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Social and contextual influences on antibiotic prescribing and antimicrobial stewardship: A qualitative study with Clinical Commissioning Group and general practice professionals

Borek, A; Anthierens, S; Allison, R; McNulty, C; Anyanwu, PE; Costelloe, C; Walker, A; (2020) Social and contextual influences on antibiotic prescribing and antimicrobial stewardship: A qualitative study with Clinical Commissioning Group and general practice professionals. Antibiotics , 9 (12) , Article 859. 10.3390/antibiotics9120859. Green open access

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Abstract

Antibiotic prescribing in England varies considerably between Clinical Commissioning Groups (CCGs) and general practices. We aimed to assess social and contextual factors affecting antibiotic prescribing and engagement with antimicrobial stewardship (AMS) initiatives. Semi-structured telephone interviews were conducted with 22 CCG professionals and 19 general practice professionals. Interviews were audio-recorded, transcribed, and analyzed thematically. Social/contextual influences were grouped into the following four categories: (1) Immediate context, i.e., patients’ social characteristics (e.g., deprivation and culture), clinical factors, and practice and clinician characteristics (e.g., “struggling” with staff shortage/turnover) were linked to higher prescribing. (2) Wider context, i.e., pressures on the healthcare system, limited resources, and competing priorities were seen to reduce engagement with AMS. (3) Collaborative and whole system approaches, i.e., communication, multidisciplinary networks, leadership, and teamwork facilitated prioritizing AMS, learning, and consistency. (4) Relativity of appropriate prescribing, i.e., “high” or “appropriate” prescribing was perceived as relative, depending on comparators, and disregarding different contexts, but social norms around antibiotic use among professionals and patients seemed to be changing. Further optimization of antibiotic prescribing would benefit from addressing social/contextual factors and addressing wider health inequalities, not only targeting individual clinicians. Tailoring and adapting to local contexts and constraints, ensuring adequate time and resources for AMS, and collaborative, whole system approaches to promote consistency may help promote AMS.

Type: Article
Title: Social and contextual influences on antibiotic prescribing and antimicrobial stewardship: A qualitative study with Clinical Commissioning Group and general practice professionals
Open access status: An open access version is available from UCL Discovery
DOI: 10.3390/antibiotics9120859
Publisher version: https://doi.org/10.3390/antibiotics9120859
Language: English
Additional information: © 2020 by the Authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Keywords: antibiotic prescribing; antimicrobial stewardship; primary care; qualitative
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10116136
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