Coping with ‘the grey area’ of antibiotic prescribing: a theory-informed qualitative study exploring family physician perspectives on antibiotic prescribing
Abstract Background Unnecessary antibiotic use is associated with adverse side effects and rising rates of resistance at the individual and population level. This study used a theory-informed approach to identify potentially modifiable determinants of antibiotic prescribing for patients presenting t...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | BMC Primary Care |
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| Online Access: | https://doi.org/10.1186/s12875-022-01806-8 |
| _version_ | 1818162860943998976 |
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| author | Michelle Simeoni Marianne Saragosa Celia Laur Laura Desveaux Kevin Schwartz Noah Ivers |
| author_facet | Michelle Simeoni Marianne Saragosa Celia Laur Laura Desveaux Kevin Schwartz Noah Ivers |
| author_sort | Michelle Simeoni |
| collection | DOAJ |
| description | Abstract Background Unnecessary antibiotic use is associated with adverse side effects and rising rates of resistance at the individual and population level. This study used a theory-informed approach to identify potentially modifiable determinants of antibiotic prescribing for patients presenting to primary care with upper respiratory tract infection symptoms. Methods Qualitative interviews were conducted with primary care physicians in Ontario, Canada who were identified as medium- or high-volume antibiotic prescribers (high volume defined as top 20th percentile versus “medium” defined as 40th to 60th percentile). The interview guide and analysis were informed by the Theoretical Domains Framework. Each interview was coded by two research team members. Sampling and analysis continued until thematic saturation was achieved. Results Twenty family physicians were interviewed. Physicians felt that many decisions about prescribing for upper respiratory tract infection symptoms were straightforward (i.e., black and white). However, intention to avoid prescribing in cases where an antibiotic was not indicated clinically did not always align with the provider action or expectation of the patient. Clinical decisions were influenced by the Theoretical Domain Framework domains that were both internal to the physician (Knowledge, Skills, Social/Professional Role, and Belief about Capabilities) and external to the physician (Social Influence, Belief about Consequences, Reinforcement, Emotions, and Behavioural Regulation). The Environmental Context and Resources played a key role. Physicians reported significant differences in their approach to antibiotic prescribing within episodic (walk-in) or continuity of care settings, as the presence (or not) of longitudinal physician–patient relationships seemed to moderate the role of these factors on the decision-making process in cases of uncertainty. Conclusions Antibiotic prescribing in primary care is a complex decision-making process in which context may outweigh biology during encounters featuring clinical uncertainty. Differential skill in handling uncertainty and tactics used to operationalize guideline recommendations in the real world seems to contribute to observed variation in prescribing patterns, as much or more than differences in knowledge of best practices. |
| first_indexed | 2024-12-11T16:40:23Z |
| format | Article |
| id | doaj.art-977020f326704108ae4dd1d84c9a62c6 |
| institution | Directory Open Access Journal |
| issn | 2731-4553 |
| language | English |
| last_indexed | 2024-12-11T16:40:23Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Primary Care |
| spelling | doaj.art-977020f326704108ae4dd1d84c9a62c62022-12-22T00:58:21ZengBMCBMC Primary Care2731-45532022-07-0123111110.1186/s12875-022-01806-8Coping with ‘the grey area’ of antibiotic prescribing: a theory-informed qualitative study exploring family physician perspectives on antibiotic prescribingMichelle Simeoni0Marianne Saragosa1Celia Laur2Laura Desveaux3Kevin Schwartz4Noah Ivers5Public Health OntarioMount SinaiWomen’s College Hospital Institute for Health System Solutions and Virtual Care, Women’s College HospitalInstitute for Better Health, Trillium Health PartnersPublic Health OntarioWomen’s College Hospital Institute for Health System Solutions and Virtual Care, Women’s College HospitalAbstract Background Unnecessary antibiotic use is associated with adverse side effects and rising rates of resistance at the individual and population level. This study used a theory-informed approach to identify potentially modifiable determinants of antibiotic prescribing for patients presenting to primary care with upper respiratory tract infection symptoms. Methods Qualitative interviews were conducted with primary care physicians in Ontario, Canada who were identified as medium- or high-volume antibiotic prescribers (high volume defined as top 20th percentile versus “medium” defined as 40th to 60th percentile). The interview guide and analysis were informed by the Theoretical Domains Framework. Each interview was coded by two research team members. Sampling and analysis continued until thematic saturation was achieved. Results Twenty family physicians were interviewed. Physicians felt that many decisions about prescribing for upper respiratory tract infection symptoms were straightforward (i.e., black and white). However, intention to avoid prescribing in cases where an antibiotic was not indicated clinically did not always align with the provider action or expectation of the patient. Clinical decisions were influenced by the Theoretical Domain Framework domains that were both internal to the physician (Knowledge, Skills, Social/Professional Role, and Belief about Capabilities) and external to the physician (Social Influence, Belief about Consequences, Reinforcement, Emotions, and Behavioural Regulation). The Environmental Context and Resources played a key role. Physicians reported significant differences in their approach to antibiotic prescribing within episodic (walk-in) or continuity of care settings, as the presence (or not) of longitudinal physician–patient relationships seemed to moderate the role of these factors on the decision-making process in cases of uncertainty. Conclusions Antibiotic prescribing in primary care is a complex decision-making process in which context may outweigh biology during encounters featuring clinical uncertainty. Differential skill in handling uncertainty and tactics used to operationalize guideline recommendations in the real world seems to contribute to observed variation in prescribing patterns, as much or more than differences in knowledge of best practices.https://doi.org/10.1186/s12875-022-01806-8Antibiotic PrescribingAntimicrobial ResistanceFamily PhysicianPrimary CareTheoretical Domains FrameworkUpper Respiratory Tract Infection |
| spellingShingle | Michelle Simeoni Marianne Saragosa Celia Laur Laura Desveaux Kevin Schwartz Noah Ivers Coping with ‘the grey area’ of antibiotic prescribing: a theory-informed qualitative study exploring family physician perspectives on antibiotic prescribing BMC Primary Care Antibiotic Prescribing Antimicrobial Resistance Family Physician Primary Care Theoretical Domains Framework Upper Respiratory Tract Infection |
| title | Coping with ‘the grey area’ of antibiotic prescribing: a theory-informed qualitative study exploring family physician perspectives on antibiotic prescribing |
| title_full | Coping with ‘the grey area’ of antibiotic prescribing: a theory-informed qualitative study exploring family physician perspectives on antibiotic prescribing |
| title_fullStr | Coping with ‘the grey area’ of antibiotic prescribing: a theory-informed qualitative study exploring family physician perspectives on antibiotic prescribing |
| title_full_unstemmed | Coping with ‘the grey area’ of antibiotic prescribing: a theory-informed qualitative study exploring family physician perspectives on antibiotic prescribing |
| title_short | Coping with ‘the grey area’ of antibiotic prescribing: a theory-informed qualitative study exploring family physician perspectives on antibiotic prescribing |
| title_sort | coping with the grey area of antibiotic prescribing a theory informed qualitative study exploring family physician perspectives on antibiotic prescribing |
| topic | Antibiotic Prescribing Antimicrobial Resistance Family Physician Primary Care Theoretical Domains Framework Upper Respiratory Tract Infection |
| url | https://doi.org/10.1186/s12875-022-01806-8 |
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