Survey identifies 31 factors providers consider when making prescribing decisions
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Researchers used a survey to identify more than 30 unique factors that providers consider when making antibiotic prescribing decisions for common infections in acute-care settings.
The survey had been used in previous research, but a medical student at the University of Iowa Carver College of Medicine revisited the findings and found that the decision-making behind antibiotic prescribing can be complex.
“I attend the Carver College of Medicine, and here students get a 12-week summer between their first and second years. Myself and many of my peers pursue research opportunities for that time, and I was lucky enough to find this project in my search,” Evan T. Economos, BS, told Healio. “My advisor, Daniel J. Livorsi, MD, was very welcoming, and I had already found antibiotic stewardship both an important and interesting topic. His research group had previously performed a number of interviews for another project, but the transcripts had quite a bit of meat left on their bones.”
Economos and colleagues set out to identify and investigate what factors providers consider when they make antibiotic prescribing decisions. To do this, the study team used data from semistructured interviews with 49 health care workers at 15 geographically dispersed Veteran’s Health Administration hospitals between 2018 and 2019. According to the study, each site had a dedicated research coordinator trained to conduct qualitative interviews with the antibiotic stewardship program physician and pharmacist champion, as well as other key players including pharmacy administrators, hospitalists, ICU physicians and ED providers. The interviews explored barriers and facilitators to the adoption of antibiotic management policies for fluoroquinolones and extended-spectrum cephalosporins, as well as decisional factors that influence the use of any antibiotics for four common infections — pneumonia, UTIs, intra-abdominal infections and skin and soft tissue infections.
Ultimately, the study identified 31 individual factors that providers consider when making prescribing decisions that can be sorted into five categories: type of infection, patient-specific factors, contextual factors, provider-specific factors and drug-specific factors. According to the study, factors identified as type of infection included diagnostic test results, including microbiologic cultures and the complexity of the infection; patient-specific factors included age, comorbidities and the patient’s risk of having an antibiotic-resistant infection; contextual factors included local rates of antibiotic-resistant bacteria, social norms around antibiotic use and antibiotic restrictions; provider-specific factors included the provider’s knowledge, clinical instincts and relative concern, or the lack thereof, for antibiotic-related adverse outcomes; and drug-specific factors included antibiotic spectrum of activity, ease of dosing and oral bioavailability.
“There was a strong consensus that these decisions are complex and require the consideration of many of these factors at once,” Economos said.
Additionally, Economos noted that although many of the factors may seem obvious to clinicians who prescribe antibiotics, few studies have tried to broadly identify the multiple facets of these decisions.
“Because of this, this study may provide targets for better education for prescribers and ultimately better antibiotic stewardship,” he said.
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Economos ET, et al. Antimicrob Stewardship Healthcare Epidemiol. 2022;doi:10.1017/ash.2022.230.
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