Antibiotic prescription for febrile outpatients: a health facility-based secondary data analysis for the Greater Accra region of Ghana

Abstract Background Misguided prescription of antibiotics is an important contributor towards the emergence and spread of antibiotic resistance. The absence of effective interventions to control antibiotic use leads to increased consumption beyond the needed requirements. Antibiotic stewardship interventions must be appropriately targeted and assessed to enhance the controlled use of antibiotics. The objective of this study was to determine the factors associated with antibiotic prescription to febrile outpatients who seek care in health facilities within the Greater Accra region of Ghana. Methods Secondary data obtained from the medical records of 2519 febrile outpatients, consecutively sampled at the outpatient department of 6 health facilities in 3 municipalities during the baseline survey of a quasi-experiment in 2015 was used. The primary outcome was prescription of any antibiotic. Independent variables included patients’ demographics, symptoms, laboratory investigations (blood film microscopy, malaria rapid diagnostic test, full blood count, urine and stool routine examinations), diagnoses, and prescribers’ demographics. Crude and adjusted logistic regression analyses were used to determine the factors associated with antibiotic prescription. Results The prevalence of antibiotic prescription was 70.1% (95% CI: 67.7–72.4). Prescribers with more years of practice (> 5 years) were more likely to prescribe antibiotics compared to those with less than 3 years of practice (p < 0.001). Integrated Management of Neonatal and Childhood Illnesses (IMNCI) training was associated with a 2.3 (95% CI: 1.54, 3.53, p < 0.001) fold odds of antibiotic prescribing. Patients aged 5 years or more were 60% less likely to receive antibiotics compared with those under 5 years (AOR = 0.40, 95% CI: 0.32, 0.51; p < 0.001). Patients referred for laboratory investigations were 29% less likely to be prescribed antibiotics than those not referred. The presence of cough as a presenting symptom was associated with a 3.5 (95% CI: 2.54, 4.92) fold odds of antibiotic prescription. Conclusion Prescription of antibiotics to febrile outpatients was high. Promoting laboratory testing can potentially reduce irrational antibiotic prescription. Prescribing antibiotics for children under five and the prescribing practices of prescribers with longer years of practice should be targeted with interventions to reduce high use of antibiotics.

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Antibiotics prescription for febrile outpatients: a health facility-based secondary data analysis for the Greater Accra region of Ghana

10.21203/rs.3.rs-21744/v2 ◽

2020 ◽

Author(s):

Michael Mireku Opoku ◽

Harriet Affran Bonful ◽

Kwadwo A. Koram

Keyword(s):

Antibiotic Prescription ◽

Secondary Data ◽

Health Facilities ◽

Full Blood Count ◽

Baseline Survey ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Factors Associated ◽

Laboratory Investigations ◽

Greater Accra Region

Abstract Background: Misguided prescription of antibiotics is an important contributor towards the emergence and spread of antibiotic resistance. The absence of effective interventions to control antibiotic use leads to increased consumption beyond the needed requirements. Antibiotic stewardship interventions must be appropriately targeted and assessed to enhance the controlled use of antibiotics. The objective of this study was to determine the factors associated with antibiotic prescription to febrile outpatients who seek care in health facilities within the Greater Accra region of Ghana.Methods: Secondary data obtained from the medical records of 2,519 febrile outpatients, consecutively sampled at the outpatient department of 6 health facilities in 3 municipalities during the baseline survey of a quasi-experiment in 2016 was used. The primary outcome was prescription of any antibiotic. Independent variables included patients’ demographics, symptoms, laboratory investigations (blood film microscopy, malaria rapid diagnostic test, full blood count, urine and stool routine examinations), diagnoses, and prescribers’ demographics. Crude and adjusted logistic regression analyses were used to determine the factors associated with antibiotic prescription. Results: The prevalence of antibiotic prescription was 70.1% (95% CI: 67.7-72.4). Prescribers with more years of practice (>5years) were more likely to prescribe antibiotics compared to those with less than 3 years of practice (p < 0.001). Integrated Management of Neonatal and Childhood Illnesses (IMNCI) training was associated with a 2.3 (95% CI: 1.54, 3.53, p < 0.001) folds odds of antibiotic prescribing. Patients aged 5 years or more were 60% less likely to receive antibiotics compared with those under 5 years (AOR=0.40, 95% CI: 0.32, 0.51; p<0.001). Patients referred for laboratory investigations were 29% less likely to be prescribed for antibiotics than those not referred. The presence of cough as a presenting symptom was associated with a 3.5 (95% CI: 2.54, 4.92) fold odds of antibiotic prescription. Conclusion: Prescription of antibiotics to febrile outpatients was high. Promoting laboratory testing can potentially reduce irrational antibiotics prescribing. Prescribing antibiotics for children under five and the prescribing practices of prescribers with longer years of practice should be targeted with interventions to reduce high use of antibiotics.

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Antibiotic prescription for febrile outpatients: a health facility-based secondary data analysis for the Greater Accra region of Ghana

10.21203/rs.3.rs-21744/v3 ◽

2020 ◽

Author(s):

Michael Mireku Opoku ◽

Harriet Affran Bonful ◽

Kwadwo A. Koram

Keyword(s):

Antibiotic Prescription ◽

Secondary Data ◽

Health Facilities ◽

Full Blood Count ◽

Baseline Survey ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Factors Associated ◽

Laboratory Investigations ◽

Greater Accra Region

Abstract Background: Misguided prescription of antibiotics is an important contributor towards the emergence and spread of antibiotic resistance. The absence of effective interventions to control antibiotic use leads to increased consumption beyond the needed requirements. Antibiotic stewardship interventions must be appropriately targeted and assessed to enhance the controlled use of antibiotics. The objective of this study was to determine the factors associated with antibiotic prescription to febrile outpatients who seek care in health facilities within the Greater Accra region of Ghana.Methods: Secondary data obtained from the medical records of 2,519 febrile outpatients, consecutively sampled at the outpatient department of 6 health facilities in 3 municipalities during the baseline survey of a quasi-experiment in 2016 was used. The primary outcome was prescription of any antibiotic. Independent variables included patients’ demographics, symptoms, laboratory investigations (blood film microscopy, malaria rapid diagnostic test, full blood count, urine and stool routine examinations), diagnoses, and prescribers’ demographics. Crude and adjusted logistic regression analyses were used to determine the factors associated with antibiotic prescription. Results: The prevalence of antibiotic prescription was 70.1% (95% CI: 67.7-72.4). Prescribers with more years of practice (>5years) were more likely to prescribe antibiotics compared to those with less than 3 years of practice (p < 0.001). Integrated Management of Neonatal and Childhood Illnesses (IMNCI) training was associated with a 2.3 (95% CI: 1.54, 3.53, p < 0.001) fold odds of antibiotic prescribing. Patients aged 5 years or more were 60% less likely to receive antibiotics compared with those under 5 years (AOR=0.40, 95% CI: 0.32, 0.51; p<0.001). Patients referred for laboratory investigations were 29% less likely to be prescribed antibiotics than those not referred. The presence of cough as a presenting symptom was associated with a 3.5 (95% CI: 2.54, 4.92) fold odds of antibiotic prescription. Conclusion: Prescription of antibiotics to febrile outpatients was high. Promoting laboratory testing can potentially reduce irrational antibiotic prescription. Prescribing antibiotics for children under five and the prescribing practices of prescribers with longer years of practice should be targeted with interventions to reduce high use of antibiotics.

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Antibiotics Prescription for Febrile Outpatients: A Health Facility-Based Secondary Data Analysis for the Greater Accra region of Ghana

10.21203/rs.3.rs-21744/v1 ◽

2020 ◽

Author(s):

Michael Mireku Opoku ◽

Harriet Affran Bonful ◽

Kwadwo A. Koram

Keyword(s):

Secondary Data ◽

Blood Film ◽

Health Facilities ◽

Full Blood Count ◽

Baseline Survey ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Factors Associated ◽

Laboratory Investigations ◽

Greater Accra Region

Abstract Background Misguided prescription of antibiotics is an important facilitator of the emergence and spread of antibiotic resistance. In the absence of the implementation of effective interventions to control antibiotic use, its consumption may increase out of proportion to requirements. Antibiotic stewardship interventions must be appropriately targeted and assessed to enhance the proper use of antibiotics. The objective of this study was to determine the factors associated with antibiotics prescription to febrile outpatients who seek care in health facilities within the Greater Accra region of Ghana.Methods Secondary data obtained from a review of medical records of 2,519 febrile patients at the outpatient department of 6 health facilities in 3 municipalities during the baseline survey of a quasi-experiment in 2016 were used. The primary outcome was prescription of any antibiotic. Independent variables included patients’ demographics, symptoms, laboratory investigations (blood film microscopy, malaria rapid diagnostic test, full blood count, urine and stool routine examinations), diagnoses, and prescribers’ demographics. Crude and adjusted logistic regression analyses were used to determine the factors associated with antibiotics prescription.Results The prevalence of antibiotics prescription was 70.1% (95% CI: 67.7–72.4). Prescribers with more years of practice (> 5 years) were more likely to prescribe antibiotics compared to those with less than 3 years of practice (p < 0.001). Integrated Management of Neonatal and Childhood Illnesses (IMNCI) training was associated with a 2.3 (95% CI: 1.54, 3.53, p < 0.001) times higher odds of antibiotic prescribing. Patients aged 5 years or more were 60% less likely to be prescribed antibiotics compared with those under 5 years (AOR = 0.40, 95% CI: 0.32, 0.51; p < 0.001). Patients referred for laboratory investigations were 29% less likely to be prescribed with antibiotics than those not referred. Presenting to the outpatient clinic with cough was associated with a 3.5 (95% CI: 2.54, 4.92) times higher odds of antibiotics prescribing.Conclusion Prescription of antibiotics to febrile outpatients was high. Promoting laboratory testing can potentially reduce irrational antibiotics prescribing. Prescribing antibiotics for children under five and the prescribing practices of prescribers with longer years of practice should be targeted with interventions to reduce high use of antibiotics.

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Antibiotics prescription for febrile patients: associated factors in a health facility-based survey in the Greater Accra region of Ghana

10.21203/rs.2.10739/v2 ◽

2019 ◽

Author(s):

Michael Mireku Opoku ◽

Harriet Affran Bonful ◽

Kwadwo Ansah Koram

Keyword(s):

Integrated Management ◽

Blood Film ◽

Health Facilities ◽

Full Blood Count ◽

Baseline Survey ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Factors Associated ◽

Laboratory Investigations ◽

Greater Accra Region

Abstract Introduction: Frequent and/or misguided prescription of antibiotics are important facilitators of the emergence and spread of antibiotic resistance. In the absence of the implementation of effective interventions to control antibiotic use, its consumption may increase out of proportion to requirements. Antibiotic stewardship interventions must be appropriately targeted and assessed to enhance the proper use of antibiotics. The objective of this study was to determine the factors associated with of antibiotics prescription to febrile patients who seek care in health facilities within the Greater Accra region of Ghana. Methods: Secondary data obtained from a review of medical records of 2,519 febrile patients at the outpatient department of 6 health facilities in 3 municipalities during the baseline survey of a quasi-experiment in 2016 were used. The primary outcome was prescription of any antibiotic. Independent variables included patients’ demographics, symptoms, laboratory investigations (blood film microscopy, malaria rapid diagnostic test, full blood count, urine and stool routine examinations), diagnoses, and prescribers’ demographics. Crude and adjusted logistic regression analyses were used to determine the factors associated with antibiotics prescription. Results: The prevalence of antibiotics prescription was 70.1% (95% CI: 67.7-72.4). Prescribers with more years of practice (>5years) were more likely to prescribe antibiotics compared to those with less than 3 years of practice (p < 0.001). Integrated Management of Neonatal and Childhood Illnesses (IMNCI) training was associated with a 2.3 (95% CI: 1.54, 3.53, p < 0.001) times higher odds of antibiotic prescribing. Patients aged 5 years or more were 60% less likely to be prescribed antibiotics compared with those under 5 years (AOR=0.40, 95% CI: 0.32, 0.51; p<0.001). Patients referred for laboratory investigations were 29% less likely to be prescribed with antibiotics than those not referred. Presenting to the outpatient clinic with cough was associated with a 3.5 (95% CI: 2.54, 4.92) times higher odds of antibiotics prescribing. Conclusion: Prescription of antibiotics to febrile patients was high. Promoting laboratory testing can potentially reduce irrational antibiotics prescribing. Prescribing antibiotics for children under five and the prescribing practices of prescribers with longer years of practice should be targeted with interventions to reduce high use of antibiotics.

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Predictors of antibiotics prescription for febrile patients: A health facility-based survey in the Greater Accra region of Ghana

10.21203/rs.2.10739/v1 ◽

2019 ◽

Author(s):

Michael Mireku Opoku ◽

Harriet Affran Bonful ◽

Kwadwo Ansah Koram

Keyword(s):

Secondary Data ◽

Antibiotic Use ◽

Health Facilities ◽

Baseline Survey ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Practice Experience ◽

Effective Interventions ◽

Laboratory Investigations ◽

Greater Accra Region

Abstract Introduction Frequent or/and misguided prescription of antibiotics are important facilitators of the emergence and spread of antibiotic resistance. In the absence of the implementation of effective interventions to control antibiotic use, its consumption may quadruple. Antibiotic stewardship interventions must be appropriately targeted to enhance the proper use of antibiotics. The objective of this study was to determine the predictors of prescribing antibiotics to febrile patients who seek care in health facilities within the Greater Accra region of Ghana. Methods Secondary data obtained from a review of medical records of 2,519 febrile patients at the outpatient department of 6 health facilities in 3 municipalities during the baseline survey of a quasi-experiment in 2016, were used. In addition, sociodemographic data on the prescribers who saw the patients were obtained. The primary outcome was prescription of any antibiotic. Predictor variables included patients’ demographics, symptoms, laboratory investigations, diagnoses and prescribed medicines. Binary and multivariable logistic regression analyses were used to determine the predictors of antibiotics prescription. Clustering was adjusted for in all the analyses. Results The prevalence of antibiotics prescription was 70.1% (95% CI: 67.7-72.4). Prescribers with 6 to 9 years and 10 or more years of practice experience were 3 (95% CI: 1.99, 4.44) and 1.6 (95% CI: 1.12, 2.27) times more likely to prescribe antibiotics, respectively (p < 0.001). IMCI training was associated with a 2.3 (95% CI: 1.54, 3.53, p < 0.001) times higher odds of antibiotic prescribing. Patients aged 5 years or more were 60% less likely to be prescribed antibiotics compared with those under 5 years (AOR=0.40, 95% CI: 0.32, 0.51; p<0.001). Patients referred for laboratory investigations were 29% less likely to be prescribed with antibiotics than those not referred. Presenting to the outpatient clinic with cough was associated with a 3.5 (95% CI: 2.54, 4.92) times higher odds of antibiotics prescribing. Conclusion Prescription of antibiotics to febrile patients was high. Promoting laboratory testing can potentially reduce irrational antibiotics prescribing. Prescribing antibiotics for children under five and the prescribing practices of experienced prescribers should be targeted with interventions.

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Analysis of patterns of antibiotic prescribing in public health facilities in Nepal

The Journal of Infection in Developing Countries ◽

10.3855/jidc.11817 ◽

2020 ◽

Vol 14 (01) ◽

pp. 18-27 ◽

Cited By ~ 3

Author(s):

Anant Nepal ◽

Delia Hendrie ◽

Suzanne Robinson ◽

Linda A Selvey

Keyword(s):

Public Health ◽

Cross Sectional Study ◽

Health Facilities ◽

Antibiotic Prescribing ◽

Who Guidelines ◽

Prescribing Practices ◽

Cross Sectional ◽

Middle Income ◽

Public Health Facilities ◽

Inappropriate Use

Introduction: Inappropriate use of antibiotics is recognised as a leading cause of antibiotic resistance. Little is known about antibiotic prescribing practices at public health facilities in low- and middle-income countries. We examined patterns of antibiotic prescribing in public health facilities in Nepal and explored factors influencing these practices. Methodology: A cross-sectional study of antibiotic prescribing in public health facilities was conducted in the Rupandehi district of Nepal. Six public health facilities were selected based on WHO guidelines, and data were extracted from administrative records for 6,860 patient encounters. Patterns of antibiotic prescribing were investigated using descriptive statistics. Chi-squared tests and logistic regressions were applied to explore factors associated with antibiotic prescribing. Results: Of patients attending public health facilities, the proportion prescribed at least one antibiotic (44.7%) was approximately twice the WHO recommended value (20.0 to 26.8%). The antibiotic prescribing rate for hospital inpatients (64.6%) was higher than for other facilities, with the prescribing rate also high in primary health care centres (50.4%) and health posts (52.2%). The most frequently (29.9%) prescribed antibiotic classes were third-generation cephalosporins. Females (p = 0.005) and younger (p < 0.001) patients were more likely to be prescribed antibiotics. High prescribing rates of antibiotics for selected diseases appeared contrary to international recommendations. Conclusion: Antibiotic prescribing in public health facilities was high compared with WHO guidelines, suggesting the need for strategies to reduce misuse of antibiotics. This study provides useful information to assist in formulating policies and guidelines to promote more appropriate use of antibiotics in Nepal.

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Prescribing antibiotics: Factors associated with C-reactive protein testing in general practice. A register-based study

10.21203/rs.3.rs-190219/v1 ◽

2021 ◽

Author(s):

Rikke Vognbjerg Sydenham ◽

Malene Plejdrup Hansen ◽

Ulrik Stenz Justesen ◽

Line Bjørnskov Pedersen ◽

Rune Munck Aabenhus ◽

...

Keyword(s):

General Practice ◽

Antibiotic Prescription ◽

Clinical Indication ◽

Antibiotic Prescribing ◽

Clinical Factors ◽

C Reactive Protein ◽

Factors Associated ◽

Reactive Protein ◽

Diagnostic Certainty ◽

Tract Infections

Abstract Background The use of C-reactive protein (CRP) tests is shown to safely reduce antibiotic prescribing for acute respiratory tract infections (RTIs). The aim of this study was to explore patient and clinical factors associated with the use of CRP testing when prescribing antibiotics recommended for RTIs. Methods A nation-wide retrospective cross-sectional register-based study based on first redeemed antibiotic prescriptions issued to adults in Danish general practice between July 2015 and June 2017. Only antibiotics recommended for treatment of RTIs were included in the analysis (penicillin-V, amoxicillin, co-amoxicillin or roxithromycin/clarithromycin). Logistic regression models were used to estimate odds ratios for patient-related and clinical factors on performing a CRP test in relation to antibiotic prescribing. Results A total of 984,149 patients redeemed at least one antibiotic prescription during the two-year period. Of these, 487,939 (49.6%) were labelled with the clinical indication RTI. Patients aged 75 years and above, with a Charlson Comorbidity Index of more than one, unemployed or on disability pension, living alone, and immigrants or descendants of immigrants had lower odds of having a CRP test performed in relation to an antibiotic prescription. Being followed in practice for a chronic condition and having CRP tests performed in the previous year were associated with higher odds of CRP testing in relation to antibiotic prescribing. Conclusions Differences were observed in the use of CRP tests among subgroups of patients indicating that both sociodemographic factors and comorbidity influence the decision to use a CRP test in general practice. Potentially, this means that CRP tests are not used to an optimal extent for all groups of patients. This leaves room for improved use of CRP tests to increase diagnostic certainty and further promote rational prescribing of antibiotics.

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Concordance of antibiotic prescribing with the American Dental Association acute oral infection guidelines within Veterans’ Affairs (VA) dentistry

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.16 ◽

2021 ◽

pp. 1-9

Author(s):

Daniel B. Carlsen ◽

Michael J. Durkin ◽

Gretchen Gibson ◽

M. Marianne Jurasic ◽

Ursula Patel ◽

...

Keyword(s):

Antibiotic Prescription ◽

Maxillofacial Surgery ◽

Apical Periodontitis ◽

Oral And Maxillofacial Surgery ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Oral Infections ◽

American Dental Association ◽

Patient Level ◽

Irreversible Pulpitis

Abstract Objective: United States dentists prescribe 10% of all outpatient antibiotics. Assessing appropriateness of antibiotic prescribing has been challenging due to a lack of guidelines for oral infections. In 2019, the American Dental Association (ADA) published clinical practice guidelines (CPG) on the management of acute oral infections. Our objective was to describe baseline national antibiotic prescribing for acute oral infections prior to the release of the ADA CPG and to identify patient-level variables associated with an antibiotic prescription. Design: Cross-sectional analysis. Methods: We performed an analysis of national VA data from January 1, 2017, to December 31, 2017. We identified cases of acute oral infections using International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Antibiotics prescribed by a dentist within ±7 days of a visit were included. Multivariable logistic regression identified patient-level variables associated with an antibiotic prescription. Results: Of the 470,039 VA dental visits with oral infections coded, 12% of patient visits with irreversible pulpitis, 17% with apical periodontitis, and 28% with acute apical abscess received antibiotics. Although the median days’ supply was 7, prolonged use of antibiotics was frequent (≥8 days, 42%–49%). Patients with high-risk cardiac conditions, prosthetic joints, and endodontic, implant, and oral and maxillofacial surgery dental procedures were more likely to receive antibiotics. Conclusions: Most treatments of irreversible pulpitis and apical periodontitis cases were concordant with new ADA guidelines. However, in cases where antibiotics were prescribed, prolonged antibiotic courses >7 days were frequent. These findings demonstrate opportunities for the new ADA guidelines to standardize and improve dental prescribing practices.

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The impact of pulse oximetry and Integrated Management of Childhood Illness (IMCI) training on antibiotic prescribing practices in rural Malawi: a mixed-methods study

10.21203/rs.3.rs-23789/v1 ◽

2020 ◽

Author(s):

Fiona Sylvies ◽

Lucy Nyirenda ◽

Alden Blair ◽

Kimberly Baltzell

Keyword(s):

Pulse Oximeter ◽

Antibiotic Prescription ◽

Integrated Management ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Continued Education ◽

Pediatric Pneumonia ◽

Prescription Rates ◽

The Impact ◽

Pulse Oximeters

Abstract Background. The misdiagnosis of non-malarial fever in sub-Saharan Africa has contributed to the significant burden of pediatric pneumonia and the inappropriate use of antibiotics in this region. This study aims to assess the impact of 1) portable pulse oximeters and 2) Integrated Management of Childhood Illness (IMCI) continued education training on the diagnosis and treatment of non-malarial fever amongst pediatric patients being treated by the Global AIDS Interfaith Alliance (GAIA) in rural Malawi. Methods. This study involved a logbook review to compare treatment patterns between five GAIA mobile clinics in Mulanje, Malawi during April-June 2019. An intervention study design was employed with four study groups: 1) 2016 control, 2) 2019 control, 3) IMCI-only, and 4) IMCI and pulse oximeter. A total of 3,504 patient logbook records were included based on these inclusion criteria: age under five years, febrile, malaria-negative, and treated during the dry season. A qualitative questionnaire was distributed to the participating GAIA providers. Fisher’s Exact Testing and odds ratios were calculated to compare the prescriptive practices between each study group and reported with 95% confidence intervals. Results. The pre- and post-exam scores for the providers who participated in the IMCI training showed an increase in content knowledge and understanding (p<0.01). The antibiotic prescription rates in each study group were 75% (2016 control), 85% (2019 control), 84% (IMCI only), and 42% (IMCI + pulse oximeter) (p<0.01). An increase in pneumonia diagnoses was detected for patients who received pulse oximeter evaluation with an oxygen saturation <95% (p<0.01). No significant changes in antibiotic prescribing practices were detected in the IMCI-only group (p>0.05). However, provider responses to the qualitative questionnaires indicated alternative benefits of the training including improved illness classification and increased provider confidence. Conclusion. Clinics that implemented both the IMCI course and pulse oximeters exhibited a significant decrease in antibiotic prescription rates, thus highlighting the potential of this tool in combatting antibiotic overconsumption in low-resource settings. Additionally, the pulse oximeters demonstrated the capacity to improve detection of pediatric pneumonia. GAIA staff appreciated the IMCI continued education training, however it did not appear to significantly impact antibiotic prescription rates and/or pneumonia diagnosis.

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Antibiotic prescriptions by medical interns in Hong Kong: influence of the hospital settings and prescription culture

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2020-138414 ◽

2020 ◽

pp. postgradmedj-2020-138414

Author(s):

Tai Pong Lam ◽

Tak Hon Chan ◽

Kai Sing Sun ◽

Kwok Fai Lam ◽

Kit Wing Kwok ◽

...

Keyword(s):

Hong Kong ◽

Focus Group ◽

Antibiotic Prescription ◽

Antibiotic Use ◽

Public Hospitals ◽

Antibiotic Prescribing ◽

Close Monitoring ◽

Prescribing Practices ◽

Inadequate Knowledge ◽

Medical Interns

BackgroundInappropriate antibiotic prescribing practices predispose to resistance emergence. Despite the inclusion of the topic in medical school curricula worldwide, it is uncertain whether newly graduated medical interns have confidence in proper antibiotic prescription.ObjectivesThis study aimed to explore the antibiotic prescribing behaviours of the medical interns in Hong Kong and their barriers to appropriate antibiotic prescription.MethodsTwo focus groups were conducted among medical interns with training experiences in different public hospitals. Their prescribing behaviours and barriers were further examined with a questionnaire survey just before completion of internship.ResultsFocus group interviews identified a variety of hospital workplace cultures, including inappropriate empirical prescriptions and dosages, interns’ passive roles in prescribing antibiotics and varied guidelines between different departments. Defensive medicine and lack of clinical experience were other barriers encountered. The interns believed that the incorrect practice learnt would perpetuate in their minds and affect their future practice. The top barriers reported by the survey respondents were adaptation to prescription culture of different hospitals (93.5%), lack of experience in antibiotic prescription (88.3%), inadequate knowledge in the choice of antibiotics (85.7%) and compliance with the seniors’ instructions (80.6%). However, some focus group participants perceived weaker barriers in paediatric departments which provided close monitoring of antibiotic use.ConclusionsInadequate knowledge and low confidence in antibiotic prescription led to the passive role of medical interns in antibiotic prescription, predisposing to future inappropriate practice. Inconsistent guidelines and prescription cultures between different hospitals and departments might further exacerbate their barriers.

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