Mike R Kohut1,2, Sara C Keller1,2, Jeffrey A Linder3, Pranita D Tamma1,4, Sara E Cosgrove1,2, Kathleen Speck1,2, Roy Ahn5, Prashila Dullabh5, Melissa A Miller6, Julia E Szymczak7. 1. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 2. Armstrong Institute for Patient Safety and Quality, Baltimore, MD. 3. Northwestern University Feinberg School of Medicine, Division of General Internal Medicine and Geriatrics, Chicago, IL. 4. Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD. 5. NORC at the University of Chicago, Chicago, IL. 6. Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, MD. 7. Perelman School of Medicine, University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics, Philadelphia, PA, USA.
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.
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.
Authors: Sima L Sharara; Alicia I Arbaje; Sara E Cosgrove; Ayse P Gurses; Kathryn Dzintars; Nicholas Ladikos; Sarojini Sonjia Qasba; Sara C Keller Journal: J Patient Saf Date: 2022-04-01 Impact factor: 2.844