The complex phenomenon of dysrational antibiotics prescribing decisions in German primary healthcare: a qualitative interview study using dual process theory

• Published in: Antimicrobial resistance & infection control 2020-01, Vol.9 (1), p.6-11, Article 6
• Main Authors: Poss-Doering, Regina, Kamradt, Martina, Stuermlinger, Anna, Glassen, Katharina, Kaufmann-Kolle, Petra, Andres, Edith, Wensing, Michel
• Format: Article
• Language: English
• Subjects: Adult; Aged; Ambulatory care; Analysis; Antibiotics; Antimicrobial agents; Antimicrobial resistance; Clinical Decision-Making; Decision making; Demographics; Disease control; Drug Prescriptions; Drug resistance; Dual process theory; Evidence-based medicine; Germany; Health aspects; Health services; Humans; Inappropriate Prescribing - prevention & control; Inappropriate Prescribing - psychology; Infection; Infections; Intervention; Interviews; Interviews as Topic; Male; Microbial drug resistance; Middle Aged; Models, Theoretical; Non-complicated infections; Organizational change; Physicians; Physicians - psychology; Practice Patterns, Physicians; Prescriptions (Drugs); Primary care; Primary Health Care; Qualitative research; Quality circles; Rational antibiotics use; Researchers; Sociodemographics; Studies; Upskilling
• ISSN: 2047-2994; 2047-2994
• DOI: 10.1186/s13756-019-0664-6

Antibiotic prescription rates in primary care in Germany are moderate, but still considered too high. The ARena study (Sustainable reduction of antibiotic-induced antimicrobial resistance) was initiated to foster awareness and understanding of the growing challenge and promotes rational antibiotics use for acute, non-complicated and self-limiting infections. The present study was performed as part of the process evaluation of the ARena study. Interviews were conducted with a purposive sample of physicians participating in the ARena study to identify factors relevant to primary care physicians' decision-making when prescribing antibiotics for acute non-complicated infections. Generated data were audio-recorded. Pseudonymized verbatim transcripts were coded using a pre-defined framework. The Dual Process Theory was applied to provide understanding of individual health professional factors that induce dysrational prescribing decisions. Based on medical as well as non-medical considerations, physicians developed habits in decision making on antibiotics prescribing. They acknowledged inadequate antibiotics prescribing for acute, non-complicated infections in situations involving uncertainty regarding diagnosis, prognosis, continuity of care, patient expectations and when not knowing the patient. Educative efforts empowered physicians to override habitual prescribing. A theory-driven model provides transparency as to how dysrational prescribing decisions occur and suggests remedy by providing new experiences and new recognizable patterns through educative efforts. Educational interventions may only change prescribing behaviours if they result in active rational rather than routine-based decision-making on antibiotics prescribing. ISRCTN, ISRCTN58150046.