Abstract
Background: Misuse of antibiotics is prevalent worldwide and primary care is a major contributor. Although a clear diagnosis is fundamental for rational antibiotic use, primary care physicians often struggle with diagnostic uncertainty. However, we know little about how physicians cope with this situation and its association with antibiotic prescribing.Methods: A total of 583 primary care physicians were surveyed using the Dealing with Uncertainty Questionnaire. Their prescriptions (n = 949,181) over the year 2018 were retrieved retrospectively. Two categories of behavioral patterns of participants were identified based on latent class analyses (high vs. low openness and collaborativeness) in responding to diagnostic uncertainty. Multi-level logistic regression models were established to determine the associations between these behavioral patterns and antibiotic prescribing (overall and broad-spectrum antibiotics) for illness without an indication for antibiotics and those with a conditional indication for antibiotics, respectively, after adjustment for variations of patient (level one) and physician (level two) characteristics.Results: Most physicians reported open communications with their patients (80.96%), collected further information (85.08%), and referred patients to specialists (68.95%) in dealing with diagnostic uncertainly. More than half (56.95%) sought help from colleagues. Less than 20% acted on intuition or adopted a “wait and see” strategy. About 40% participants (n = 238) were classified into the group of low openness and collaborativeness in coping with diagnostic uncertainty. They were more likely to prescribe antibiotics for the recorded illness without an indication for antibiotics (AOR = 1.013 for all antibiotics, p = 0.024; AOR = 1.047 for broad-spectrum antibiotics, p < 0.001), as well as for the recorded illness with a conditional indication for antibiotics (AOR = 1.226 for all antibiotic, p < 0.001; AOR = 1.257 for broad-spectrum antibiotics, p < 0.001).Conclusion: Low tolerance with diagnostic uncertainty is evident in primary care. Inappropriate and over antibiotic prescribing is shaped by physicians' coping methods of diagnostic uncertainty. Physicians' openness and collaborativeness in responding to diagnostic uncertainty is associated with lower antibiotic prescribing in primary care. Interventions targeting on better management of diagnostic uncertainty may offer a promising approach in reducing antibiotic use in primary care.
Highlights
Antimicrobial resistance (AMR), a major threat to global health and economic development, has been increasingly recognized as a priority in public health interventions worldwide [1]
This study found that the primary care physicians in Hubei had low tolerance towards diagnostic uncertainty
The Latent class analyses (LCA) results of this study indicate that most primary care physicians in Hubei have already endorsed high openness and collaborativeness in responding to diagnostic uncertainly, which leaves limited room for further improvement
Summary
Antimicrobial resistance (AMR), a major threat to global health and economic development, has been increasingly recognized as a priority in public health interventions worldwide [1]. There is a consensus that the development of AMR has been accelerating at a speed beyond its natural occurrence This has been fueled, at least partly, by the over- and irrational use of antibiotics [2]. Primary care services are widely accessible and have become a major contributor to the over- and irrational use of antibiotics worldwide [2, 3]. Diagnostic uncertainty of pathogens has been highlighted as one resulting from a combination of multiple factors, including the early presentation of illness and insufficient diagnostic capacity in primary care settings [6]. This represents an inherent nature of primary care. We know little about how physicians cope with this situation and its association with antibiotic prescribing
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