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J Hosp Infect. 2019 Apr;101(4):428-439. doi: 10.1016/j.jhin.2018.08.007. Epub 2018 Aug 9.

Balancing the risks to individual and society: a systematic review and synthesis of qualitative research on antibiotic prescribing behaviour in hospitals.

Author information

1
Department of Health Sciences, University of Leicester, Leicester, UK. Electronic address: emk12@le.ac.uk.
2
Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK.
3
School of Media, Communication and Sociology, University of Leicester, Leicester, UK.
4
Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK.
5
Tygerberg Academic Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa.
6
Department of Health Sciences, University of Leicester, Leicester, UK.

Abstract

BACKGROUND:

Antimicrobial resistance is a global health threat, partly driven by inappropriate antibiotic prescriptions for acute medical patients in hospitals.

AIM:

To provide a systematic review of qualitative research on antibiotic prescribing decisions in hospitals worldwide, including broad-spectrum antibiotic use.

METHODS:

A systematic search of qualitative research on antibiotic prescribing for adult hospital patients published between 2007 and 2017 was conducted. Drawing on the Health Belief Model, a framework synthesis was conducted to assess threat perceptions associated with antimicrobial resistance, and perceived benefits and barriers associated with antibiotic stewardship.

FINDINGS:

The risk of antimicrobial resistance was generally perceived to be serious, but the abstract and long-term nature of its consequences led physicians to doubt personal susceptibility. While prescribers believed in the benefits of optimizing prescribing, the direct link between over-prescribing and antimicrobial resistance was questioned, and prescribers' behaviour change was frequently considered futile when fighting the complex problem of antimicrobial resistance. The salience of individual patient risks was a key barrier to more conservative prescribing. Physicians perceived broad-spectrum antibiotics to be effective and low risk; prescribing broad-spectrum antibiotics involved low cognitive demand and enabled physicians to manage patient expectations. Antibiotic prescribing decisions in low-income countries were shaped by a context of heightened uncertainty and risk due to poor microbiology and infection control services.

CONCLUSIONS:

When tackling antimicrobial resistance, the tensions between immediate individual risks and long-term collective risks need to be taken into account. Efforts to reduce diagnostic uncertainty and to change risk perceptions will be critical in shifting practice.

KEYWORDS:

Acute medical patients; Antibiotic prescribing; Antimicrobial resistance; Broad-spectrum antibiotics; Hospital; Qualitative methods

PMID:
30099092
DOI:
10.1016/j.jhin.2018.08.007
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