Factors influencing physicians’ antimicrobial prescribing decisions: A systematic review of qualitative studies
Inappropriate and overuse of antimicrobials is increasing antimicrobial resistance. Understanding physicians' antimicrobial decision‐making is essential for developing interventions to optimize prescribing. The aim of this review was to identify the factors that influence physicians' antim...
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| Published in: | British journal of clinical pharmacology Vol. 91; no. 5; pp. 1330 - 1351 |
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| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
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England
John Wiley and Sons Inc
01.05.2025
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| ISSN: | 0306-5251, 1365-2125, 1365-2125 |
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| Abstract | Inappropriate and overuse of antimicrobials is increasing antimicrobial resistance. Understanding physicians' antimicrobial decision‐making is essential for developing interventions to optimize prescribing. The aim of this review was to identify the factors that influence physicians' antimicrobial prescribing decisions. A systematic literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Embase, Medline and Scopus were searched from 2014 onwards using three key concepts: antimicrobial, prescribing and attitude. The search identified 11 038 articles for review. Studies were included if they used qualitative methods and obtained data directly from physicians. Factors influencing antimicrobial prescribing were extracted and categorized into physician‐related, patient‐related, medication‐ and condition‐related, and external factors. A model of the antimicrobial prescribing process was created to illustrate how these factors influence decision‐making. Fifty‐three articles from 23 countries met the inclusion criteria. Forty factors influencing antimicrobial prescribing were identified, with the most common being time pressures, patient/carer demand for antimicrobials, diagnostic uncertainty, clinical experience, and the use of evidence‐based guidelines and diagnostic tests. The harm to the patient and the physician of underprescribing were considered to outweigh the potential population harm of antimicrobial resistance due to overprescribing. Antimicrobial decision making is a complex process influenced by many different types of factors at each point in the prescribing journey. Awareness of these factors is vital for the success of interventions aiming to optimize antimicrobial prescribing. Future interventions should investigate how to balance individual and population harm whilst considering the individual factors that influence prescribing decisions. |
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| AbstractList | Inappropriate and overuse of antimicrobials is increasing antimicrobial resistance. Understanding physicians' antimicrobial decision‐making is essential for developing interventions to optimize prescribing. The aim of this review was to identify the factors that influence physicians' antimicrobial prescribing decisions. A systematic literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Embase, Medline and Scopus were searched from 2014 onwards using three key concepts: antimicrobial, prescribing and attitude. The search identified 11 038 articles for review. Studies were included if they used qualitative methods and obtained data directly from physicians. Factors influencing antimicrobial prescribing were extracted and categorized into physician‐related, patient‐related, medication‐ and condition‐related, and external factors. A model of the antimicrobial prescribing process was created to illustrate how these factors influence decision‐making. Fifty‐three articles from 23 countries met the inclusion criteria. Forty factors influencing antimicrobial prescribing were identified, with the most common being time pressures, patient/carer demand for antimicrobials, diagnostic uncertainty, clinical experience, and the use of evidence‐based guidelines and diagnostic tests. The harm to the patient and the physician of underprescribing were considered to outweigh the potential population harm of antimicrobial resistance due to overprescribing. Antimicrobial decision making is a complex process influenced by many different types of factors at each point in the prescribing journey. Awareness of these factors is vital for the success of interventions aiming to optimize antimicrobial prescribing. Future interventions should investigate how to balance individual and population harm whilst considering the individual factors that influence prescribing decisions. Inappropriate and overuse of antimicrobials is increasing antimicrobial resistance. Understanding physicians' antimicrobial decision-making is essential for developing interventions to optimize prescribing. The aim of this review was to identify the factors that influence physicians' antimicrobial prescribing decisions. A systematic literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Embase, Medline and Scopus were searched from 2014 onwards using three key concepts: antimicrobial, prescribing and attitude. The search identified 11 038 articles for review. Studies were included if they used qualitative methods and obtained data directly from physicians. Factors influencing antimicrobial prescribing were extracted and categorized into physician-related, patient-related, medication- and condition-related, and external factors. A model of the antimicrobial prescribing process was created to illustrate how these factors influence decision-making. Fifty-three articles from 23 countries met the inclusion criteria. Forty factors influencing antimicrobial prescribing were identified, with the most common being time pressures, patient/carer demand for antimicrobials, diagnostic uncertainty, clinical experience, and the use of evidence-based guidelines and diagnostic tests. The harm to the patient and the physician of underprescribing were considered to outweigh the potential population harm of antimicrobial resistance due to overprescribing. Antimicrobial decision making is a complex process influenced by many different types of factors at each point in the prescribing journey. Awareness of these factors is vital for the success of interventions aiming to optimize antimicrobial prescribing. Future interventions should investigate how to balance individual and population harm whilst considering the individual factors that influence prescribing decisions.Inappropriate and overuse of antimicrobials is increasing antimicrobial resistance. Understanding physicians' antimicrobial decision-making is essential for developing interventions to optimize prescribing. The aim of this review was to identify the factors that influence physicians' antimicrobial prescribing decisions. A systematic literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Embase, Medline and Scopus were searched from 2014 onwards using three key concepts: antimicrobial, prescribing and attitude. The search identified 11 038 articles for review. Studies were included if they used qualitative methods and obtained data directly from physicians. Factors influencing antimicrobial prescribing were extracted and categorized into physician-related, patient-related, medication- and condition-related, and external factors. A model of the antimicrobial prescribing process was created to illustrate how these factors influence decision-making. Fifty-three articles from 23 countries met the inclusion criteria. Forty factors influencing antimicrobial prescribing were identified, with the most common being time pressures, patient/carer demand for antimicrobials, diagnostic uncertainty, clinical experience, and the use of evidence-based guidelines and diagnostic tests. The harm to the patient and the physician of underprescribing were considered to outweigh the potential population harm of antimicrobial resistance due to overprescribing. Antimicrobial decision making is a complex process influenced by many different types of factors at each point in the prescribing journey. Awareness of these factors is vital for the success of interventions aiming to optimize antimicrobial prescribing. Future interventions should investigate how to balance individual and population harm whilst considering the individual factors that influence prescribing decisions. |
| Author | Reali, Savannah Cho, Jin‐Gun Kwang, Yee Chin Aslani, Parisa Alffenaar, Jan‐Willem |
| AuthorAffiliation | 2 Pharmacy Department Prince of Wales Hospital Randwick Australia 1 School of Pharmacy, Faculty of Medicine and Health The University of Sydney Camperdown Australia 5 Pharmacy Department Wagga Wagga Base Hospital Wagga Wagga Australia 6 Department of Respiratory and Sleep Medicine Westmead Hospital Westmead Australia 4 The University of Sydney Institute for Infectious Diseases (Sydney ID), The University of Sydney Westmead Australia 7 Sydney Medical School, Faculty of Medicine and Health The University of Sydney Camperdown Australia 3 Westmead Hospital Westmead Australia |
| AuthorAffiliation_xml | – name: 5 Pharmacy Department Wagga Wagga Base Hospital Wagga Wagga Australia – name: 4 The University of Sydney Institute for Infectious Diseases (Sydney ID), The University of Sydney Westmead Australia – name: 7 Sydney Medical School, Faculty of Medicine and Health The University of Sydney Camperdown Australia – name: 2 Pharmacy Department Prince of Wales Hospital Randwick Australia – name: 6 Department of Respiratory and Sleep Medicine Westmead Hospital Westmead Australia – name: 3 Westmead Hospital Westmead Australia – name: 1 School of Pharmacy, Faculty of Medicine and Health The University of Sydney Camperdown Australia |
| Author_xml | – sequence: 1 givenname: Savannah orcidid: 0009-0002-5651-2526 surname: Reali fullname: Reali, Savannah email: savannah.reali@sydney.edu.au organization: The University of Sydney Institute for Infectious Diseases (Sydney ID), The University of Sydney – sequence: 2 givenname: Yee Chin orcidid: 0009-0000-4714-6339 surname: Kwang fullname: Kwang, Yee Chin organization: Wagga Wagga Base Hospital – sequence: 3 givenname: Jin‐Gun orcidid: 0000-0002-7976-8236 surname: Cho fullname: Cho, Jin‐Gun organization: The University of Sydney – sequence: 4 givenname: Jan‐Willem orcidid: 0000-0001-6703-0288 surname: Alffenaar fullname: Alffenaar, Jan‐Willem organization: The University of Sydney Institute for Infectious Diseases (Sydney ID), The University of Sydney – sequence: 5 givenname: Parisa orcidid: 0000-0002-0735-4691 surname: Aslani fullname: Aslani, Parisa organization: The University of Sydney |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/40070317$$D View this record in MEDLINE/PubMed |
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| Keywords | antimicrobial clinical decision making prescribing behaviour systematic review antimicrobial resistance qualitative |
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| SubjectTerms | Anti-Bacterial Agents - therapeutic use Anti-Infective Agents - therapeutic use antimicrobial antimicrobial resistance Attitude of Health Personnel Clinical Decision-Making Decision Making Humans Inappropriate Prescribing - prevention & control Physicians - psychology Practice Guidelines as Topic Practice Patterns, Physicians' - standards Practice Patterns, Physicians' - statistics & numerical data prescribing behaviour qualitative Qualitative Research Review systematic review |
| Title | Factors influencing physicians’ antimicrobial prescribing decisions: A systematic review of qualitative studies |
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