The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting

Abstract

Background Perceived patient demand for antibiotics drives unnecessary antibiotic prescribing in outpatient settings, but little is known about how clinicians experience this demand or how this perceived demand shapes their decision-making. Objective To identify how clinicians perceive patient demand for antibiotics and the way these perceptions stimulate unnecessary prescribing. Methods Qualitative study using semi-structured interviews with clinicians in outpatient settings who prescribe antibiotics. Interviews were analyzed using conventional and directed content analysis. Results Interviews were conducted with 25 clinicians from nine practices across three states. Patient demand was the most common reason respondents provided for why they prescribed non-indicated antibiotics. Three related factors motivated clinically unnecessary antibiotic use in the face of perceived patient demand: (i) clinicians want their patients to regard clinical visits as valuable and believe that an antibiotic prescription demonstrates value; (ii) clinicians want to avoid negative repercussions of denying antibiotics, including reduced income, damage to their reputation, emotional exhaustion, and degraded relationships with patients; (iii) clinicians believed that certain patients are impossible to satisfy without an antibiotic prescription and felt that efforts to refuse antibiotics to such patients wastes time and invites the aforementioned negative repercussions. Clinicians in urgent care settings were especially likely to describe being motivated by these factors. Conclusion Interventions to improve antibiotic use in the outpatient setting must address clinicians’ concerns about providing value for their patients, fear of negative repercussions from denying antibiotics, and the approach to inconvincible patients.

“There is no one to pick up the pieces”: Sustainability of antibiotic stewardship programs in nursing homes

“…[24][25][26] Furthermore, medically fragile residents make diagnostic processes challenging, 21,24,27,28 and our participants struggled to sustain and balance antibiotic stewardship with the clinical uncertainties of the population. These inner contextual factors along with external factors, such as regulations and pressure from families and residents to prescribe antibiotics, 15,29,30 affected ASP sustainability in nursing homes.…”

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.…”

Antimicrobial stewardship in the outpatient setting: A review and proposed framework

“…Patient expectations (or clinician perception of their expectations) may impact antibiotic prescribing. 10 In a recent study, only 19% of patients with ARI symptoms contacted their doctors, but more than half of these patients expected antibiotics. 11 Unfortunately, clinicians generally do not have a good sense of when these expectations are present.…”