Contextual factors influencing physicians’ perception of antibiotic prescribing in primary care in Germany — a prospective observational study

Abstract

Background Antimicrobial resistance is a worldwide challenge for health services and systems alike. To reduce the overuse of antibiotics, multifaceted interventions are often used to achieve sustainable effects. It can be assumed that these effects are influenced by contextual factors. Embedded in the cluster randomized trial ARena (Sustainable reduction of antibiotic-induced antimicrobial resistance), the aim of this present study was to identify contextual factors associated with practitioners’ perceptions of antibiotic prescribing in German primary health care. Methods In a prospective observational study, data were generated in a three-wave survey study between January 2018 and July 2019. Analysis was performed using logistic regression models. The outcome of interest was the physician perceived impact of participating in the ARena project on decision-making regarding antibiotic prescribing, the independent variables of interest included individual characteristics, intervention arm allocation, primary care network (PCN) environment and characteristics of the medical practice. Results Forty Six point eight percent (n = 126) of participants indicated to have perceived an impact on their decision-making regarding antibiotic prescribing by participating in the ARena project. Bivariate logistic regression analyses indicated that work experience (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.006–1.103), PCN environment (OR 2.06, 95% CI 1.256–3.363), structural conditions (OR 1.66, 95% CI 1.161–2.371), environment of existing processes (OR 1.46, 95% CI 1.011–2.094), and externally defined general conditions (OR 1.57, 95% CI 1.035–2.378) were associated with physicians’ perceived impact of participating in the ARena project on decision-making regarding antibiotic prescribing. In the multivariable logistic regression analysis, only work experience OR 1.05 (95% CI 1.001–1.104) continuously showed a significant influence. Conclusions This study indicates that contextual factors at individual, practice, and system level influence physicians’ perceptions of antibiotic prescribing. Longer work experience appeared to be a significant influencing factor to be considered in antimicrobial stewardship programs. Trial registration ISRCTN, ISRCTN58150046 (registered 13.09.2017).

Factors contributing to the variation in antibiotic prescribing among primary health care physicians: a systematic review

“…This study also reported that specialized paediatric physicians were more likely to adhere to guidelines for managing the treatment and less likely to prescribe antibiotics without positive tests. The included studies also showed that the majority of practice-level variation in antibiotic prescribing was explained by the variation in physicians’ individual practice patterns, perceptions, attitudes, and knowledge [ 12 , 18 , 32 , 42 , 43 ] (as shown in Table 2 ). According to Tang, et al [ 59 ], exposure to different medical cases can have a favourable impact on the variability of antibiotic prescribing patterns of physicians for upper respiratory tract infections.…”

“…This is also supported by another study [ 53 ], which shows that physicians with high experience in diagnosing and treating various medical conditions exhibited lower prescribing due to their heightened confidence. According to Queder, et al [ 18 ], the physician's attitude toward sustainable use of antibiotics is based on professional experience in prescribing and acquired knowledge about antibiotics. This suggestion is supported by another study [ 43 ] junior physicians might be more likely to be guideline oriented than senior physicians.…”

“…Published studies overlooked physicians’ beliefs on antibiotic resistance and the unforeseen factors contribute to prescription variability [ 15 , 16 ]. Recent studies by Durand, et al [ 17 ], Manne, et al [ 14 ], and Queder, et al [ 18 ] investigated factors influencing physician’s antibiotic prescribing practice in specific locations. These findings indicated that physicians’ antibiotic prescribing is influenced by contextual factors at the individual practice and systemic levels.…”