Physician Perceptions and Attitudes Towards an Antimicrobial Stewardship Program and Computerized Decision-making Systems: A Focus Group Study

Abstract

Background. Antimicrobial stewardship programs (ASPs) ofen employ multi-pronged strategies, including Computerized Decision Support Systems (CDSSs), to promote appropriate hospital antibiotic prescribing. Physicians are key determinants of the program's effectiveness; yet little is known about their attitudes towards these interventions. We aimed to examine hospital physicians' attitudes toward ASPs and their delivery via computerized systems, and their potential infuence on physician antibiotic prescribing habits. Methods. The focus group study was conducted in a large acute tertiary care teaching hospital in Singapore. We recruited physicians by purposive sampling and snowballing. Focus group discussions (FGDs) for junior and senior physicians were conducted separately. Tey were audio-recorded and transcripts were independently coded with subsequent adjudication. Major themes on facilitators and barriers to the adoption of ASPs were extracted. FGDs and coding occurred concurrently, consistent with the grounded theory approach. Results. Twenty-nine junior physicians and eight senior physicians participated in six and two FGDs respectively. Teme saturation was achieved. Two motivators for adoption of ASPs were: (1) helpfulness of ASP initiatives/strategies; and (2) ASP team members' proactive contact, both of which guide antibiotic prescription. Four barriers were identified: (1) the primary team's clinical judgment is deemed of utmost importance; (2) the attending physician makes the final decision; (3) lack of awareness of ASP initiatives/strategies; and (4) complexity of the CDSS. Conclusion. Temes extracted from the FGDs revealed that communication and education has a major infuence on the adoption of ASP. The authors proposed a set of solutions for enhanced uptake of ASP initiatives through inter-professional collaboration. Future work is needed to identify the best and most effective methods to enhance collaboration between the physicians and the ASP team to improve antibiotic prescribing habits.