Tags

Type your tag names separated by a space and hit enter

Attitudes of High Versus Low Antibiotic Prescribers in the Management of Upper Respiratory Tract Infections: a Mixed Methods Study.

Abstract

IMPORTANCE

Inappropriate antibiotic use for upper respiratory tract infections (URTIs) is an ongoing problem in primary care. There is extreme variation in the prescribing practices of individual physicians, which cannot be explained by clinical factors.

OBJECTIVE

To identify factors associated with high and low prescriber status for management of URTIs in primary care practice.

DESIGN AND PARTICIPANTS

Exploratory sequential mixed-methods design including interviews with primary care physicians in a large health system followed by a survey. Twenty-nine physicians participated in the qualitative interviews. Interviews were followed by a survey in which 109 physicians participated.

MAIN MEASURES

Qualitative interviews were used to obtain perspectives of high and low prescribers on factors that influenced their decision making in the management of URTIs. A quantitative survey was created based on qualitative interviews and responses compared to actual prescribing rates. An assessment of self-prescribing pattern relative to their peers was also conducted.

RESULTS

Qualitative interviews identified themes such as clinical factors (patient characteristics, symptom duration, and severity), nonclinical factors (physician-patient relationship, concern for patient satisfaction, preference and expectation, time pressure), desire to follow evidence-based medicine, and concern for adverse effects to influence prescribing. In the survey, reported concern regarding antibiotic side effects and the desire to practice evidence-based medicine were associated with lower prescribing rates whereas reported concern for patient satisfaction and patient demand were associated with high prescribing rates. High prescribers were generally unaware of their high prescribing status.

CONCLUSIONS AND RELEVANCE

Physicians report that nonclinical factors frequently influence their decision to prescribe antibiotics for URTI. Physician concerns regarding antibiotic side effects and patient satisfaction are important factors in the decision-making process. Changes in the health system addressing both physicians and patients may be necessary to attain desired prescribing levels.

Authors+Show Affiliations

Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA. Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA.Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA. Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA. Quantitative Health Services, Cleveland, OH, USA.Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.University Hospitals Portage Medical Center, Ravenna, OH, USA.Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA.Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA. rothbem@ccf.org. Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA. rothbem@ccf.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31630364

Citation

Patel, Aditi, et al. "Attitudes of High Versus Low Antibiotic Prescribers in the Management of Upper Respiratory Tract Infections: a Mixed Methods Study." Journal of General Internal Medicine, 2019.
Patel A, Pfoh ER, Misra Hebert AD, et al. Attitudes of High Versus Low Antibiotic Prescribers in the Management of Upper Respiratory Tract Infections: a Mixed Methods Study. J Gen Intern Med. 2019.
Patel, A., Pfoh, E. R., Misra Hebert, A. D., Chaitoff, A., Shapiro, A., Gupta, N., & Rothberg, M. B. (2019). Attitudes of High Versus Low Antibiotic Prescribers in the Management of Upper Respiratory Tract Infections: a Mixed Methods Study. Journal of General Internal Medicine, doi:10.1007/s11606-019-05433-5.
Patel A, et al. Attitudes of High Versus Low Antibiotic Prescribers in the Management of Upper Respiratory Tract Infections: a Mixed Methods Study. J Gen Intern Med. 2019 Oct 19; PubMed PMID: 31630364.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Attitudes of High Versus Low Antibiotic Prescribers in the Management of Upper Respiratory Tract Infections: a Mixed Methods Study. AU - Patel,Aditi, AU - Pfoh,Elizabeth R, AU - Misra Hebert,Anita D, AU - Chaitoff,Alexander, AU - Shapiro,Aryeh, AU - Gupta,Niyati, AU - Rothberg,Michael B, Y1 - 2019/10/19/ PY - 2019/05/09/received PY - 2019/09/24/accepted PY - 2019/08/23/revised PY - 2019/10/21/entrez PY - 2019/10/21/pubmed PY - 2019/10/21/medline KW - antibiotic prescribing KW - mixed methods KW - upper respiratory tract infections JF - Journal of general internal medicine JO - J Gen Intern Med N2 - IMPORTANCE: Inappropriate antibiotic use for upper respiratory tract infections (URTIs) is an ongoing problem in primary care. There is extreme variation in the prescribing practices of individual physicians, which cannot be explained by clinical factors. OBJECTIVE: To identify factors associated with high and low prescriber status for management of URTIs in primary care practice. DESIGN AND PARTICIPANTS: Exploratory sequential mixed-methods design including interviews with primary care physicians in a large health system followed by a survey. Twenty-nine physicians participated in the qualitative interviews. Interviews were followed by a survey in which 109 physicians participated. MAIN MEASURES: Qualitative interviews were used to obtain perspectives of high and low prescribers on factors that influenced their decision making in the management of URTIs. A quantitative survey was created based on qualitative interviews and responses compared to actual prescribing rates. An assessment of self-prescribing pattern relative to their peers was also conducted. RESULTS: Qualitative interviews identified themes such as clinical factors (patient characteristics, symptom duration, and severity), nonclinical factors (physician-patient relationship, concern for patient satisfaction, preference and expectation, time pressure), desire to follow evidence-based medicine, and concern for adverse effects to influence prescribing. In the survey, reported concern regarding antibiotic side effects and the desire to practice evidence-based medicine were associated with lower prescribing rates whereas reported concern for patient satisfaction and patient demand were associated with high prescribing rates. High prescribers were generally unaware of their high prescribing status. CONCLUSIONS AND RELEVANCE: Physicians report that nonclinical factors frequently influence their decision to prescribe antibiotics for URTI. Physician concerns regarding antibiotic side effects and patient satisfaction are important factors in the decision-making process. Changes in the health system addressing both physicians and patients may be necessary to attain desired prescribing levels. SN - 1525-1497 UR - https://www.unboundmedicine.com/medline/citation/31630364/Attitudes_of_High_Versus_Low_Antibiotic_Prescribers_in_the_Management_of_Upper_Respiratory_Tract_Infections:_a_Mixed_Methods_Study L2 - https://dx.doi.org/10.1007/s11606-019-05433-5 DB - PRIME DP - Unbound Medicine ER -