Abstract
BackgroundNorway has a low, but increasing prevalence of resistance and few antimicrobial stewardship initiatives. When developing stewardship interventions, an understanding of the determinants of antimicrobial prescribing is needed. We report on the first qualitative study investigating factors influencing doctors’ antimicrobial prescribing practices in Norwegian hospitals.MethodsQualitative semi-structured interviews were conducted with 15 Norwegian hospital doctors prescribing antimicrobials to adult patients. Interviews were transcribed verbatim and thematic analysis was applied to analyse the data.ResultsColleagues, in particular infectious disease specialists, microbiology test results and the newly published national guideline on antimicrobials were identified as key factors influencing antimicrobial prescribing practices. Delayed availability was a barrier for the utilization of microbiology test results and increasing clinical experience overrides the influence of the national guideline.Patient assessment, informal training by experienced colleagues, and infectious disease specialists replacing managers in promoting prudent prescribing policies, also influenced prescribing practices.ConclusionThis study identified the following contextual factors that need to be addressed when developing antimicrobial stewardship programs in Norway: a common work practice for seeking collegial advice, logistics of microbiology test results, and formal leadership and systematic training on prudence. Other countries initiating stewardship programmes may benefit from performing a similar mapping of facilitators and barriers, to identify important stakeholders and organisational obstacles, before developing sustainable and tailored antimicrobial stewardship interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s13756-015-0065-4) contains supplementary material, which is available to authorized users.
Highlights
Norway has a low, but increasing prevalence of resistance and few antimicrobial stewardship initiatives
Another review concludes that cultural, contextual and behavioural factors need to be addressed to influence antimicrobial use [10]. Both qualitative and quantitative studies have been performed on the topic [11,12,13,14,15,16,17,18], we report on the first qualitative study in Norway investigating factors influencing antimicrobial prescribing practices among hospital doctors
ID-specialists’ prescribing practices differs significantly from other doctors’. We considered it important to include them in order to obtain a comprehensive picture of the antimicrobial prescribing practices in Norwegian hospitals
Summary
But increasing prevalence of resistance and few antimicrobial stewardship initiatives. An understanding of the determinants of antimicrobial prescribing is needed. We report on the first qualitative study investigating factors influencing doctors’ antimicrobial prescribing practices in Norwegian hospitals. Though several countries have antimicrobial stewardship programmes (ASPs) in place [1], many are initiating stewardship activities, including such diverse countries as India and Norway [2, 3]. In Norway antimicrobial resistance (AMR) rates are low, but increasing, and antimicrobial consumption, in particular broad spectrum antimicrobials, has increased the last 20 years [4, 5]. The increasing national and international threat of AMR has highlighted the need for interventions to contain the low rates of AMR in Norway [3].
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