Abstract
BackgroundWith inappropriate use of antimicrobials becoming a great public health concern globally, the issue of applying clinical practice guidelines (CPGs) to regulate the rational use of antimicrobials has attracted increasing attention. Taking tertiary general hospitals in China for example, this study aimed to identify factors to investigate the comprehensive influencing mechanism for physicians’ intention to use CPGs on antimicrobials.MethodsBased on the integration of Theory of Planned Behavior (TPB), Technology Acceptance Model (TAM), and Technology-Organization-Environment framework (TOE), a questionnaire survey was conducted covering potential determinants of affecting physicians’ intentions to use CPGs on antimicrobials at the individual level (attitude, subjective norms and perceived risk), technical level (relative advantage and ease of use), and organizational level (top management support and organizational implementation). Data were collected from 644 physicians in tertiary general hospitals in eastern, central and western China, which were obtained by multi-stage random sampling. The structural equation modeling (SEM) was used to link three-level factors with physicians’ behavioral intentions.ResultsThe majority of the participants (94.57%) showed a positive tendency toward intention to use CPGs on antimicrobials. The reliability and validity analysis showed the questionnaire developed from the theoretical model was acceptable. SEM results revealed physicians’ intentions to use CPGs on antimicrobials was associated with attitude (β = 0.166, p < 0.05), subjective norms (β = 0.244, p < 0.05), perceived risk (β = − 0.113, p < 0.05), relative advantage (β = 0.307, p < 0.01), top management support (β = 0.200, p < 0.05) and organizational implementation (β = 0.176, p < 0.05). Besides, subjective norms, perceived risk, relative advantage, ease of use, and top management support showed their mediating effects from large to small on the intentions, which were 0.215, 0.140, 0.103, 0.088, − 0.020, respectively.ConclusionsThis study revealed the significance of multifaceted factors to enhance the intention to use CPGs on antimicrobials. These findings will not only contribute to the development of targeted intervention strategies on promoting the use of CPGs on antimicrobials, but also provide insights for future studies about physicians’ adoption behaviors on certain health services or products.
Highlights
With inappropriate use of antimicrobials becoming a great public health concern globally, the issue of applying clinical practice guidelines (CPGs) to regulate the rational use of antimicrobials has attracted increasing attention
To avoid further deteriorations caused by antimicrobial resistance (AMR) and improve outcomes of antimicrobials, many countries have launched clinical practice guidelines (CPGs) on antimicrobials, which provide recommendations for physicians based on the current best evidence
The regulation policy for the clinical application of antimicrobials covers all levels of medical institutions, for the weakness of the primary medical services system in China, the provision of vast medical services is heavily dependent on hospitals, especially tertiary hospitals
Summary
With inappropriate use of antimicrobials becoming a great public health concern globally, the issue of applying clinical practice guidelines (CPGs) to regulate the rational use of antimicrobials has attracted increasing attention. The spread of inappropriate use of antimicrobials has driven the emergence of antimicrobial resistance (AMR), which is a widely acknowledged threat to global health and sustainable development [2] It leads to weakened effectiveness and persistent infections [3] that will greatly undermine our ability to fight infectious disease, resulting in negative consequences at the individual and societal levels [4], such as longer hospital stays, higher medical costs, poor patient outcomes and waste of health resources. Clear principles had been established with significant effectiveness of CPGs well proved, the expansion of regulation implementation was still halted with poor adherence to regarding guidelines This situation was outstanding especially in many developing countries, where antimicrobials consumption doubled between 2000 and 2015 [8]. In China, one of the world’s largest consumers of antimicrobials for human health [9], the inappropriate use of antimicrobials is still striking even after the launch of Guiding Principles for Clinical Application of Antimicrobials in 2015 [10]
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