ReviewUnderstanding physician antibiotic prescribing behaviour: a systematic review of qualitative studies
Introduction
Concerns raised about antibiotic resistance have highlighted this field as an important public health problem calling for prompt countermeasures. According to the World Health Organization (WHO), infections caused by microorganisms often fail to respond to conventional therapy, increasing health costs, morbidity and mortality, and threatening a return to the pre-antibiotic era [1]. In Europe, wide variations in resistance status are found depending on the pathogen type, antimicrobial substance and geographical region, with unimpeded growth rates being observed for some resistant strains [2], [3], [4].
Currently, there are few doubts about the association between the use of antibiotics and the spread of antibiotic resistance, with misprescription of antibiotics being one of the major favouring factors [5], [6], [7]. As key stakeholders in the field, physicians have been the target of numerous interventions aimed at addressing the factors underlying the misprescription of antibiotics and, ultimately, improving the quality of such prescribing [8], [9]. Exploring and understanding the factors specific to each setting is the first and most important step towards designing effective interventions [10].
Insofar as published reviews seek to evaluate the influence on antibiotic prescribing of the aspects identified, they have nevertheless not attempted to explore and identify the subjective opinions held by physicians or the type of prescriber-related attitudes and knowledge that could not be identified by researchers a priori [11]. This is the main objective of qualitative studies and could prove extremely useful in terms of improving knowledge in this field.
Qualitative methods are becoming increasingly prevalent in medical and related research [12], and several qualitative studies have investigated the factors involved in antibiotic prescribing. A review of such qualitative literature is fundamental to gaining insight into the culture of antibiotic prescribing, and this review therefore set out to explore and identify physicians’ perceptions of factors, attitudes and knowledge influencing antibiotic prescribing.
Section snippets
Search strategy/search methods for identification of studies
For the purpose of this systematic bibliographic review, MEDLINE PubMed scientific database was searched from January 1987 to December 2011 using the following broad-based search term strategy: (attitud* OR knowle* OR percept*) AND (physician* OR doctor* OR practitioner*) AND (antibiotic OR antimicrobial*). The selection criteria required papers to be published in English, Portuguese or Spanish, with those in other languages being excluded from the review.
Study content inclusion
Studies were deemed eligible for review
Search results
The search strategy identified a total of 1032 studies in the MEDLINE PubMed scientific database. Following screening, 223 papers were retrieved and assessed as eligible for perusal of the full text, resulting in a final total of 35 studies included in the review (Fig. 1) [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49]. Of these, 26
Discussion
This was a systematic review of qualitative studies focused on examining the subjective opinions of physicians about all the factors that influence the antibiotic prescribing process, providing a new, specific overview of each factor involved and its influence on the outcomes of antibiotic use. In the results, attitudes emerge as being the most important factor affecting antibiotic prescription, a finding that could be of great importance when it comes to designing interventions to improve
Implications for practice and research
Qualitative methodology is becoming routine in medical studies, assuming the main role of exploring complex topics and defining new approaches to the field targeted [74], [75]. With regard to antibiotic prescribing, this methodology has shown itself to be very useful for understanding the subjective perceptions of all the players involved, essentially physicians and policy-makers. This paper presents a fundamental understanding of the factors that physicians see as influencing antibiotic
Conclusions
In conclusion, we believe that these findings will promote a better understanding of physicians’ perceptions of the factors that influence the antibiotic prescribing process, clarify how such factors influence the decision-making process, and highlight their importance in the design of strategies aimed at tackling this concern effectively.
Funding: This work was supported by the Fundação para a Ciência e a Tecnologia (FCT) [grant PTDC/SAU-ESA/105530/2008] from the Portuguese Ministry of Science
References (75)
- et al.
Variation in antibiotic use in the European Union
Lancet
(2001) - et al.
Outpatient antibiotic use in Europe and association with resistance: a cross-national database study
Lancet
(2005) - et al.
Interventions in health care professionals to improve treatment in children with upper respiratory tract infections
Int J Pediatr Otorhinolaryngol
(2010) Minimising antibiotic resistance
Lancet Infect Dis
(2005)- et al.
Obstetricians’ attitudes, subjective norms, perceived controls, and intentions on antibiotic prophylaxis in Caesarean section
Soc Sci Med
(2003) - et al.
Factors influencing physicians’ prescribing behaviour in the treatment of childhood diarrhoea: knowledge may not be the clue
Soc Sci Med
(1996) - et al.
Urinary tract infections in the elderly: a survey of physicians and nurses
Geriatr Nurs
(2005) - et al.
Antibiotic use for emergency department patients with upper respiratory infections: prescribing practices, patient expectations, and patient satisfaction
Ann Emerg Med
(2007) - et al.
Factors influencing antibiotic prescribing in China: an exploratory analysis
Health Policy
(2009) - et al.
Factors conditioning prescription in primary care
Aten Primaria
(2001)