Implementing antibiotic stewardship in high-prescribing English general practices: a mixed-methods study

Sarah Tonkin-Crine; Monsey McLeod; Aleksandra J Borek; Anne Campbell; Philip Anyanwu; Céire Costelloe; Michael Moore; Benedict Hayhoe; Koen B Pouwels; Laurence SJ Roope; Liz Morrell; Susan Hopkins; Christopher C Butler; Ann Sarah Walker

doi:10.3399/BJGP.2022.0298

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Social cognitive theory for antimicrobial stewardship
Ryuichi Ohta

Published on: 15 March 2023

Published on: (15 March 2023)
Page navigation anchor for Social cognitive theory for antimicrobial stewardship
Social cognitive theory for antimicrobial stewardship
Ryuichi Ohta, Family physician, Unnan City Hospial, Japan
Antimicrobial stewardship (AMS) is a critical issue worldwide because of the increase in the morbidity and mortality of multi-drug resistant bacteria. As this article shows, antibiotics are used mainly in primary care.¹ In addition, physicians’ tendency to use antibiotics is affected by various factors such as medical education, clinical settings, and patient preferences.² Thus, changing the flow of prescribing antibiotics in medical institutions did not change the rate of antibiotic prescriptions.
Psychosocial factors are strongly related to the prescription of antibiotics in communities. Especially, patients’ and physicians’ perceptions regarding antibiotics can affect the prescription.² Patients and physicians who have experienced positive experiences from prescribing antibiotics can favor antibiotic prescription in upper respiratory infections. The framework of social cognitive theory (SCT) should be applied to solve the problems of AMS.

The SCT is vital for the effective implementation of AMS. In the SCT, individuals, the environment, and interactions between individuals and the environment are essential for learning and performance situations. AMS respecting SCT can include the approaches to not only physicians’ behaviors but also patients’ and government’s behaviors.³ Patients’ and physicians’ behaviors are affected by their surroundings and societies. In additi...
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Antimicrobial stewardship (AMS) is a critical issue worldwide because of the increase in the morbidity and mortality of multi-drug resistant bacteria. As this article shows, antibiotics are used mainly in primary care.¹ In addition, physicians’ tendency to use antibiotics is affected by various factors such as medical education, clinical settings, and patient preferences.² Thus, changing the flow of prescribing antibiotics in medical institutions did not change the rate of antibiotic prescriptions.
Psychosocial factors are strongly related to the prescription of antibiotics in communities. Especially, patients’ and physicians’ perceptions regarding antibiotics can affect the prescription.² Patients and physicians who have experienced positive experiences from prescribing antibiotics can favor antibiotic prescription in upper respiratory infections. The framework of social cognitive theory (SCT) should be applied to solve the problems of AMS.

The SCT is vital for the effective implementation of AMS. In the SCT, individuals, the environment, and interactions between individuals and the environment are essential for learning and performance situations. AMS respecting SCT can include the approaches to not only physicians’ behaviors but also patients’ and government’s behaviors.³ Patients’ and physicians’ behaviors are affected by their surroundings and societies. In addition to this study’s intervention, continual education of AMS changing social conditions gradually change perceptions of physicians’ and patients’ perceptions, leading to better usage of antibiotics. The change in persistent usage of inappropriate antibiotics needs time, but steady and down-to-earth approaches can change the situation.

References
1. Tonkin-Crine S, McLeod M, Borek AJ, et al. Implementing antibiotic stewardship in high-prescribing English general practices: a mixed-methods study. Br J Gen Pract 2023;73: e164-e75.
2. Horwood J, Cabral C, Hay AD, Ingram J. Primary care clinician antibiotic prescribing decisions in consultations for children with RTIs: a qualitative interview study. Br J Gen Pract 2016; 66:e207-13.
3. Hartman EAR, van de Pol AC, Heltveit-Olsen SR, et al. Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults (ImpresU): pragmatic cluster randomised controlled trial in four European countries. BMJ 2023;380: e072319.
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Competing Interests: None declared.