Primary care physicians’ attitudes and perceptions towards antibiotic resistance and outpatient antibiotic stewardship in the USA: a qualitative study

Abstract

ObjectivesAt least 30% of outpatient antibiotic prescriptions are unnecessary. Outpatient antibiotic stewardship is needed to improve prescribing and address the threat of antibiotic resistance. A better understanding of primary care physicians (PCPs) attitudes towards antibiotic prescribing and outpatient antibiotic stewardship is needed to identify barriers to stewardship implementation and help tailor stewardship strategies. The aim of this study was to assess PCPs current attitudes towards antibiotic resistance, inappropriate antibiotic prescribing and the feasibility of outpatient stewardship efforts.DesignEight focus groups with PCPs were conducted by an independent moderator using a moderator guide. Focus groups were audio recorded, transcribed and coded for major themes using deductive and inductive content analysis methods.SettingFocus groups were conducted in four US cities: Philadelphia, Birmingham, Chicago and Los Angeles.ParticipantsTwo focus groups were conducted in each city—one with family medicine and internal medicine physicians and one with paediatricians. A total of 26 family medicine/internal medicine physicians and 26 paediatricians participated.ResultsParticipants acknowledged that resistance is an important public health issue, but not as important as other pressing problems (eg, obesity, opioids). Many considered resistance to be more of a hospital issue. While participants recognised inappropriate prescribing as a problem in outpatient settings, many felt that the key drivers were non-primary care settings (eg, urgent care clinics, retail clinics) and patient demand. Participants reacted positively to stewardship efforts aimed at educating patients and clinicians. They questioned the validity of antibiotic prescribing metrics. This scepticism was due to a number of factors, including the feasibility of capturing prescribing quality, a belief that physicians will ‘game the system’ to improve their measures, and dissatisfaction and distrust of quality measurement in general.ConclusionsStakeholders will need to consider physician attitudes and beliefs about antibiotic stewardship when implementing interventions aimed at improving prescribing.

Barriers of Appropriate Antibiotic Prescription at PHCC in Qatar: Perspective of Physicians and Pharmacists

“…This is a common finding across other studies, e.g., Ashworth et al who state that, ‘antibiotic prescribing was a significant determinant of patient experience [ 21 ]. Zetts et al (2020) state that because of the pressure, physicians understandably feel that resistance can be futile, especially when the patient can seek antibiotics from alternative healthcare providers [ 22 ].…”

“…By providing this data, in addition to providing training to pharmacists specifically on how to conduct audits, information would consequently become a facilitator to appropriate antibiotic prescription. This would ensure that all those in a position with authority would fall under the same umbrella of responsibility [ 22 ].…”

“…To successfully reduce patient pressure, Zetts et al (2020) state that a patient’s awareness and understanding of antibiotic prescription, needs to increase [ 22 ]. By educating a patient successfully, the patient will be less likely to pressurize their physician, in addition, the patient would also have the added understanding of how to correctly take antibiotics.…”

Using defined daily doses to review antibiotic prescribing

“…21 This scepticism was due to a number of factors, including the feasibility of capturing prescribing quality, a belief that physicians will 'game the system' to improve their measures, and dissatisfaction and distrust of quality measurement in general. 22 The Res Consortium simple rule 3 from Table 1 -to reduce average number of DDDs in each prescription to 11 DDDs -did not warrant any discussion at the meetings. For NHS Kernow CCG as a whole, this rule did not generate an opportunity to reduce DDDs, and did not translate into an opportunity at prac-tice level.…”

Need of the hour: Dental stewardship

“…2 Physicians first need to recognize the issue of antibiotic resistance and their inappropriate prescribing practice to convince them to be part of AMS efforts. 3 Although most dental diseases are primarily managed by oral hygiene measures and operative intervention, dentists commonly prescribe antibiotics in following scenarios: primary prophylaxis during the perioperative period to decrease the risk of surgical site infection, secondary prophylaxis to prevention infective endocarditis in certain heart conditions before certain dental procedures (involving manipulation of gingival or periapical tissue or perforation of oral mucosa), and treatment of dental infections. In 2007, the American Heart Association (AHA) revised the guidelines to limit prophylaxis to only high-risk individuals to prevent infective endocarditis because the risks outweigh the benefits and because antibiotic resistance is increasing.…”