The influence of context on the antibiotic prescribing behaviour of healthcare professionals: implications for intervention

Abstract

Background Antibiotic resistance is a global threat and requires prudent use of antibiotics across healthcare contexts. Many antibiotics are prescribed unnecessarily in primary care for children with acute. Behavioural interventions have been successful in changing prescribing behaviour in general practice but research has not been undertaken in emergency departments (EDs). This study sought to identify influences on antibiotic prescribing behaviour in EDs. Methods Semi-structured interviews were carried out with clinicians working in two EDs. Purposive and opportunistic sampling was used to recruit clinicians with variation in role and speciality. HCPs were asked about their views on antibiotic prescribing for children with fever. Interviews were analysed following thematic analysis. Results In twenty five interviews, clinicians discussed the management of acutely unwell febrile children as routine with a variety of resources available to them to aid diagnosis. Few clinicians were aware of any antibiotic stewardship efforts in EDs and few reported incentives to prescribe more prudently. Clinicians’ views between the two EDs varied. Patient demand for antibiotics was discussed infrequently, with nurses most often reporting parent pressure to prescribe. Discussion Clinicians in EDs report different influences on their antibiotic prescribing behaviour compared to GPs, despite caring for similar populations. Whilst ED clinicians have more resources than GPs they lack incentives to improve their prescribing. Health psychology theory can help identify the mechanisms influencing behaviour in different contexts to design tailored interventions for specific healthcare settings. Behavioural interventions in EDs will help support consistency in care across all acute sectors.