Abstract
BackgroundAntibiotic prescription rates in primary care in Germany are moderate, but still considered too high. The ARena study (Sustainable reduction of antibiotic-induced antimicrobial resistance) was initiated to foster awareness and understanding of the growing challenge and promotes rational antibiotics use for acute, non-complicated and self-limiting infections.MethodsThe present study was performed as part of the process evaluation of the ARena study. Interviews were conducted with a purposive sample of physicians participating in the ARena study to identify factors relevant to primary care physicians’ decision-making when prescribing antibiotics for acute non-complicated infections. Generated data were audio-recorded. Pseudonymized verbatim transcripts were coded using a pre-defined framework. The Dual Process Theory was applied to provide understanding of individual health professional factors that induce dysrational prescribing decisions.ResultsBased on medical as well as non-medical considerations, physicians developed habits in decision making on antibiotics prescribing. They acknowledged inadequate antibiotics prescribing for acute, non-complicated infections in situations involving uncertainty regarding diagnosis, prognosis, continuity of care, patient expectations and when not knowing the patient. Educative efforts empowered physicians to override habitual prescribing. A theory-driven model provides transparency as to how dysrational prescribing decisions occur and suggests remedy by providing new experiences and new recognizable patterns through educative efforts.ConclusionsEducational interventions may only change prescribing behaviours if they result in active rational rather than routine-based decision-making on antibiotics prescribing.Trial registrationISRCTN, ISRCTN58150046.
Highlights
Antibiotic prescription rates in primary care in Germany are moderate, but still considered too high
Overview Within the Tailored Implementation for Chronic Disease (TICD) domain of ‘Individual health professional factors’, results outlined below are structured with a focus on individual perceptions, emotions and images and domain-specific context
Findings are presented with an indication of how frequent aspects were brought up
Summary
Antibiotic prescription rates in primary care in Germany are moderate, but still considered too high. Antimicrobial resistance (AMR) is a naturally occurring process, driven by diverse factors. Research suggests that it is accelerated by misuse and overuse of antibiotics in people and livestock [1]. A European comparison shows that the usage of antibiotics is moderate in Germany [5] and declining [6]. This may be related to scientific research on rational use of antibiotics and the implementation of evidence-based practice guidelines in the previous decade [7]. The volume of inappropriate, non-indicated antibiotics prescribed in German ambulatory care remains too high, the consumption of broad-spectrum antibiotics such as cephalosporins and fluoroquinolones [5, 8, 9], leaving substantial room for improvement [10]
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