Determinants of antibiotic prescribing in primary care in Vietnam: a qualitative study using the Theoretical Domains Framework

Determinants of antibiotic prescribing in primary care in Vietnam: a qualitative study using the Theoretical Domains Framework

To formulate effective strategies for antimicrobial stewardship (AMS) in primary care, it is crucial to gain a thorough understanding of factors influencing prescribers' behavior within the context. This qualitative study utilizes the Theoretical Domains Framework (TDF) to uncover these influen...

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Published in:Antimicrobial resistance & infection control Vol. 13; no. 1; pp. 115 - 12
Main Authors: Vu Minh, Duy, Nguyen Thi Hong, Yen, Nagraj, Shobhana, Do Thi Thuy, Nga, Vu Thi Lan, Huong, Nguyen Vinh, Nam, Nguyen Thi Cam, Tu, Nguyen Hai, Yen, Cai Ngoc Thien, Huong, Tran Thi, Hang, Nguyen Yen, Nhi, Alban, Hannah, Khuong Thanh, Vinh, Duong Thi Thanh, Huyen, Tran Huy, Hoang, Van Nuil, Jennifer, Lewycka, Sonia
Format: Journal Article
Language:English
Published: England BioMed Central Ltd 30-09-2024
BioMed Central
BMC
Subjects:
Adult
Analysis
Anti-Bacterial Agents - therapeutic use
Antibiotic prescribing
Antibiotic stewardship
Antibiotics
Antimicrobial resistance
Antimicrobial Stewardship
Attitude of Health Personnel
Drug Prescriptions
Drug resistance in microorganisms
Female
Focus Groups
Health Knowledge, Attitudes, Practice
Humans
Information management
Male
Middle Aged
Pharmacists
Physician and patient
Practice Patterns, Physicians
Primary care
Primary Health Care
Qualitative Research
Theoretical domains framework
Vietnam
Vietnam
Theoretical domains framework
Antimicrobial resistance
Antibiotic stewardship
Primary care
Antibiotic prescribing
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Summary:To formulate effective strategies for antimicrobial stewardship (AMS) in primary care, it is crucial to gain a thorough understanding of factors influencing prescribers' behavior within the context. This qualitative study utilizes the Theoretical Domains Framework (TDF) to uncover these influential factors. We conducted a qualitative study using in-depth interviews and focus group discussions with primary care workers in two provinces in rural Vietnam. Data analysis employed a combined inductive and deductive approach, with the deductive aspect grounded in the TDF. Thirty-eight doctors, doctor associates, and pharmacists participated in twenty-two interviews and two focus group discussions. We identified sixteen themes, directly mapping onto seven TDF domains: knowledge, skills, behavioral regulation, environmental context and resources, social influences, social/professional role and identity, and optimism. Factors driving unnecessary prescription of antibiotics include low awareness of antimicrobial resistance (AMR), diagnostic uncertainty, prescription-based reimbursement policy, inadequate medication supplies, insufficient financing, patients' perception of health insurance medication as an entitlement, and maintaining doctor-patient relationships. Potential factors facilitating AMS activities include time availability for in-person patient consultation, experience in health communication, and willingness to take action against AMR. Utilizing the TDF to systematically analyze and present behavioral determinants offers a structured foundation for designing impactful AMS interventions in primary care. The findings underscore the importance of not only enhancing knowledge and skills but also implementing environmental restructuring, regulation, and enablement measures to effectively tackle unnecessary antibiotic prescribing in this context.
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ISSN:2047-2994
2047-2994
DOI:10.1186/s13756-024-01471-9