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Provider views on rapid diagnostic tests and antibiotic prescribing for respiratory tract infections: A mixed methods
Shana A B Burrowes1,2, Tamar F Barlam1, Alexandra Skinner2
1Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, United States of America.
Background:
Respiratory tract infections (RTIs) are often inappropriately treated with antibiotics. Rapid diagnostic tests (RDTs) have been developed with the aim of improving antibiotic prescribing but uptake remains low. The aim of this study was to examine provider knowledge, attitudes and behaviors regarding RDT use and their relationship to antibiotic prescribing decisions across multiple clinical departments in an urban safety-net hospital.
Methods:
We conducted a mixed methods sequential explanatory study. Providers with prescribing authority (attending physicians, nurse practitioners and physician assistants) who had at least 20 RTI encounters from January 1, 2016 to December 31, 2018. Eighty-five providers completed surveys and 16 participated in interviews. We conducted electronic surveys via RedCap from April to July 2019, followed by semi-structured individual interviews from October to December 2019, to ascertain knowledge, attitudes and behaviors related to RDT use and antibiotic prescribing.
Results:
Survey findings indicated that providers felt knowledgeable about antibiotic prescribing guidelines. They reported high familiarity with the rapid streptococcus and rapid influenza tests. Familiarity with comprehensive respiratory panel PCR (RPP-respiratory panel PCR) and procalcitonin differed by clinical department. Qualitative interviews identified four main themes: providers trust their clinical judgment more than rapid test results; patient-provider relationships play an important role in prescribing decisions; there is patient demand for antibiotics and providers employ different strategies to address the demand and providers do not believe RDTs are implemented with sufficient education or evidence for clinical practice.
Conclusion:
Prescribers are knowledgeable about prescribing guidelines but often rely on clinical judgement to make final decisions. The utility of RDTs is specific to the type of RDT and the clinical department. Given the low familiarity and clinical utility of RPP and procalcitonin, providers may require additional education and these tests may need to be implemented differently based on clinical department.
Insights
Provider knowledge of antibiotic prescribing is high, but clinical judgment often overrides rapid diagnostic test (RDT) results. RDT utility varies by type and department, suggesting a need for tailored education and implementation strategies for better antibiotic stewardship.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Health Services Research
Background:
- Respiratory tract infections (RTIs) are frequently treated with antibiotics, leading to inappropriate use.
- Rapid diagnostic tests (RDTs) aim to improve antibiotic prescribing for RTIs, but their adoption is limited.
- Understanding provider perspectives on RDTs is crucial for enhancing their implementation and impact on antibiotic stewardship.
Purpose of the Study:
- To investigate healthcare provider knowledge, attitudes, and behaviors concerning RDT use in managing RTIs.
- To explore the relationship between provider perspectives on RDTs and their antibiotic prescribing decisions.
- To examine these factors across different clinical departments within an urban safety-net hospital.
Main Methods:
- A mixed-methods sequential explanatory study design was employed.
- Electronic surveys and semi-structured interviews were conducted with 85 and 16 prescribers, respectively.
- Data collection focused on provider knowledge, attitudes, and behaviors regarding RDTs and antibiotic prescribing for RTIs.
Main Results:
- Providers reported high confidence in antibiotic prescribing guidelines and familiarity with basic RDTs (e.g., rapid strep, influenza).
- Familiarity with advanced RDTs like respiratory panel PCR (RPP) and procalcitonin varied significantly by clinical department.
- Key themes included reliance on clinical judgment over RDTs, influence of patient-provider relationships and demand for antibiotics, and perceived lack of adequate RDT education and evidence.
Conclusions:
- While prescribers are knowledgeable about guidelines, clinical judgment remains paramount in prescribing decisions.
- The clinical utility of RDTs is context-dependent, varying by test type and clinical setting.
- Enhanced education and department-specific implementation strategies are needed for RPP and procalcitonin to improve their effective use in antibiotic stewardship.
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