1887. Primary Care Physicians’ Attitudes and Perceptions Toward Antibiotic Resistance and Outpatient Antibiotic Stewardship: A Qualitative Study

Abstract Background At least 30% of outpatient antibiotic prescriptions are unnecessary. Outpatient antibiotic stewardship can improve prescribing and minimize the threat of antibiotic resistance. We assessed primary care physicians’ (PCPs) perceptions of antibiotic resistance, inappropriate antibiotic use, and the need for and impact of antibiotic stewardship activities. Methods We conducted a national survey of 1,550 internal and family medicine physicians and pediatricians recruited from a medical market research panel. Quotas were established to recruit participants by geographic region and specialty. For sample representativeness, survey weights were generated according to these characteristics using the American Medical Association’s Masterfile. Results Among respondents, 94% agreed that resistance is a problem in the United States, but only 55% felt it was a problem for their practice; 65% of respondents agreed they had seen an increase in resistant infections in their patients over the past 5 years. Responses about inappropriate antibiotic use were similar: 91% agreed that it was a problem, but 37% agreed that it is a problem in their practice. Additionally, 60% felt they prescribed antibiotics more appropriately than their peers. For antibiotic stewardship, 91% felt it was appropriate for office-based practices, but 53% believed that discussions with patients on the appropriate use of antibiotics is sufficient to address the problem. The majority of respondents indicated they were likely, very likely, or extremely likely to implement stewardship interventions in response to feedback or incentives from payers or health departments. The activities with the strongest likelihood to spur stewardship adoption included the state health department publishing local resistance patterns (82%), a payer creating a stand-alone incentive program for stewardship (80%), or a payer including it in a broader quality incentive program (76%). Conclusion PCPs feel that antibiotic resistance, inappropriate prescribing, and stewardship are important in the United States, but not for their own practices. This disconnect poses a challenge for the success of outpatient stewardship programs. Incentive or data feedback activities may help encourage stewardship uptake. Disclosures All authors: No reported disclosures.

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Primary Care Physicians’ Attitudes and Perceptions Towards Antibiotic Resistance and Antibiotic Stewardship: A National Survey

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa244 ◽

2020 ◽

Vol 7 (7) ◽

Author(s):

Rachel M Zetts ◽

Andrea M Garcia ◽

Jason N Doctor ◽

Jeffrey S Gerber ◽

Jeffrey A Linder ◽

...

Keyword(s):

United States ◽

Primary Care ◽

Antibiotic Resistance ◽

Antibiotic Stewardship ◽

Primary Care Physicians ◽

Inappropriate Prescribing ◽

The United States ◽

Vaccine Hesitancy ◽

Resistant Bacteria ◽

Antibiotic Prescribing

Abstract Background Outpatient antibiotic stewardship is needed to reduce inappropriate prescribing and minimize the development of resistant bacteria. We assessed primary care physicians’ perceptions of antibiotic resistance, antibiotic use, and the need for stewardship activities. Methods We conducted a national online survey of 1550 internal, family, and pediatric medicine physicians in the United States recruited from an opt-in panel of healthcare professionals. Descriptive statistics were generated for respondent demographics and question responses. Responses were also stratified by geographic region and medical specialty, with a χ 2 test used to assess for differences. Results More respondents agreed that antibiotic resistance was a problem in the United States (94%) than in their practice (55%) and that inappropriate antibiotic prescribing was a problem in outpatient settings (91%) than in their practice (37%). In addition, 60% agreed that they prescribed antibiotics more appropriately than their peers. Most respondents (91%) believed that antibiotic stewardship was appropriate in office-based practices, but they ranked antibiotic resistance as less important than other public health issues such as obesity, diabetes, opioids, smoking, and vaccine hesitancy. Approximately half (47%) believed they would need a lot of help to implement stewardship. Respondents indicated that they were likely to implement antibiotic stewardship efforts in response to feedback or incentives provided by payers or health departments. Conclusions Primary care physicians generally did not recognize antibiotic resistance and inappropriate prescribing as issues in their practice. This poses a challenge for the success of outpatient stewardship. Healthcare stakeholders will need to explore opportunities for feedback and incentive activities to encourage stewardship uptake.

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Awareness of antibiotic resistance and antibiotic prescribing in UTI treatment: A qualitative study among primary care physicians in Sweden

Scandinavian Journal of Primary Health Care ◽

10.3109/02813432.2012.751695 ◽

2013 ◽

Vol 31 (1) ◽

pp. 50-55 ◽

Cited By ~ 16

Author(s):

Ingeborg Björkman ◽

Johanna Berg ◽

Nina Viberg ◽

Cecilia Stålsby Lundborg

Keyword(s):

Primary Care ◽

Antibiotic Resistance ◽

Qualitative Study ◽

Primary Care Physicians ◽

Antibiotic Prescribing

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Primary care physicians’ attitudes and perceptions towards antibiotic resistance and outpatient antibiotic stewardship in the USA: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2019-034983 ◽

2020 ◽

Vol 10 (7) ◽

pp. e034983

Author(s):

Rachel M Zetts ◽

Andrea Stoesz ◽

Andrea M Garcia ◽

Jason N Doctor ◽

Jeffrey S Gerber ◽

...

Keyword(s):

Internal Medicine ◽

Primary Care ◽

Antibiotic Resistance ◽

Family Medicine ◽

Focus Groups ◽

Antibiotic Stewardship ◽

Primary Care Physicians ◽

Physician Attitudes ◽

Urgent Care ◽

Antibiotic Prescribing

ObjectivesAt least 30% of outpatient antibiotic prescriptions are unnecessary. Outpatient antibiotic stewardship is needed to improve prescribing and address the threat of antibiotic resistance. A better understanding of primary care physicians (PCPs) attitudes towards antibiotic prescribing and outpatient antibiotic stewardship is needed to identify barriers to stewardship implementation and help tailor stewardship strategies. The aim of this study was to assess PCPs current attitudes towards antibiotic resistance, inappropriate antibiotic prescribing and the feasibility of outpatient stewardship efforts.DesignEight focus groups with PCPs were conducted by an independent moderator using a moderator guide. Focus groups were audio recorded, transcribed and coded for major themes using deductive and inductive content analysis methods.SettingFocus groups were conducted in four US cities: Philadelphia, Birmingham, Chicago and Los Angeles.ParticipantsTwo focus groups were conducted in each city—one with family medicine and internal medicine physicians and one with paediatricians. A total of 26 family medicine/internal medicine physicians and 26 paediatricians participated.ResultsParticipants acknowledged that resistance is an important public health issue, but not as important as other pressing problems (eg, obesity, opioids). Many considered resistance to be more of a hospital issue. While participants recognised inappropriate prescribing as a problem in outpatient settings, many felt that the key drivers were non-primary care settings (eg, urgent care clinics, retail clinics) and patient demand. Participants reacted positively to stewardship efforts aimed at educating patients and clinicians. They questioned the validity of antibiotic prescribing metrics. This scepticism was due to a number of factors, including the feasibility of capturing prescribing quality, a belief that physicians will ‘game the system’ to improve their measures, and dissatisfaction and distrust of quality measurement in general.ConclusionsStakeholders will need to consider physician attitudes and beliefs about antibiotic stewardship when implementing interventions aimed at improving prescribing.

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How can Primary Care Physicians Best Support Contraceptive Decision Making? A Qualitative Study Exploring the Perspectives of Baltimore Latinas

Women s Health Issues ◽

10.1016/j.whi.2016.09.015 ◽

2017 ◽

Vol 27 (2) ◽

pp. 158-166 ◽

Cited By ~ 16

Author(s):

Diana N. Carvajal ◽

Deborah Gioia ◽

Estefania Rivera Mudafort ◽

Pamela Bohrer Brown ◽

Beth Barnet

Keyword(s):

Primary Care ◽

Decision Making ◽

Qualitative Study ◽

Primary Care Physicians

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Antibiotic stewardship program in Pakistan: a multicenter qualitative study exploring medical doctors’ knowledge, perception and practices

BMC Infectious Diseases ◽

10.1186/s12879-021-06043-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Muhammad Atif ◽

Beenish Ihsan ◽

Iram Malik ◽

Nafees Ahmad ◽

Zikria Saleem ◽

...

Keyword(s):

Antibiotic Resistance ◽

Qualitative Study ◽

Antibiotic Stewardship ◽

Antibiotic Prescription ◽

Successful Implementation ◽

Rational Use ◽

Factors Associated ◽

Prescription Practices ◽

Stewardship Program ◽

Rational Use Of Antibiotics

Abstract Background The emerging threat of antibiotic resistance is growing exponentially and antibiotic stewardship programs are cornerstone to fight against this global threat. The study aimed to explore the knowledge, perspectives and practices of physicians regarding various aspects of antibiotic stewardship program including antibiotic stewardship activities, rational use of antibiotics, antibiotic resistance, prescribing practices and factors associated with these practices. Methods In this qualitative study, a total of 17 semi-structured, in-depth interviews with doctors of three tertiary care public sector hospitals in Bahawalpur and Rahim Yar Khan were conducted. The convenient sampling method was adopted to collect the data and the saturation point criterion was applied to determine the sample size. Thematic analysis approach was used to draw conclusions from the data. Results The analysis of data yielded five themes, 12 subthemes and 26 categories. The themes included, (i) perception about antibiotic use and antibiotic stewardship, (ii) antibiotic prescription practices, (iii) antibiotic resistance, (iv) limited strategies adopted by hospital administration to ensure quality and safe distribution of antibiotics, (v) implementation of antibiotic stewardship program: barriers, suggestion and future benefits. Doctors had misconceptions about the rational use of antibiotics. The perception regarding antibiotic stewardship programs was poor. Moreover, very few activities related to ASP existed. The participants gave many suggestions for successful implementation of ASP in order to reduce the burden of antibiotic resistance, including development of guidelines for the use of antibiotics, strict legislation regarding use of antibiotics, active participation of healthcare professionals and awareness program among general public about the use of antibiotics. Conclusion This study concluded that poor knowledge of doctors regarding ASP, non-existence of antibiogram of hospital and lack of rules for the safe use of antibiotics were the main driving factors associated with irrational antibiotic prescription practices and development of AR.

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