Using theory to explore facilitators and barriers to delayed prescribing in Australia: a qualitative study using the Theoretical Domains Framework and the Behaviour Change Wheel

Abstract

BackgroundDelayed antibiotic prescribing reduces antibiotic use for acute respiratory infections in trials in general practice, but the uptake in clinical practice is low. The aim of the study was to identify facilitators and barriers to general practitioners’ (GPs’) use of delayed prescribing and to gain pharmacists’ and the public’s views about delayed prescribing in Australia.MethodsThis study used the Theoretical Domains Framework and the Behaviour Change Wheel to explore facilitators and barriers to delayed prescribing in Australia. Forty-three semi-structured, face-to-face interviews with general practitioners, pharmacists and patients were conducted. Responses were coded into domains of the Theoretical Domains Framework, and specific criteria from the Behaviour Change Wheel were used to identify which domains were relevant to increasing the use of delayed prescribing by GPs.ResultsThe interviews revealed nine key domains that influence GPs’ use of delayed prescribing: knowledge; cognitive and interpersonal skills; memory, attention and decision-making processes; optimism; beliefs about consequences; intentions; goals; emotion; and social influences: GPs knew about delayed prescribing; however, they did not use it consistently, preferring to bring patients back for review and only using it with patients in a highly selective way. Pharmacists would support GPs and the public in delayed prescribing but would fill the prescription if people insisted. The public said they would delay taking their antibiotics if asked by their GP and given the right information on managing symptoms and when to take antibiotics.ConclusionsUsing a theory-driven approach, we identified nine key domains that influence GPs’ willingness to provide a delayed prescription to patients with an acute respiratory infection presenting to general practice. These data can be used to develop a structured intervention to change this behaviour and thus reduce antibiotic use for acute respiratory infections in general practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-017-0589-1) contains supplementary material, which is available to authorized users.

Barriers and facilitators to the uptake of an antimicrobial stewardship program in primary care: A qualitative study

“…The willingness of Australian general practitioners to use delayed antibiotic prescriptions was influenced by their knowledge of the intervention and interpersonal skills, but also by expectations for antibiotics by patients and concern about misuse of delayed prescriptions. [40] Patient pressure or expectations for antibiotics has been consistently commented on by providers in various studies as a barrier to appropriate antibiotic use, [41,42] and was also a concern of providers in the current study. Reimbursement issues, the need for quality control and impact on work flows were other factors identified in a European study affecting the adoption of a point of care c-reactive protein test in primary care clinics to limit antibiotic use in lower respiratory infections.…”

“…[17] Other potential barriers to ASP activities in primary care identified in the current study and others included time constraints to learning about ASP content, [22,36] the time needed during clinical encounters to explain decisions not to prescribe an antimicrobials, [40,43] patient dissatisfaction with not being prescribed antibiotics, [40,46,49] and uncertainty brought about by clinical or situational factors such as the day of the week being before a weekend. [40] Two specific strategies had been included in the PC-ASP to assist providers in addressing patient expectations and concerns about not receiving antimicrobials (delayed prescriptions [35] and condition-specific communication points. [33,34] However, this did not appear to be recognized by participants as none made comments linking the two.…”

Recommendations from Two Citizens’ Juries on the Surgical Management of Obesity

“…These studies have predominantly been conducted on GPs practising in Europe and the USA, with different governance, funding structures and infrastructure to that of Australia which may impact clinical practice. Research involving Australian GPs on antibiotic prescribing, previously scarce, is growing [14][15][16][17][18]. However, it remains unclear which factors are most important in influencing GP decision-making in antibiotic prescribing and therefore more critical to address to promote prudent use of antibiotics.…”

<p>Bleeding Management Practices of Australian Cardiac Surgeons, Anesthesiologists and Perfusionists: A Cross-Sectional National Survey Incorporating the Theoretical Domains Framework (TDF) and COM-B Model</p>

“…27 This combination of theoretical constructs has been used in a variety of settings to understand, explain and improve practice but not before in cardiac surgical bleeding management. 28,29 Current intra-operative bleeding management practice in Australian cardiac surgery units is not understood. The barriers and enablers to implementing effective bleeding management strategies, including the relationships between key stakeholders, and institutional support, likely impact on the uptake of evidence-based practice.…”