Abstract
Background
Antimicrobial resistance is a threat to human health. We need to strive for a rational use of antibiotics to reduce the selection of resistant bacteria. Most antibiotics are prescribed in general practice, but little is known about factors influencing general practitioners’ (GPs) decision-making when prescribing antibiotics.
Aim
To 1) assess the importance of factors that influence decisions by GPs to prescribe antibiotics for acute respiratory tract infections (RTIs) and 2) identify segments of GPs influenced differently when deciding to prescribe antibiotics.
Methods
A questionnaire survey including a discrete choice experiment was conducted. Danish GPs were asked to indicate whether they would prescribe antibiotics in six hypothetical choice sets with six variables: whether the GP is behind schedule, patient's temperature, patient's general condition, lung auscultation findings, C-reactive protein (CRP) level, and whether the patient expects antibiotics. Error component and latent class models were estimated and the probabilities of prescribing in different scenarios were calculated.
Results
The questionnaire was distributed to every Danish GP (n = 3,336); 1,152 (35%) responded. Results showed that GPs were influenced by (in prioritised order): CRP level (Relative importance (RI) 0.54), patient's general condition (RI 0.20), crackles at auscultation (RI 0.15), and fever (RI 0.10). Being behind schedule and patient expectations had no significant impact on antibiotic prescription at the aggregate level. The latent class analysis identified five classes of GPs: generalists, CRP-guided, general condition-guided, reluctant prescribers, and stethoscopy-guided. For all classes, CRP was the most important driver, while GPs were heterogeneously affected by other drivers.
Conclusion
The most important factor affecting Danish GPs’ decision to prescribe antibiotics at the aggregate level, in subgroups of GPs, and across latent classes was the CRP value. Hence, the use of CRP testing is an important factor to consider in order to promote rational antibiotic use in the battle against antimicrobial resistance.
Antimicrobial resistance is a threat to human health. We need to strive for a rational use of antibiotics to reduce the selection of resistant bacteria. Most antibiotics are prescribed in general practice, but little is known about factors influencing general practitioners’ (GPs) decision-making when prescribing antibiotics.
Aim
To 1) assess the importance of factors that influence decisions by GPs to prescribe antibiotics for acute respiratory tract infections (RTIs) and 2) identify segments of GPs influenced differently when deciding to prescribe antibiotics.
Methods
A questionnaire survey including a discrete choice experiment was conducted. Danish GPs were asked to indicate whether they would prescribe antibiotics in six hypothetical choice sets with six variables: whether the GP is behind schedule, patient's temperature, patient's general condition, lung auscultation findings, C-reactive protein (CRP) level, and whether the patient expects antibiotics. Error component and latent class models were estimated and the probabilities of prescribing in different scenarios were calculated.
Results
The questionnaire was distributed to every Danish GP (n = 3,336); 1,152 (35%) responded. Results showed that GPs were influenced by (in prioritised order): CRP level (Relative importance (RI) 0.54), patient's general condition (RI 0.20), crackles at auscultation (RI 0.15), and fever (RI 0.10). Being behind schedule and patient expectations had no significant impact on antibiotic prescription at the aggregate level. The latent class analysis identified five classes of GPs: generalists, CRP-guided, general condition-guided, reluctant prescribers, and stethoscopy-guided. For all classes, CRP was the most important driver, while GPs were heterogeneously affected by other drivers.
Conclusion
The most important factor affecting Danish GPs’ decision to prescribe antibiotics at the aggregate level, in subgroups of GPs, and across latent classes was the CRP value. Hence, the use of CRP testing is an important factor to consider in order to promote rational antibiotic use in the battle against antimicrobial resistance.
| Original language | English |
|---|---|
| Article number | 115033 |
| Number of pages | 9 |
| Journal | Social Science and Medicine |
| Volume | 305 |
| Early online date | 23 May 2022 |
| DOIs | |
| Publication status | Published - 1 Jul 2022 |
Bibliographical note
Study data were collected using REDCap (Research Electronic Data Capture) electronic data capture tools hosted at The Open Patient data Explorative Network (Harris and Taylor, 2019; Harris and Taylor, 2009; OPEN, 2020). The authors would like to thank Jonathan Howard Sydenham for proofreading the manuscript. Financial support for this study was provided in part by grants from the Danish Ministry of Health (grant number 1608957), the Faculty of Health Sciences at University of Southern Denmark, The Region of Southern Denmark (grant number 15/51294), the Danish Foundation for General Practice (grant numbers R38-A947 and EMN-2017-01317), and Knud and Edith Eriksen’s Foundation (grant number 62786). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the manuscript.Data Availability Statement
Supplementary data to this article can be found online at https://doi.org/10.1016/j.socscimed.2022.115033.Keywords
- Antibiotics
- Anti-microbial medicine
- Infectious diseases
- Respiratory tract infections
- Discrete choice experiment
- Stated preference
- Primary health care
- General practice
Access to Document
- Sydenham_etal_SSM_Prescribing_Antibiotics_Factors_VoR
This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).