Abstract
BackgroundInappropriate prescribing of antibiotics poses an urgent public health threat. Limited research has examined factors associated with antibiotic prescribing practices in outpatient settings. The goals of this study were to explore elements influencing provider decisions to prescribe antibiotics, identify provider recommendations for interventions to reduce inappropriate antibiotic use, and inform the clinical management of patients in the outpatient environment for infections that do not require antibiotics.MethodsThis was a qualitative study using semi-structured interviews with key informants. Seventeen outpatient providers (10 medical doctors and 7 advanced care practitioners) within a large healthcare system in Charlotte, North Carolina, participated. Interviews were audio recorded, transcribed, and analyzed for themes.ResultsPrimary barriers to reducing inappropriate antibiotic prescribing included patient education and expectations, system-level factors, and time constraints. Providers indicated they would be interested in having system-wide, evidence-based guidelines to inform their prescribing decisions and that they would also be receptive to efforts to improve their awareness of their own prescribing practices. Results further suggested that providers experience a high demand for antibiotic prescriptions; consequently, patient education around appropriate use would be beneficial.ConclusionsFindings suggest that antibiotic prescribing in the outpatient setting is influenced by many pressures, including patient demand and patient satisfaction. Training on appropriate antibiotic prescribing, guideline-based decision support, feedback on prescribing practices, and patient education are recommended interventions to improve levels of appropriate prescribing.
Highlights
Inappropriate prescribing of antibiotics poses an urgent public health threat
Research on the specific factors that impact antibiotic prescribing practices in outpatient settings [4] and how patient-provider dynamics play a role in influencing care decisions made in those environments is limited
Given that most antibiotic prescriptions originate in the outpatient setting [14], these interactions may be crucial to clinical outcomes
Summary
Inappropriate prescribing of antibiotics poses an urgent public health threat. Limited research has examined factors associated with antibiotic prescribing practices in outpatient settings. Antibiotic resistant organisms and the infections they cause are an urgent public health threat worldwide [1]. Inappropriate antibiotic prescribing is the most significant factor behind increasing resistance that causes more than two million illnesses annually in the United States [1, 2]. Research on the specific factors that impact antibiotic prescribing practices in outpatient settings [4] and how patient-provider dynamics play a role in influencing care decisions made in those environments is limited. If the same pattern is true for antibiotics in the outpatient setting, addressing these dynamics has the potential to improve practice and reduce inappropriate prescribing
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