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Why do physicians prescribe antibiotics? An in-depth understanding of psycho-socio-cultural factors related to antimicrobial prescribing : A mixed-method approach

Lansink, Chiara (2023) Why do physicians prescribe antibiotics? An in-depth understanding of psycho-socio-cultural factors related to antimicrobial prescribing : A mixed-method approach.

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Abstract:Background: To prevent the development of antibiotic resistant bacteria, antibiotic prescribing should be kept low. This study revealed an in-depth insight of psycho-socio-cultural factors related to antimicrobial prescribing according to physicians in primary, secondary, and tertiary care. Methods: A mixed-method approach was used. A systematic review was conducted using the electronic databases PubMed and Scopus, from 01-01-2000 till the date of search, which was 08-03-2023. To evaluate study quality and risk-of-bias, several checklists were used. Because of the prevalently qualitative nature of the literature outcomes, a narrative summary was chosen as the synthesis method. To get in-depth insight of the found factors and to validate the found information of the systematic review, in-depth qualitative interviews took place. For the interviews semi-structured interview guides were used. Two clinical microbiologists and 12 physicians who prescribe antibiotics on a regular base were purposively selected out of primary, secondary, and tertiary care. Rather than developing concepts and theories, the focus was to gain an in-depth understanding of the physicians’ perspective; for this reason, a deductive approach was used. To gain insight into possible other factors that did not emerge from the systematic review, an inductive question was asked at the end of the interviews. Thematic analysis with a combination of semantic and latent approach was used for the analysis. Results: 8,370 articles were identified, 58 of which met the inclusion criteria and were reviewed. Eventually, 32 articles, which included 23 different countries, were included in the systematic review, resulting in three main themes: 1) personal, 2) psychological, and 3) organisational factors. Personal factors included: 1.1) work experience, 1.2) knowledge and 1.3) use of guidelines. Psychological factors included: 2.1) uncertainty avoidance, and 2.2) perceived patient and/or parental pressure. Organisational factors included: 3.1) diagnostic tests and results, ease to follow up, ease of referral, and costs, and 3.2) time and work pressure. These themes were used as the basis for the semi-structured interviews. Two clinical microbiologists and five physicians out of primary, secondary, and tertiary care agreed to participate and were interviewed by the author. The theme 2.3) psychological distance, was further in-depth explored in the interviews and the theme 2.4) other factors, emerged from the interviews. Other factors included good communication between health care professionals and personal preferences of physicians. Conclusion: The study identified several psycho-socio-cultural factors that are related to antimicrobial prescribing. Cultural differences (in health systems) play a role in these factors. The most important factor of this is uncertainty avoidance. Prescribing physicians feel the least uncertainty when their decision is supported by microbiology laboratory results, but some microbiology tests can be burdensome for the patient, so this is not always the solution. The CRP test, however, provides a good solution. Work experience and knowledge are important factors that helped to reduce uncertainty. So, to reduce uncertainty, it is both important to better educate physicians about antimicrobials during their initial training and to maintain knowledge while working. In addition to reducing uncertainty, it is also important to teach physicians how to manage uncertainty. When physicians experience less uncertainty and cope with it better, physicians will also experience less patient and/or parental pressure, which in turn may contribute to reducing potentially inappropriate prescribing (PIP). Lastly, it is important to give physicians enough time per patient to reduce time and work pressure and therefore may reduce PIP.
Item Type:Essay (Master)
Antibioticaresistentie Zorgnetwerk Noord Nederland (ABRZNN), Groningen, Netherlands
Faculty:TNW: Science and Technology
Subject:02 science and culture in general
Programme:Health Sciences MSc (66851)
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