Evaluation of clinicians’ knowledge, attitudes, and planned behaviors related to an intervention to improve acute respiratory infection management

Abstract

Background:Acute respiratory tract infections (ARIs) are commonly diagnosed and major drivers of antibiotic prescribing. Clinician-focused interventions can reduce unnecessary antibiotic prescribing for ARIs. We elicited clinician feedback to design sustainable interventions to improve ARI management by understanding the mental framework of clinicians surrounding antibiotic prescribing within Veterans’ Health Administration clinics.Methods:We conducted one-on-one interviews with clinicians (n = 20) from clinics targeted for intervention at 5 facilities. The theory of planned behavior guided interview questions. Interviews were audio recorded and transcribed for qualitative analysis. An iterative coding approach identified 6 themes.Results:Emergent themes: (1) barriers to appropriate prescribing are multifactorial and include challenges of behavior change; (2) antibiotic prescribing decisions are perceived as autonomous yet, diagnostic uncertainty and perceptions of patient demand can make prescribing decisions difficult; (3) clinicians perceive variation in peer prescribing practices and influences; (4) clinician-focused interventions are valuable if delivered with sensitivity; (5) communication strategies for educating patients are preferred to a shared decisions process; and (6) team standardization of practice and communication are key to facilitate appropriate prescribing. Clinicians perceived audit-and-feedback with peer comparison, academic detailing, and enhanced patient communication strategies as viable approaches to improving appropriate prescribing.Conclusion:Implementation strategies that enable clinicians to overcome diagnostic uncertainty, perceived patient demand, and improve patient education are desired. Implementation strategies were welcomed, and some were more readily accepted (eg, audit feedback) than others (eg, shared decision making). Implementation strategies should address clinicians’ perceptions of antibiotic prescribing practices and should enhance their patient communication skills.

Autonomy, power dynamics and antibiotic use in primary healthcare: A qualitative study

“…Recent qualitative research on this area has explored service users' [32] and prescribers' [33][34][35][36][37] attitudes towards delayed antibiotic prescription, prescribers' attitudes and experiences on antibiotic prescribing [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54], service users' experiences on antibiotic use [38,39,48,51,[55][56][57][58], self-care treatments for ALRTIs [32,59], service users' [48,60] and health professionals' [47,48] understandings of AMR and antibiotic use, interactions between health Committee of the Institut de Recerca en Atenció Primària Jordi Gol i Gurina (IDIAPJGol) (contact via cei@idiapjgol.info) for researchers who meet the criteria for access to confidential data. For more information on data availability restrictions you can contact the ethics committee at cei@idiapjgol.info.…”

Association of antibiotics with veteran visit satisfaction and antibiotic expectations for upper respiratory tract infections

“…The decision to prescribe antibiotics is complex and influenced by many clinical and nonclinical factors. 8,[26][27][28] Nevertheless, our findings suggest that working with patients to understand what drives expectations could inform patient-focused interventions to reduce URI prescribing. Previous research has shown that it is feasible to change patients' expectations for antibiotics for URIs.…”

“…3 Many providers perceive that patients desire or expect antibiotics, 4,5 which strongly influences provider prescribing. [6][7][8] Although patient expectations for antibiotics may be decreasing over time, 5,9 a reported 50%-72% of patients expect antibiotics for URI-like symptoms. 6,[10][11][12] Many studies have shown increased patient satisfaction associated with antibiotic receipt; [13][14][15] others showed no association.…”

Factors influencing antibiotic prescribing by nurse practitioners: A quantitative pilot study using the theory of planned behavior

“…This sample is highly educated, often practices full-time in adult care specialties across inpatient and outpatient settings and is not a frequent antibiotic prescriber. Similar to other studies, most of the NPs are knowledgeable about the association between antibiotic overuse and the development of AR infections, as well as the importance of using evidence-based guidelines for prescribing antibiotics to optimize patient outcomes (Hamilton et al, 2020; Hruza et al, 2020; Knobloch et al, 2021). Surprisingly, almost 18% of participants failed to recognize that antibiotics are powerful drugs that carry a wide range of adverse effects, making this an important area to emphasize in any related educational offering.…”