Factors Influencing Antibiotic-Prescribing Decisions Among Inpatient Physicians: A Qualitative Investigation. (16th June 2015)

• Record Type: Journal Article
• Authors: Livorsi, Daniel; Comer, Amber; Matthias, Marianne S.; Perencevich, Eli N.; Bair, Matthew J.
• Is Part Of: Infection control and hospital epidemiology. Volume 36:Number 9(2015)
• Page Start: 1065
• Page End: 1072
• Publication Date: 2015-06-16
• Subjects: Nosocomial infections -- Epidemiology -- Periodicals; Health facilities -- Sanitation -- Periodicals; Hospital buildings -- Sanitation -- Periodicals; Cross Infection -- Periodicals; Epidemiology -- Periodicals; Hospitals -- Periodicals; Infection Control -- Periodicals; 614.44
• DOI: 10.1017/ice.2015.136
• Languages: English
• ISSNs: 0899-823X

Abstract

<abstract abstract-type="normal"> <title> <x content-type="archive" xml:space="preserve">Abstract</x> </title> <sec id="abs1" sec-type="general"> <title>OBJECTIVE</title> <p>To understand the professional and psychosocial factors that influence physician antibiotic prescribing habits in the inpatient setting.</p> </sec> <sec id="abs2" sec-type="general"> <title>DESIGN</title> <p>We conducted semi-structured interviews with 30 inpatient physicians. Interviews consisted of open-ended questions and flexible probes based on participant responses. Interviews were audio recorded, transcribed, de-identified, and reviewed for accuracy and completeness. Data were analyzed using emergent thematic analysis.</p> </sec> <sec id="abs3" sec-type="general"> <title>SETTING</title> <p>Two teaching hospitals in Indianapolis, Indiana</p> </sec> <sec id="abs4" sec-type="general"> <title>PARTICIPANTS</title> <p>A total of 30 inpatient physicians (10 physicians-in-training, 20 supervising staff) were enrolled in this study.</p> </sec> <sec id="abs5" sec-type="results"> <title>RESULTS</title> <p>Participants recognized that antibiotics are overused, and many admitted to prescribing antibiotics even when the clinical evidence of infection was uncertain. Overprescription was largely driven by anxiety about missing an infection, whereas potential adverse effects of antibiotics did not strongly influence decision making. Participants did not routinely disclose potential adverse effects of antibiotics to inpatients. Physicians-in-training were strongly influenced by the antibiotic prescribing behavior of their supervising staff physicians. Participants sometimes questioned their colleagues' antibiotic prescribing decisions, but they frequently avoided providing direct feedback or critique. These physicians cited obstacles of hierarchy, infrequent face-to-face encounters, and the awkwardness of these conversations.</p> </sec> <sec id="abs6" sec-type="conclusion"> <title>CONCLUSION</title> <p>A physician-based culture of prescribing antibiotics involves overusing antibiotics and not challenging the decisions of colleagues. The potential adverse effects of antibiotics did not strongly influence decision making in this sample. A better understanding of these factors could be leveraged in future efforts to improve antibiotic prescribing practices in the inpatient setting.</p> <p> <italic>Infect. Control Hosp. Epidemiol.</italic> 2015;36(9):1065–1072</p> </sec> </abstract>