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Factors Influencing Antibiotic-Prescribing Decisions Among Inpatient Physicians: A Qualitative Investigation

Published online by Cambridge University Press:  16 June 2015

Daniel Livorsi ,
Amber Comer ,
Marianne S. Matthias ,
Eli N. Perencevich  and
Matthew J. Bair
Daniel Livorsi*
Affiliation:
Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana
Amber Comer
Affiliation:
Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
Marianne S. Matthias
Affiliation:
Veterans Affairs Health Services Research and Development Service Center for Health Information and Communication, Richard Roudebush VA Medical Center, Indianapolis, Indiana Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana
Eli N. Perencevich
Affiliation:
Division of General Internal Medicine and Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa Iowa City VA Health Care System, Iowa City, Iowa
Matthew J. Bair
Affiliation:
Veterans Affairs Health Services Research and Development Service Center for Health Information and Communication, Richard Roudebush VA Medical Center, Indianapolis, Indiana Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana
*
Address correspondence to Daniel Livorsi, MD, MSc, Assistant Professor, Division of Infectious Diseases, Indiana University School of Medicine, 545 Barnhill Drive, EH 421 Indianapolis, IN 46202 ([email protected]).
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Abstract

OBJECTIVE

To understand the professional and psychosocial factors that influence physician antibiotic prescribing habits in the inpatient setting.

DESIGN

We conducted semi-structured interviews with 30 inpatient physicians. Interviews consisted of open-ended questions and flexible probes based on participant responses. Interviews were audio recorded, transcribed, de-identified, and reviewed for accuracy and completeness. Data were analyzed using emergent thematic analysis.

SETTING

Two teaching hospitals in Indianapolis, Indiana

PARTICIPANTS

A total of 30 inpatient physicians (10 physicians-in-training, 20 supervising staff) were enrolled in this study.

RESULTS

Participants recognized that antibiotics are overused, and many admitted to prescribing antibiotics even when the clinical evidence of infection was uncertain. Overprescription was largely driven by anxiety about missing an infection, whereas potential adverse effects of antibiotics did not strongly influence decision making. Participants did not routinely disclose potential adverse effects of antibiotics to inpatients. Physicians-in-training were strongly influenced by the antibiotic prescribing behavior of their supervising staff physicians. Participants sometimes questioned their colleagues’ antibiotic prescribing decisions, but they frequently avoided providing direct feedback or critique. These physicians cited obstacles of hierarchy, infrequent face-to-face encounters, and the awkwardness of these conversations.

CONCLUSION

A physician-based culture of prescribing antibiotics involves overusing antibiotics and not challenging the decisions of colleagues. The potential adverse effects of antibiotics did not strongly influence decision making in this sample. A better understanding of these factors could be leveraged in future efforts to improve antibiotic prescribing practices in the inpatient setting.

Infect. Control Hosp. Epidemiol. 2015;36(9):1065–1072

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Supplement 9 , September 2015 , pp. 1065 - 1072
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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