Balancing the risks to individual and society : a systematic review and synthesis of qualitative research on antibiotic prescribing behaviour in hospitals
Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Abstract
Background: Antimicrobial resistance is a global health threat, partly driven by inappropriate
antibiotic prescriptions for acute medical patients in hospitals.
Aim: To provide a systematic review of qualitative research on antibiotic prescribing
decisions in hospitals worldwide, including broad-spectrum antibiotic use.
Methods: A systematic search of qualitative research on antibiotic prescribing for adult
hospital patients published between 2007 and 2017 was conducted. Drawing on the Health
Belief Model, a framework synthesis was conducted to assess threat perceptions associated
with antimicrobial resistance, and perceived benefits and barriers associated with
antibiotic stewardship.
Findings: The risk of antimicrobial resistance was generally perceived to be serious, but
the abstract and long-term nature of its consequences led physicians to doubt personal
susceptibility. While prescribers believed in the benefits of optimizing prescribing, the
direct link between over-prescribing and antimicrobial resistance was questioned, and
prescribers’ behaviour change was frequently considered futile when fighting the complex
problem of antimicrobial resistance. The salience of individual patient risks was a key
barrier to more conservative prescribing. Physicians perceived broad-spectrum antibiotics
to be effective and low risk; prescribing broad-spectrum antibiotics involved low cognitive
demand and enabled physicians to manage patient expectations. Antibiotic prescribing
decisions in low-income countries were shaped by a context of heightened uncertainty and
risk due to poor microbiology and infection control services.
Conclusions: When tackling antimicrobial resistance, the tensions between immediate individual
risks and long-term collective risks need to be taken into account. Efforts to reduce
diagnostic uncertainty and to change risk perceptions will be critical in shifting practice.
Description
CITATION: Krockow, E. M., et al. 2019. Balancing the risks to individual and society : a systematic review and synthesis of qualitative research on antibiotic prescribing behaviour in hospitals. Journal of Hospital Infection, 101(4):428-439, doi:10.1016/j.jhin.2018.08.007.
The original publication is available at https://www.sciencedirect.com
The original publication is available at https://www.sciencedirect.com
Keywords
Antimicrobial resistance, Antibiotics -- Prescribing, Qualitative methods (Research), Antimicrobial drugs
Citation
Krockow, E. M., et al. 2019. Balancing the risks to individual and society : a systematic review and synthesis of qualitative research on antibiotic prescribing behaviour in hospitals. Journal of Hospital Infection, 101(4):428-439, doi:10.1016/j.jhin.2018.08.007