Prescribing pattern of antibiotics by family physicians in primary health care

Abstract

Purpose Irrational prescription of antibiotics is an ongoing global public health concern, leading to antibiotic resistance. Understanding the prescribing pattern of antibiotics is important to tackling mal-prescription and antibiotic resistance. We aimed to investigate the pattern and factors affecting outpatients’ antibiotic prescribing by family physicians in Primary Health Care (PHC). Methods A cross-sectional study was conducted in 19 PHC facilities in Alborz province. Prescribing pattern of antibiotics was evaluated among 1068 prescriptions by family physicians. Prescribing pattern of antibiotics included prescriptions containing antibiotics, the number of antibiotics per prescription, type, name of antibiotic, and mal-prescription. Multiple logistic regression analysis was used to estimate the adjusted odds ratios and 95% confidence intervals. Results Overall, 57% of the prescriptions had ≥ 1 antibiotic and the average number of antibiotics per prescription was 1.27. Amoxicillin was the commonly prescribed antibiotic. There was a significant relationship between age, sex, type of health insurance, work experience of the physician, and seasons with antibiotic prescribing (P < 0.05). In 59.31% of antibiotic prescriptions at least one of the scientific criteria was not fulfilled. In the final analysis, after adjusting for the potential confounders, field experts of physicians (OR = 1.59; 95% CI: 1.08–6.17), female sex (OR = 2.23; 95% CI: 1.18–4.21), and winter season (OR = 3.34; 95% CI: 1.26–8.15) were found associated factors with antibiotic prescribing. Conclusion The average number of antibiotics per prescription and the percentage of irrational prescriptions were relatively high in this study. There is need to improve antibiotic prescribing patterns among family physicians working in primary health care.

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

“…The senior and more clinical experienced physicians with higher professional degrees had higher control towards antibiotic prescription Regular conferences, workshops, and continuing medical education are used to train physicians to expand their knowledge Tang, et al [ 59 ] Public reporting can positively influence antimicrobial prescribing patterns of doctors particularly for acute respiratory tract infections in primary health care settings, with reduction in the prescription rate of antibiotics and use of antibiotics Public reporting intervention with special concentration on the physician prescription patterns Rodrigues, et al [ 60 ] Working in the emergency department, workload, and physicians’ attitudes were identified as critical factors affecting antibiotics prescriptions Junior doctors' knowledge and clinical behaviour should be improved, and decision-makers should be made aware of the connection between higher workload and subpar performance when prescribing antibiotics Al-Homaidan and Barrimah [ 61 ] Physicians have some shortage of knowledge and attitude about antibiotics regarding beneficial effects of antibiotics, the efficacy of alternatives to antibiotics, antibiotic resistance, harmful effects of antibiotics, practice guidelines, and the advice that should be given to patients who are prescribed antibiotics The adoption of practice guidelines, bettering patient awareness and education, and rules for prescription and dispensing antibiotics are some of the more targeted treatments that primary healthcare providers need Frost, et al [ 62 ] Knowledge deficits regarding current guidelines, specialities and peer prescribing habits, experience, confidence level treating patient and parent factors were main barriers for antibiotic prescription. Additionally, diagnostic uncertainty is a leading driver of antibiotic prescribing To focus Antibiotic Stewardship Program efforts; research on the knowledge, attitudes, and beliefs influencing prescribing practices can be useful Karimi, et al [ 63 ] Study of experience, cultural and societal characteristics, and belief in the significant impact of antibiotic prescription. Self-medication, as well as the people's habits and cultural elements as a whole, encourage them to recommend doctors who frequently prescribe antibiotics There is a need to increase family doctors' knowledge and proficiency in prescription antibiotics in the primary healthcare setting Huang, et al [ 64 ] Diagnostic uncertainty and knowledge gaps, Organizational-related factors (organization norms and culture) were determinants of antibiotics prescribing practices …”

“…Chem, et al [ 54 ] reported that complacency, fear, and insufficient knowledge were other factors that influenced the prescribing of antibiotics by physicians. Kumar, et al [ 44 ] and Karimi, et al [ 63 ] stated that knowledge, skills and insights acquired through interaction with patients and medical cases were associated with physicians’ prescription practices and decisions to prescribe antibiotics.…”

“…Many physicians did not think that antibiotic prescribing in primary care was responsible for the growth of antibiotic resistance or that their individual prescribing could make any difference in light of other issues, such as hospital prescribing [ 45 , 49 , 52 ]. The included studies show that engagement with antibiotic stewardship in primary health care influences prescribing by reducing the frequency of prescription [ 6 , 28 , 38 , 63 ].…”

“…Chem, et al [ 54 ] reported that the external pressure of the pharmaceutical industry and over-the-counter antibiotics were factors that influenced the prescribing of antibiotics by physicians. Two other studies reported that biomedical evidence, policy statements and service provision were factors influencing prescribing [ 44 , 63 ].…”

“…Another piece of evidence we found in this review pertained to the habits and cultural factors of the patients can encourage frequent prescribing and self-medication [ 63 , 64 ]. This might be the result of cultural norms and traditions may shape individual views on health, favouring for quick relief through antibiotics.…”