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Published on: August 30, 2018
Factors influencing antimicrobial decision-making in respiratory tract infections: A qualitative interview study with
Savannah Reali1, Jin-Gun Cho2, Jan-Willem Alffenaar1
1School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia; Westmead Hospital, Westmead, Australia; The University of Sydney Institute for Infectious Diseases (Sydney ID), The University of Sydney, Westmead, Australia.
Background:
Respiratory tract infections (RTIs) have one of the highest rates of inappropriate antimicrobial use, which contributes to antimicrobial resistance (AMR) and poor patient outcomes. This study aimed to describe factors that influence physicians and antimicrobial stewardship (AMS) pharmacists' decision-making around antimicrobials prescribed in hospitalised patients with RTIs.
Methods:
Semi-structured interviews were conducted with physicians and AMS pharmacists from hospitals in New South Wales, Australia. Interviews were audio-recorded, transcribed verbatim, and coded for inductive thematic analysis.
Results:
Seventeen participants (ten AMS pharmacists and seven physicians) were interviewed. Five themes influencing antimicrobial decision-making were identified: considerations in the diagnosis of RTIs, harm to the patient and the physician, clinical experience and knowledge, ease of using an antimicrobial, and desire to minimise AMR. Diagnoses of RTIs were reported to be at times difficult and focused on speculating if symptoms were infective and what the likely pathogen was. Consideration was given to the likely patient harm based on the infection, medical history, and comorbidities, as well as the feasibility of antimicrobial administration and resistance. Clinical experience influenced these considerations and decisions. There was a desire amongst healthcare professionals to minimise antimicrobial use and prescribe optimally.
Conclusions:
Concerns for patient deterioration, diagnostic difficulty in RTIs and uncertainty, lack of AMS knowledge and training, and administration constraints challenged optimal prescribing of antimicrobials. Improving equity of access to diagnostics, ensuring proper AMS training for healthcare professionals, and finding solutions to administration issues with narrow spectrum antimicrobials will assist in optimising antimicrobial prescribing and potentially mitigating AMR.
Insights
Physicians and pharmacists face challenges in prescribing antimicrobials for respiratory tract infections (RTIs), influenced by diagnostic uncertainty and a desire to minimize antimicrobial resistance (AMR). Optimizing prescribing requires better diagnostics and training.
Area of Science:
- Infectious Diseases
- Antimicrobial Stewardship
- Public Health
Background:
- Respiratory tract infections (RTIs) are frequently associated with inappropriate antimicrobial use.
- This contributes significantly to antimicrobial resistance (AMR) and adverse patient outcomes.
- Understanding decision-making factors for antimicrobial prescribing in RTIs is crucial.
Purpose of the Study:
- To explore factors influencing antimicrobial prescribing decisions for hospitalized patients with RTIs.
- To identify challenges faced by physicians and antimicrobial stewardship (AMS) pharmacists.
Main Methods:
- Conducted semi-structured interviews with physicians and AMS pharmacists in New South Wales, Australia.
- Utilized inductive thematic analysis on transcribed interview data.
- Involved 17 participants (7 physicians, 10 AMS pharmacists).
Main Results:
- Identified five key themes influencing decisions: diagnostic considerations, patient/physician harm, clinical experience, ease of use, and AMR minimization.
- Diagnostic difficulty and uncertainty regarding infective symptoms and pathogens were common.
- Considerations included patient harm, comorbidities, and antimicrobial administration feasibility and resistance.
Conclusions:
- Diagnostic uncertainty, concerns about patient deterioration, limited AMS knowledge, and administration constraints hinder optimal antimicrobial prescribing for RTIs.
- Improving access to diagnostics and enhancing AMS training are vital.
- Addressing administration issues with narrow-spectrum antimicrobials can aid in optimizing prescribing and mitigating AMR.
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