Primary Care Physicians’ Attitudes and Perceptions Towards Antibiotic Resistance and Antibiotic Stewardship: A National Survey

Abstract

Background Outpatient antibiotic stewardship is needed to reduce inappropriate prescribing and minimize the development of resistant bacteria. We assessed primary care physicians’ perceptions of antibiotic resistance, antibiotic use, and the need for stewardship activities. Methods We conducted a national online survey of 1,550 internal, family, and pediatric medicine physicians in the United States recruited from an opt-in panel of healthcare professionals. Descriptive statistics were generated for respondent demographics and question responses. Responses were also stratified by geographic region and medical specialty, with a χ2 test used to assess for differences. Results More respondents agreed that antibiotic resistance was a problem in the US (94%) than in their practice (55%) and that inappropriate antibiotic prescribing was a problem in outpatient settings (91%) than in their practice (37%). Additionally, 60% agreed that they prescribed antibiotics more appropriately than their peers. Most respondents (91%) felt that antibiotic stewardship was appropriate in office-based practices, but ranked antibiotic resistance as less important than other public health issues like obesity, diabetes, opioids, smoking, and vaccine hesitancy. About half (47%) felt they would need a lot of help to implement stewardship. Respondents indicated that they were likely to implement antibiotic stewardship efforts in response to feedback or incentives provided by payers or health departments. Conclusions PCPs generally did not recognize antibiotic resistance and inappropriate prescribing as issues in their practice. This poses a challenge for the success of outpatient stewardship. Healthcare stakeholders will need to explore opportunities for feedback and incentive activities to encourage stewardship uptake.

Behavioral Economics and Ambulatory Antibiotic Stewardship: A Narrative Review

“…52 , 53 Although antibiotic resistance looms large in the minds of researchers and policymakers, as a rationale for avoiding inappropriate prescribing, antibiotic resistance is generally of low priority to the public, patients, and clinicians. [54][55][56][57] Although not as great a cost as many other clinical problems, the inappropriate prescribing of antibiotics increases costs through unnecessary visits, antibiotic use, complications, and antibiotic resistance. Each ambulatory antibiotic prescription may be associated with a hidden societal cost of increasing antibiotic resistance of between 3 and 95 US dollars (USD).…”

“…Clinicians feel that they perform better than other clinicians or prescribers in other settings. 56,57 For example, in a survey of 323 physicians, 99% of respondents considered antibiotic resistance as a national problem, but only 63% believed that it was a problem in their workspace, and thus likely did not recognize antibiotic overprescribing as a concrete problem. 126 It is challenging to get someone to change their behavior if he feels his behavior is not problematic.…”

Validation of a Questionnaire for Patient Awareness and the Need for a Community-Based Outpatient Antimicrobial Stewardship Program (O-ASP): A Pilot Study

“…Therefore, targeted educational programs and committed personnel are required to develop and implement a successful ASP in outpatient settings. Further studies are necessary to evaluate interventions for improving antibiotic stewardship efforts, such as feedback or incentives provided by payers or government health departments [ 33 ].…”

Antimicrobial stewardship among Nigerian children: A pilot study of the knowledge, attitude, and practices of prescribers at two tertiary healthcare facilities in Bayelsa State

“…The FMC is a 425-bed hospital with a paediatrician staff strength of 50. Sample size: A sample size of 20 pediatricians was targeted, generally considered appropriate for a pilot study (23,24). To provide information on prescribing practices around pregnancy and childbirth, the survey was extended to prescribers with obstetrics and gynaecology (O&G) specialization, increasing the sample size to 40.…”