Intentions, strategies and uncertainty inherent in antibiotic prescribing

Abstract

Objectives: Many interventions have been implemented in an attempt to correct physicians' seemingly nonprudent prescribing habits, but in general without great success. The aim of this study was to explore physicians' perceived reasons for deciding to prescribe antibiotics. Methods: Qualitative, semi-structured in-depth interviews with ten Icelandic general practitioners (GPs) were conducted, and three of them were observed at work. The interviews were tape recorded and transcribed in full, and field notes were taken during observations. Open, axial and selective coding was used in the analysis. Results: Several non-therapeutic aspects of prescribing emerged as important factors in the GPs' decision-making. The attitude of physicians towards prescribing of antibiotics in general, either restrictive or liberal, played a role, as uncertainty about prescribing, time pressure, individual patient characteristics (e.g., proneness to complain, job situation, compliance, prosperity) and relations with colleagues. Three decision-making routes leading to a prescription were identified: 1) The GP believes that the infection can/will interfere with the patient's planned activities, knows or thinks that the infection is or might be bacterial, and believes that antibiotics might help and will not harm. 2) The patient does not accept refusal and the GP lacks resources to explain why antibiotics are not appropriate. 3) The GP values patient autonomy higher than patient welfare. The primary purpose of prescribing antibiotics was to help patients to carry on with their everyday activities. Conclusions: Non-clinical factors seem at least as important as clinical factors in decision-making regarding antibiotic prescribing. Intervention planners should acknowledge this.