Barriers and facilitators to prudent antibiotic prescribing for acute respiratory tract infections: A qualitative study with general practitioners in Malta

• Published in: PloS one Vol. 16; no. 2; p. e0246782
• Main Authors: Saliba-Gustafsson, Erika A, Nyberg, Anna, Borg, Michael A, Rosales-Klintz, Senia, Stålsby Lundborg, Cecilia
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 11-02-2021; Public Library of Science (PLoS)
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotic resistance; Antibiotics; Attitude of Health Personnel; Beliefs, opinions and attitudes; Biology and Life Sciences; Consumption; Diagnosis; Disease control; Dosage and administration; Drug Prescriptions; Drug stores; Drug therapy; Drugs; Editing; Electronic mail; Ethics; Funding; General Practitioners; Health care; Health risks; Heat shock proteins; Humans; Infections; Interviews; Malta; Medicin och hälsovetenskap; Medicine; Medicine and Health Sciences; Methodology; Patients; People and places; Pharmacy; Physicians (General practice); Practice Patterns, Physicians; Prescribing; Prevention; Primary care; Public health; Public policy; Qualitative Research; Respiratory tract; Respiratory tract diseases; Respiratory tract infection; Respiratory tract infections; Respiratory Tract Infections - drug therapy; Services; Social Sciences; Surgery; Malta; Sweden; Europe
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0246782

Antibiotic resistance is a leading global public health concern and antibiotic use is a key driver. Effective interventions are needed to target key stakeholders, including general practitioners (GPs). In Malta, little is known about factors that influence GPs' antibiotic prescribing, making it challenging to implement targeted interventions. We therefore aimed to explore GPs' understanding of antibiotic use and resistance, and describe their perceived barriers and facilitators to prudent antibiotic prescribing for acute respiratory tract infections in Malta.
Face-to-face individual semi-structured interviews were held with a quota sample of 20 GPs in 2014. Interviews were audio recorded and transcribed verbatim, and later analysed iteratively using manifest and latent content analysis. Findings were collated in a socioecological model to depict how GPs as individuals are embedded within larger social systems and contexts, and how each component within this system impacts their prescribing behaviour.
We found that GPs' antibiotic prescribing decisions are complex and impacted by numerous barriers and facilitators at the individual, interpersonal, organisational, community, and public policy level. Predominant factors found to impact GPs' antibiotic prescribing included not only intrinsic GP factors such as knowledge, awareness, experience, and misconceptions, but also several external factors. At the interpersonal level, GPs' perceived patient demand and behaviour to be a persistent issue that impacts their prescribing decisions. Similarly, some GPs found pressure from drug reps to be concerning despite being considered an important source of information. Organisational and public policy-level issues such as lack of access to relevant antibiotic prescribing guidelines and current antibiotic resistance data from the community, were also considered major barriers to appropriate antibiotic prescribing. Utilisation of diagnostic testing was found to be low and GPs' perceptions on the introduction of rapid point-of-care tests to support antibiotic prescription decisions, were mixed.
This study revealed the complexity of the antibiotic prescribing decision and the numerous barriers and facilitators that impact it, visualised through a socioecological model. Addressing GPs' antibiotic prescribing practices will require targeted and coordinated implementation activities at all levels to change behaviour and address misconceptions, whilst also improving the physical and social environment.
NCT03218930; https://clinicaltrials.gov/ct2/show/NCT03218930.