics (e.g. continuing medical education). Factors relating to microbiology, pharmacology and clinical conditions could be targeted through the use of clinical decision support systems in everyday clinical practice.

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GP根据特定的临床情况使用什么理由选择特定的抗生素？

背景技术许多研究已经调查了医师决定是否开抗生素的方法，但是很少有研究集中于全科医生（GPs）在特定临床情况下选择开特定抗生素的原因。我们对全科医生决定依据的理解的进一步了解将提供对全科医生并不总是开处方临床实践指南中推荐的抗生素的原因的了解，并有助于制定适当的干预措施以改善抗生素处方。这项研究的目的是了解全科医生在特定临床情况下决定开哪种抗生素的基本原理，并提出一个代表该基本原理的模型。方法我们使用了一个三步过程。第一的，从20位全科医生的访谈中收集数据，并根据扎根的理论方法进行分析。其次，从出版物中收集数据，探讨GPs选择抗生素的因素。第三，数据被用来建立全科医生用于决定开哪种抗生素的基本原理的综合模型。结果全科医生在选择抗生素时考虑了多种因素：与微生物学（细菌耐药性），药理学（不良反应，疗效，给药方案的实用性，抗生素类别，药物费用），临床状况（患者情况和合并症，症状，感染的进展，抗生素治疗的历史，喜好）和个人因素（GP的经验，知识，情感，喜好）。结论各种干预措施，针对抗生素选择的所有潜在因素，需要改善抗生素处方。可以通过旨在改善全科医生对抗生素知识的干预措施（例如，继续医学教育）来改善与全科医生有关的因素。可以通过在日常临床实践中使用临床决策支持系统来确定与微生物学，药理学和临床状况有关的因素。