In 2003, the Centers for Disease Control and Prevention (CDC) launched Get Smart: Know When Antibiotics Work, a campaign to improve antibiotic use for common outpatient respiratory infections. While improvements in prescribing have been observed for children, inappropriate prescribing remains a problem in all healthcare settings. In order to update CDC’s communications materials for the new Be Antibiotics Aware educational effort, we sought to identify factors that influence antibiotic prescribing behavior among healthcare professionals (HCPs).
We conducted semi-structured interviews with 21 HCPs using purposive sampling to target geographic regions and provider types with the highest antibiotic prescribing rates. We recorded, transcribed, and analyzed interviews using emergent thematic analysis.
The HCPs interviewed included nine family practitioners (four physicians, three nurse practitioners, and two physician assistants), four emergency medicine physicians, three urgent care providers, and five hospitalists. One new theme emerged: HCPs report that concern for adverse drug events does not affect whether HCPs prescribe an antibiotic but rather which antibiotic they choose. We also identified four themes that have been previously described: 1) HCPs recognize inappropriate prescribing occurs but deny doing it frequently themselves; 2) diagnostic uncertainty and the “fear of missing something” influence HCPs’ decisions to initiate (and continue) antibiotics; 3) HCPs experience a tension between adherence to guideline recommendations and individualizing patient care based on comorbidities and sociodemographic characteristics; and 4) strength and continuity of the patient-provider relationship influences how antibiotics are prescribed. Each theme spanned all specialties, although some themes were more prevalent among certain specialties.
Adverse drug event messaging may be most effective if the focus is on improving antibiotic selection rather than the decision to prescribe. Similar principles influence antibiotic prescribing patterns of HCPs in different practice settings, which may suggest that similar messaging can be used across specialties.
J. O. Spicer,
K. E. O'Neill, None
R. Herrera, None
L. A. Hicks, None