Factors influencing antibiotic prescribing in long-term care facilities: a qualitative in-depth study

Abstract

Background: Insight into factors that influence antibiotic prescribing is crucial when developing interventions aimed at a more rational use of antibiotics. We examined factors that influence antibiotic prescribing in long-term care facilities, and present a conceptual model that integrates these factors. Methods: Semi-structured qualitative interviews were conducted with physicians (n = 13) and nursing staff (n = 13) in five nursing homes and two residential care homes in the central-west region of the Netherlands. An iterative analysis was applied to interviews with physicians to identify and categorize factors that influence antibiotic prescribing, and to integrate these into a conceptual model. This conceptual model was triangulated with the perspectives of nursing staff. Results: The analysis resulted in the identification of six categories of factors that can influence the antibiotic prescribing decision: the clinical situation, advance care plans, utilization of diagnostic resources, physicians' perceived risks, influence of others, and influence of the environment. Each category comprises several factors that may influence the decision to prescribe or not prescribe antibiotics directly (e.g. pressure of patients' family leading to antibiotic prescribing) or indirectly via influence on other factors (e.g. unfamiliarity with patients resulting in a higher physician perceived risk of non-treatment, in turn resulting in a higher tendency to prescribe antibiotics).

Determinants of antibiotic prescription in paediatric patients: The case of two hospitals in Maputo, Mozambique

“…Physician-perceived risks associated with the need for rapid assistance may also have influenced the decisions to use antibiotics at HCM and HGM. [7] Even though these perceptions were not explored, our findings highlight the excessive use of antibiotics in paediatrics patients, regardless of verified bacterial infections. …”

“…[1,2] These and other childhood diseases can be caused by different pathogens including viruses, bacteria, fungi and protozoa and identifying the aetiological agents to establish the appropriate therapeutic approach is essential. [3][4][5][6] According to van Buul et al, [7] a physician's decision to use antibiotics is guided by six factors: the patient's clinical condition, advance care plans, using diagnostic resources, physician-perceived risks, the influence of family members, and the influence of the environment. Good prescription practice relies on determining the infection aetiology.…”

Systemic antibiotic use for nonbacterial dermatological conditions among referring providers

“…Such factors include perceptions of illness or pharmaceuticals, perceived risks of nontreatment, time pressure, and implemented policies or guidelines. [11][12][13][14] Although these and similar studies have set a foundation upon which antimicrobial stewardship can be addressed, much still remains unknown.…”

<p>Inappropriate Dental Antibiotic Prescriptions: Potential Driver of the Antimicrobial Resistance in Albaha Region, Saudi Arabia</p>

“…However, several factors may contribute to this difference, including dentists' qualifications (undergraduate or postgraduate), dentists' clinical experiences and situations, the duration of symptoms, fear of spreading infection, advance care plans, use of diagnostic resources and patient expectations. [22][23][24] The findings of this study revealed that antibiotics were provided in several conditions for which they are medically not recommended, including gingivitis, chronic apical abscess, preapical cysts, dental caries, periodontitis, pulpal necrosis, and reversible and irreversible pulpitis. These findings are consistent not only with the recent report of a national survey of antibiotic use by American endodontists 16 but also with a survey conducted in Brazil.…”