Utilization of clinical practice guideline on antimicrobial in China: an exploratory survey on multilevel determinants

Abstract

Background: Nowadays, irrational use of antimicrobials has threatened public health. It's necessary to expand the use of clinical practice guideline (CPG) on antimicrobial for facilitating the proper use of antimicrobial. However, the utilization status of CPG on antimicrobial and the influencing factors, especially the ones at the organizational level, remain largely unknown. Methods: A cross-sectional questionnaire survey was conducted on a sample among physicians from 16 public hospitals in the eastern, central and western parts of China. A multilevel regression model was employed to examine factors associated with physicians' utilization of CPG on antimicrobial. Results: A total of 815 physicians were included in this study. About 80% of the surveyed physicians reported their adherence to the CPG on antimicrobial. Dimensions of "subjective norm", "perceived risk" and "behavioral intention" from the domain of physician belief, a dimension of "ease of use" from the domain of CPG traits, and dimensions of "top management support" and "organization & implementation" from the domain of hospital practice were significantly associated with physicians' utilization of CPG on antimicrobial. And except for working department, most demographics characteristics of the physician were not found to be significantly related to the CPG use. In addition, it also showed that region is a significant factor affecting physicians' CPG use. Conclusions: This study depicted the current status of CPG on antimicrobial and comprehensively identified its potential determinants not only from the three domains at the individual level, such as physician belief, but also from the location region at the organizational level. The results will provide a direct reference for the implementation of CPG on antimicrobial.

Understanding factors influencing the use of clinical guidelines in low-income and middle-income settings: a scoping review

“…Supportive leadership and management that facilitate guideline implementation are also cited as major enablers of guideline adoption 3 14 16–18 20–22 24 25 27 30 32 33 38 40 43 44 46 49 52 53. Leadership and management that encourage guideline use require dissemination of the explicit details of the implementation strategy for guideline use 40 48 52…”

“…The use of clinical guidelines can be constrained by healthcare provider perceptions of the guidelines, including their confidence in the quality of clinical guidelines,37 42 44 views on whether the use of clinical guidelines threatens their professional autonomy,21 25 32 54 interest in or attitude to evidence-based management,13 16 22 prioritising experience or personal beliefs 14 19 27 43 47. Individual beliefs on the consequences of guideline adherence including clinical outcomes, improving drug prescription efficiency, time and money savings and legal repercussions were also enablers in clinical guideline usage 30 35 52…”

Predictors of physicians’ intentions to use clinical practice guidelines on antimicrobial in tertiary general hospitals of China: a structural equation modeling approach

“…In terms of hospital level, it is reported that physicians’ intentions and utilization of using CPGs on antimicrobials were significantly influenced by top management support [ 48 ]. As influential people in the hospitals, top managers play important roles in developing the organizational vision and culture, as well as shaping the expected behavior and norms of physicians [ 49 ].…”

The Effect of Social Norms on Physicians’ Intentions to Use Liver Cancer Screening: A Cross-Sectional Study Using Extended Theory of Planned Behavior

“…To date, the TPB has been applied in considerable research about health professionals' intentions, 10 including the acceptance of innovative health technology, 11,12 and the adherence to clinical guidelines. 13 Moreover, numerous TPB studies have explained over fifty percent of the total variance of intentions. [14][15][16] According to Ajzen, "TPB is principally open to the inclusion of additional predictors if it can be shown that they capture a significant proportion of the variance".…”