Identifying Antibiotic Prescribing Patterns Through Multi-Level Latent Profile Analyses: A Cross-Sectional Survey of Primary Care Physicians

Background: Overuse of antibiotics significantly fuels the development of Antimicrobial resistance, which threating the global population health. Great variations existed in antibiotic prescribing practices among physicians, indicating improvement potential for rational use of antibiotics. This study aims to identify antibiotic prescribing patterns of primary care physicians and potential determinants.Methods: A cross-sectional survey was conducted on 551 physicians from 67 primary care facilities in Hubei selected through random cluster sampling, tapping into their knowledge, attitudes and prescribing practices toward antibiotics. Prescriptions (n = 501,072) made by the participants from 1 January to March 31, 2018 were extracted from the medical records system. Seven indicators were calculated for each prescriber: average number of medicines per prescription, average number of antibiotics per prescription, percentage of prescriptions containing antibiotics, percentage of antibiotic prescriptions containing broad-spectrum antibiotics, percentage of antibiotic prescriptions containing parenteral administered antibiotics, percentage of antibiotic prescriptions containing restricted antibiotics, and percentage of antibiotic prescriptions containing antibiotics included in the WHO “Watch and Reserve” list. Two-level latent profile analyses were performed to identify the antibiotic prescribing patterns of physicians based on those indicators. Multi-nominal logistic regression models were established to identify determinants with the antibiotic prescribing patterns.Results: On average, each primary care physician issued 909 (ranging from 100 to 11,941 with a median of 474) prescriptions over the study period. The mean percentage of prescriptions containing antibiotics issued by the physicians reached 52.19% (SD = 17.20%). Of those antibiotic prescriptions, an average of 82.29% (SD = 15.83%) contained broad-spectrum antibiotics; 71.92% (SD = 21.42%) contained parenteral administered antibiotics; 23.52% (SD = 19.12%) contained antibiotics restricted by the regional government; and 67.74% (SD = 20.98%) contained antibiotics listed in the WHO “Watch and Reserve” list. About 28.49% of the prescribers were identified as low antibiotic users, compared with 51.18% medium users and 20.33% high users. Higher use of antibiotics was associated with insufficient knowledge, indifference to changes, complacency with satisfied patients, low household income and rural location of the prescribers.Conclusion: Great variation in antibiotic prescribing patterns exists among primary care physicians in Hubei of China. High use of antibiotics is not only associated with knowledge shortfalls but also low socioeconomic status of prescribers.

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Identifying antibiotic prescribing patterns through multi-level latent profile analyses: a cross-sectional survey of primary care physicians in Hubei of China

10.21203/rs.3.rs-16669/v1 ◽

2020 ◽

Author(s):

Dan Wang ◽

Chaojie Liu ◽

Xinping Zhang ◽

Chenxi Liu

Keyword(s):

Primary Care ◽

Broad Spectrum ◽

Primary Care Physicians ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Latent Profile Analyses ◽

Broad Spectrum Antibiotics

Abstract Background Overuse of antibiotics significantly fuels the development of AMR, which threating the global population health. Great variations existed in antibiotic prescribing practices among physicians, indicating improvement potential for rational use of antibiotics. This study aims to identify antibiotic prescribing patterns of primary care physicians and potential determinants. Methods A cross-sectional survey was conducted on 551 physicians from 67 primary care facilities in Hubei selected through random cluster sampling, tapping into their knowledge, attitudes and prescribing practices toward antibiotics. Prescriptions (n=501,072) made by the participants from 1 January to 31 March 2018 were extracted from the medical records system. Seven indicators were calculated for each prescriber: average number of medicines per prescription, average number of antibiotics per prescription, percentage of prescriptions containing antibiotics, percentage of antibiotic prescriptions containing broad-spectrum antibiotics, percentage of antibiotic prescriptions containing parenteral administered antibiotics, percentage of antibiotic prescriptions containing restricted antibiotics, and percentage of antibiotic prescriptions containing antibiotics included in the WHO “Watch and Reserve” list. Two-level latent profile analyses were performed to identify the antibiotic prescribing patterns of physicians based on those indicators. Multi-nominal logistic regression models were established to identify determinants with the antibiotic prescribing patterns. Results On average, each primary care physician issued 909 (ranging from 100 to 11941 with a median of 474) prescriptions over the study period. The mean percentage of prescriptions containing antibiotics issued by the physicians reached 52.19% (SD=17.20%). Of those antibiotic prescriptions, an average of 82.29% (SD=15.83%) contained broad-spectrum antibiotics; 71.92% (SD=21.42%) contained parenteral administered antibiotics; 23.52% (SD=19.12%) contained antibiotics restricted by the regional government; and 67.74% (SD=20.98%) contained antibiotics listed in the WHO “Watch and Reserve” list. About 28.49% of the prescribers were identified as low antibiotic users, compared with 51.18% medium users and 20.33% high users. Higher use of antibiotics was associated with insufficient knowledge, indifference to changes, complacency with satisfied patients, low household income and rural location of the prescribers. Conclusion Great variation in antibiotic prescribing patterns exists among primary care physicians in Hubei of China. High use of antibiotics is not only associated with knowledge shortfalls but also low socioeconomic status of prescribers.

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Identifying antibiotic prescribing patterns through multi-level latent profile analyses: a cross-sectional survey of primary care physicians in Hubei of China

10.21203/rs.3.rs-19162/v1 ◽

2020 ◽

Author(s):

Dan Wang ◽

Chaojie Liu ◽

Xinping Zhang ◽

Chenxi Liu

Keyword(s):

Primary Care ◽

Broad Spectrum ◽

Primary Care Physicians ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Latent Profile Analyses ◽

Broad Spectrum Antibiotics

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Management of Common Infections in German Primary Care: A Cross-Sectional Survey of Knowledge and Confidence among General Practitioners and Outpatient Pediatricians

Antibiotics ◽

10.3390/antibiotics10091131 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1131

Author(s):

Peter Konstantin Kurotschka ◽

Elena Tiedemann ◽

Dominik Wolf ◽

Nicola Thier ◽

Johannes Forster ◽

...

Keyword(s):

Primary Care ◽

General Practitioners ◽

Primary Care Physicians ◽

Antibiotic Use ◽

Educational Interventions ◽

Treatment Decisions ◽

Antimicrobial Treatment ◽

Antibiotic Prescribing ◽

Cross Sectional Survey ◽

Cross Sectional

Outpatient antibiotic use is closely related to antimicrobial resistance and in Germany, almost 70% of antibiotic prescriptions in human health are issued by primary care physicians (PCPs). The aim of this study was to explore PCPs, namely General Practitioners’ (GPs) and outpatient pediatricians’ (PDs) knowledge of guideline recommendations on rational antimicrobial treatment, the determinants of confidence in treatment decisions and the perceived need for training in this topic in a large sample of PCPs from southern Germany. Out of 3753 reachable PCPs, 1311 completed the survey (overall response rate = 34.9%). Knowledge of guideline recommendations and perceived confidence in making treatment decisions were high in both GPs and PDs. The two highest rated influencing factors on prescribing decisions were reported to be guideline recommendations and own clinical experiences, hence patients’ demands and expectations were judged as not influencing treatment decisions. The majority of physicians declared to have attended at least one specific training course on antibiotic use, yet almost all the participating PCPs declared to need more training on this topic. More studies are needed to explore how consultation-related and context-specific factors could influence antibiotic prescriptions in general and pediatric primary care in Germany beyond knowledge. Moreover, efforts should be undertaken to explore the training needs of PCPs in Germany, as this would serve the development of evidence-based educational interventions targeted to the improvement of antibiotic prescribing decisions rather than being focused solely on knowledge of guidelines.

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Coping With Diagnostic Uncertainty in Antibiotic Prescribing: A Latent Class Study of Primary Care Physicians in Hubei China

Frontiers in Public Health ◽

10.3389/fpubh.2021.741345 ◽

2021 ◽

Vol 9 ◽

Author(s):

Chaojie Liu ◽

Dan Wang ◽

Lixia Duan ◽

Xinping Zhang ◽

Chenxi Liu

Keyword(s):

Primary Care ◽

Broad Spectrum ◽

Primary Care Physicians ◽

Latent Class ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Behavioral Patterns ◽

Diagnostic Uncertainty ◽

Logistic Regression Models ◽

Broad Spectrum Antibiotics

Background: Misuse of antibiotics is prevalent worldwide and primary care is a major contributor. Although a clear diagnosis is fundamental for rational antibiotic use, primary care physicians often struggle with diagnostic uncertainty. However, we know little about how physicians cope with this situation and its association with antibiotic prescribing.Methods: A total of 583 primary care physicians were surveyed using the Dealing with Uncertainty Questionnaire. Their prescriptions (n = 949,181) over the year 2018 were retrieved retrospectively. Two categories of behavioral patterns of participants were identified based on latent class analyses (high vs. low openness and collaborativeness) in responding to diagnostic uncertainty. Multi-level logistic regression models were established to determine the associations between these behavioral patterns and antibiotic prescribing (overall and broad-spectrum antibiotics) for illness without an indication for antibiotics and those with a conditional indication for antibiotics, respectively, after adjustment for variations of patient (level one) and physician (level two) characteristics.Results: Most physicians reported open communications with their patients (80.96%), collected further information (85.08%), and referred patients to specialists (68.95%) in dealing with diagnostic uncertainly. More than half (56.95%) sought help from colleagues. Less than 20% acted on intuition or adopted a “wait and see” strategy. About 40% participants (n = 238) were classified into the group of low openness and collaborativeness in coping with diagnostic uncertainty. They were more likely to prescribe antibiotics for the recorded illness without an indication for antibiotics (AOR = 1.013 for all antibiotics, p = 0.024; AOR = 1.047 for broad-spectrum antibiotics, p < 0.001), as well as for the recorded illness with a conditional indication for antibiotics (AOR = 1.226 for all antibiotic, p < 0.001; AOR = 1.257 for broad-spectrum antibiotics, p < 0.001).Conclusion: Low tolerance with diagnostic uncertainty is evident in primary care. Inappropriate and over antibiotic prescribing is shaped by physicians' coping methods of diagnostic uncertainty. Physicians' openness and collaborativeness in responding to diagnostic uncertainty is associated with lower antibiotic prescribing in primary care. Interventions targeting on better management of diagnostic uncertainty may offer a promising approach in reducing antibiotic use in primary care.

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Trends in Antibiotic Prescribing in Out-of-Hours Primary Care in England from January 2016 to June 2020 to Understand Behaviours during the First Wave of COVID-19

Antibiotics ◽

10.3390/antibiotics10010032 ◽

2021 ◽

Vol 10 (1) ◽

pp. 32

Author(s):

Nina J. Zhu ◽

Monsey McLeod ◽

Cliodna A. M. McNulty ◽

Donna M. Lecky ◽

Alison H. Holmes ◽

...

Keyword(s):

Primary Care ◽

Time Series ◽

Patient Outcomes ◽

Broad Spectrum ◽

Antibiotic Prescribing ◽

Broad Spectrum Antibiotic ◽

Out Of Hours ◽

Broad Spectrum Antibiotics ◽

National Quality ◽

General Practices

We describe the trend of antibiotic prescribing in out-of-hours (OOH) general practices (GP) before and during England’s first wave of the COVID-19 pandemic. We analysed practice-level prescribing records between January 2016 to June 2020 to report the trends for the total prescribing volume, prescribing of broad-spectrum antibiotics and key agents included in the national Quality Premium. We performed a time-series analysis to detect measurable changes in the prescribing volume associated with COVID-19. Before COVID-19, the total prescribing volume and the percentage of broad-spectrum antibiotics continued to decrease in-hours (IH). The prescribing of broad-spectrum antibiotics was higher in OOH (OOH: 10.1%, IH: 8.7%), but a consistent decrease in the trimethoprim-to-nitrofurantoin ratio was observed OOH. The OOH antibiotic prescribing volume diverged from the historical trend in March 2020 and started to decrease by 5088 items per month. Broad-spectrum antibiotic prescribing started to increase in OOH and IH. In OOH, co-amoxiclav and doxycycline peaked in March to May in 2020, which was out of sync with seasonality peaks (Winter) in previous years. While this increase might be explained by the implementation of the national guideline to use co-amoxiclav and doxycycline to manage pneumonia in the community during COVID-19, further investigation is required to see whether the observed reduction in OOH antibiotic prescribing persists and how this reduction might influence antimicrobial resistance and patient outcomes.

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Prepared and highly committed despite the risk of COVID-19 infection: a cross-sectional survey of primary care physicians’ concerns and coping strategies in Singapore

BMC Family Practice ◽

10.1186/s12875-021-01370-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jerrald Lau ◽

David Hsien-Yung Tan ◽

Gretel Jianlin Wong ◽

Yii-Jen Lew ◽

Ying-Xian Chua ◽

...

Keyword(s):

Primary Care ◽

Coping Strategies ◽

Stress Management ◽

Primary Care Physicians ◽

Well Being ◽

Pandemic Preparedness ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Accessible Information ◽

And Coping

Abstract Background Primary care physicians (PCPs) are first points-of-contact between suspected cases and the healthcare system in the current COVID-19 pandemic. This study examines PCPs’ concerns, impact on personal lives and work, and level of pandemic preparedness in the context of COVID-19 in Singapore. We also examine factors and coping strategies that PCPs have used to manage stress during the outbreak. Methods Two hundred and sixteen PCPs actively practicing in either a public or private clinic were cluster sampled via email invitation from three primary care organizations in Singapore from 6th to 29th March 2020. Participants completed a cross-sectional online questionnaire consisting of items on work- and non-work-related concerns, impact on personal and work life, perceived pandemic preparedness, stress-reduction factors, and personal coping strategies related to COVID-19. Results A total of 158 questionnaires were usable for analyses. PCPs perceived themselves to be at high risk of COVID-19 infection (89.9%), and a source of risk (74.7%) and concern (71.5%) to loved ones. PCPs reported acceptance of these risks (91.1%) and the need to care for COVID-19 patients (85.4%). Overall perceived pandemic preparedness was extremely high (75.9 to 89.9%). PCPs prioritized availability of personal protective equipment, strict infection prevention guidelines, accessible information about COVID-19, and well-being of their colleagues and family as the most effective stress management factors. Conclusions PCPs continue to serve willingly on the frontlines of this pandemic despite the high perception of risk to themselves and loved ones. Healthcare organizations should continue to support PCPs by managing both their psychosocial (e.g. stress management) and professional (e.g. pandemic preparedness) needs.

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Do primary care physicians’ own AUDIT scores predict their use of brief alcohol intervention? A cross-sectional survey

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2005.11.010 ◽

2006 ◽

Vol 83 (2) ◽

pp. 169-173 ◽

Cited By ~ 10

Author(s):

Mauri Aalto ◽

Senja Hyvönen ◽

Kaija Seppä

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Alcohol Intervention ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Brief Alcohol Intervention

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Transfer of care of postsurgical patients from hospital to the community setting: cross-sectional survey of primary care physicians

The American Journal of Surgery ◽

10.1016/j.amjsurg.2015.03.006 ◽

2015 ◽

Vol 210 (4) ◽

pp. 778-782 ◽

Cited By ~ 5

Author(s):

Navjeet K. Uppal ◽

David Eisen ◽

Jeff Weissberger ◽

Roy J. Wyman ◽

David R. Urbach ◽

...

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Community Setting ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Transfer Of Care

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General practitioner attitudes and confidence to deprescribing for elderly patients

Geriatric Care ◽

10.4081/gc.2020.8703 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Pier Riccardo Rossi ◽

Sarah E. Hegarty ◽

Vittorio Maio ◽

Marco Lombardi ◽

Andrea Pizzini ◽

...

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Real Life ◽

Care Physician ◽

Local Health Authority ◽

Local Health ◽

Cross Sectional Survey ◽

Patient Centered ◽

Cross Sectional ◽

Factors Affecting

Deprescribing is a patient-centered process of medication withdrawal intended to achieve improved health outcomes through discontinuation of one or more medications that are either potentially harmful or no longer required. The objective of this study was to assess the perceptions of primary care physicians on deprescribing and potential barriers to deprescribing in the Local Health Authority (LHA) of Turin, Piedmont, Italy. Secondary objective was to evaluate educational needs of primary care physician. Cross sectional survey of primary care physicians working in the LHA of Turin, Piedmont, Italy. 439 GPs (71.3% of the total number of primary care physicians) attended an educational session related to deprescribing and were asked to anonymously answer a paper survey. Participants were asked to complete a previously published questionnaire about deprescribing and potential factors affecting the deprescribing process. A correlation coefficient was calculated to assess the association between physicians’ confidence in deprescribing and attitudes or barriers associated with deprescribing. Many GPs (71%) reported general confidence in their ability to deprescribe. Most respondents (83%) reported they were comfortable deprescribing preventive medications, however almost half expressed doubts regarding deprescribing when medication was initially prescribed by a colleague (45%) or when patient and/or caregiver supported the opportunity to continue the assumption (49%). Around a third of doctors maintain that the absence of strong evidence supporting deprescribing prevents them from considering it (38%), that they do not have the necessary time to effectively go through the process of deprescribing (29%), and that fear of possible effects due on withdrawal prevents them from deprescribing (31%). There was no strong correlation between physicians’ confidence and attitudes or barriers associated with deprescribing. The present study confirms that general practitioners sense the importance of deprescribing and feel prepared to face it managing communication with patients and caregivers, but find barriers when enacting the practice in a real-life context.

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