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

Anti-Bacterial Agents / therapeutic use Attitude of Health Personnel Drug Utilization / standards Female Hospitals Humans Male Practice Patterns, Physicians' Qualitative Research
Acute medical patients Antibiotic prescribing Antimicrobial resistance Broad-spectrum antibiotics Hospital Qualitative methods

Journal

The Journal of hospital infection
ISSN: 1532-2939
Titre abrégé: J Hosp Infect
Pays: England
ID NLM: 8007166

Informations de publication

Date de publication:
Apr 2019
Historique:
received: 04 06 2018
accepted: 03 08 2018
pubmed: 14 8 2018
medline: 30 4 2019
entrez: 13 8 2018
Statut: ppublish

Résumé

Antimicrobial resistance is a global health threat, partly driven by inappropriate antibiotic prescriptions for acute medical patients in hospitals. To provide a systematic review of qualitative research on antibiotic prescribing decisions in hospitals worldwide, including broad-spectrum antibiotic use. 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. 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. 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.

Sections du résumé

BACKGROUND BACKGROUND
Antimicrobial resistance is a global health threat, partly driven by inappropriate antibiotic prescriptions for acute medical patients in hospitals.
AIM OBJECTIVE
To provide a systematic review of qualitative research on antibiotic prescribing decisions in hospitals worldwide, including broad-spectrum antibiotic use.
METHODS 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 RESULTS
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 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.

Identifiants

DOI: 10.1016/j.jhin.2018.08.007 PMID: 30099092
pubmed: 30099092
pii: S0195-6701(18)30418-3
doi: 10.1016/j.jhin.2018.08.007
pii:
doi:

Substances chimiques

Anti-Bacterial Agents 0

Types de publication

Journal Article Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

428-439

Informations de copyright

Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Auteurs

E M Krockow (EM)

Department of Health Sciences, University of Leicester, Leicester, UK. Electronic address: emk12@le.ac.uk.

A M Colman (AM)

Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK.

E Chattoe-Brown (E)

School of Media, Communication and Sociology, University of Leicester, Leicester, UK.

D R Jenkins (DR)

Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK.

N Perera (N)

Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK.

S Mehtar (S)

Tygerberg Academic Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa.

C Tarrant (C)

Department of Health Sciences, University of Leicester, Leicester, UK.

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Classifications MeSH

questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antibactériens › Balancing the risks to individual and society:...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Attitude du personnel soignant › Balancing the risks to individual and society:...
questionsmedicales.fr › Administration des services de santé › Organisation et administration › Administration pharmacie › Utilisation médicament › Balancing the risks to individual and society:...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Hôpitaux › Balancing the risks to individual and society:...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Balancing the risks to individual and society:...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Types de pratiques des médecins › Balancing the risks to individual and society:...
questionsmedicales.fr › Disciplines des sciences naturelles › Science › Recherche › Recherche empirique › Recherche qualitative › Balancing the risks to individual and society:...