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Determinants of physician antibiotic prescribing behavior: a 3 year cohort study in Portugal
António Teixeira Rodrigues1,2, Mónica Ferreira1, Maria Piñeiro-Lamas3
1a Department of Medical Sciences and Institute for Biomedicine - iBiMED , University of Aveiro , Aveiro , Portugal ;
Abstract:
Objectives Antibiotic misprescription is a major driver of resistance, which is a worldwide public health problem. Therefore, our aim is to assess the influence of the determinants of physician prescribing on the quality of antibiotic use. Methods A 3 year cohort study including all primary-care physicians working in Portugal's Central Regional Health Administration (n = 1094) was conducted. We assessed the determinants of prescribing using a pre-validated, personally addressed, reply-paid, self-administered questionnaire (sent four times to non-responders, between September 2011 and February 2012) designed to collect information on physicians' attitudes to and knowledge of antibiotic prescribing as well as their socio-demographic and professional data. To evaluate antibiotic prescribing, we've calculated ESAC 12 quality indicators per physician per year, allowing us to stratify them as good or poor prescribers according to their performance on those indicators. Associations between determinants and outcomes were fitted with generalized linear mixed models. Results The overall response rate was 46.1%. Emergency activity (OR [95% CI] = 0.29 [0.16-0.54]; p < 0.05) and workload (number of patients seen per day: OR [95% CI] = 0.97 [0.94-1.00]; p < 0.05; number of patients seen per week in emergencies: OR [95% CI] = 0.98 [0.97-0.99]; p < 0.05) were both related to poor quality of antibiotic prescribing. Statistically significant odds ratios were also obtained for ignorance (IqOR [95% CI] = 2.14 [1.31-3.52]), complacency (1/IqOR [95% CI] = 1.19 [1.01-1.41]) and responsibility of others (1/IqOR [95% CI] = 1.78 [1.10-3.06]). Conclusions The above results serve to emphasize workload, working at emergency departments and physicians' attitudes identified as critical factors affecting antibiotic prescribing. This provides new insights for clinicians, researchers and policy makers when it comes to developing and improving the clinical and economic outcomes of antibiotic use. Key limitations of the study included the difficulty of results extrapolation and the limitations of the stratification method based on the antibiotic prescribing quality indicators.
Insights
Physician workload, emergency department work, and prescribing attitudes significantly impact antibiotic prescription quality. Addressing these factors is crucial for improving antibiotic use and combating resistance.
Area of Science:
- Public Health
- Infectious Diseases
- Health Services Research
Background:
- Antibiotic resistance is a global public health crisis driven by inappropriate antibiotic use.
- Understanding the factors influencing physician prescribing behavior is essential for improving antibiotic stewardship.
Purpose of the Study:
- To assess how physician-specific determinants influence the quality of antibiotic prescribing in primary care.
- To identify key factors associated with both good and poor antibiotic prescribing practices.
Main Methods:
- A 3-year cohort study of 1094 primary care physicians in Portugal.
- A validated questionnaire collected data on physician knowledge, attitudes, and socio-demographic factors.
- Antibiotic prescribing quality was evaluated using ESAC 12 indicators, stratifying physicians as good or poor prescribers.
Main Results:
- High workload (patients per day/week) and emergency department activity were linked to poorer antibiotic prescribing quality.
- Physician ignorance, complacency, and a tendency to attribute prescribing issues to others were significantly associated with poor prescribing.
- The study achieved a 46.1% response rate.
Conclusions:
- Physician workload, emergency department practice, and attitudes towards prescribing are critical determinants of antibiotic prescribing quality.
- These findings offer insights for developing targeted interventions to improve antibiotic use and clinical outcomes.
- Policy makers and clinicians should consider these factors when designing antibiotic stewardship programs.
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