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01.08.2011 | Clinical and Epidemiological Study | Ausgabe 4/2011

Infection 4/2011

A national cross-sectional study on socio-behavioural factors that influence physicians’ decisions to begin antimicrobial therapy

Zeitschrift:
Infection > Ausgabe 4/2011
Autoren:
E. Velasco, W. Espelage, M. Faber, I. Noll, A. Ziegelmann, G. Krause, T. Eckmanns

Abstract

Purpose

Current efforts to prevent antimicrobial resistance include limiting antimicrobial use, providing education about appropriate use, and developing better point-of-care tests, but what do physicians actually think of rational prescribing and potential interventions? We tried to ascertain which factors can influence a physician’s decision to start antimicrobial therapy on a patient, and their opinions on measures to promote rational prescribing.

Methods

We conducted a nationwide, cross-sectional survey of 10,600 physicians from medical registries of all known board-certified physicians in Germany.

Results

Among respondents (n = 3,492; 33%; detailed non-response bias analysis included), 90% indicated that they decide to start antimicrobial therapy on a patient at least weekly, and 66% reported that they decide daily. We identified correlates for deciding to start antimicrobial therapy on a patient. Predictors were status as a hospital physician (odds ratio (OR) 1.29 (95% confidence interval (CI) 1.00–1.68)), male physician (OR 1.81 (95% CI 1.42–2.31)), being age 50–59 (OR 1.56 (95% CI 1.10–2.21)), and practising in states in the former East Germany (OR 1.60 (95% CI 1.15–2.21)). Each specialist was significantly less likely to decide to start a course of antimicrobial therapy than ENTs and urologists. Other predictors were agreeing to prescribe to be on the safe side (OR 1.34 (95% CI 1.03–1.76)), believing that the quality of prescribing practice improves after receiving continuing education from pharmaceutical companies (OR 1.43 (95% CI 1.11–1.84)), and having experience with failed therapy for resistant pathogens (OR 2.42 (95% CI 1.83–3.19)).

Conclusions

Physicians in our sample decide to start antimicrobial therapy on a patient, and they value intervention to support prudent use, for example continuing education, practice guidelines and implementation of surveillance measures. Socio-behavioural factors, regional variation, gender, and age merit further research to promote rational antimicrobial prescribing and explore related influencing factors.

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