Drivers influencing antibiotic over-prescribing by GPs

This qualitative literature review explores the drivers influencing antibiotic over-prescribing by GPs in primary care and makes recommendations to reduce unnecessary prescribing, by Joanna Rose, Michelle Crosbie and Anthony Stewart.

Perspect Public Health. 2019 Oct 21:1757913919879183. doi: 10.1177/1757913919879183.
A qualitative literature review exploring the drivers influencing antibiotic over-prescribing by GPs in primary care and recommendations to reduce unnecessary prescribing.
Rose J, Crosbie M, Stewart A.

This is a qualitative literature review which aims to assess and analyse the published literature to discover the hidden reasons for antibiotic over-prescribing by general practitioners (GPs). It explores their views and opinions, and seeks to determine how antibiotic prescribing can be improved removing unnecessary prescribing, that will in turn reduce the threat to public health from antibiotic resistance. The article tries to invoke new was of thinking in this area while adding to the existing knowledge base relevant to GPs’ antibiotic prescribing behaviour.

Three main themes were identified through this literature review.
1. GP attitudes and or feelings.
Basically GPs want to maintain a good relationship with their patients. This means the patient needs to be satisfied with the service they receive from their GP, what could be more satisfying than walking out of the consult room with your anti-biotic script in hand because you "know" it will fix you? Along with this is the thought that anti-microbial resistance pertains more to hospitals and not general dispensing. Along with a GPs general fear of diagnostic uncertainty, risk avoidance and like fears the path is set for the prescription pad to come out.

2. External factors -time pressures and financial incentives.
Here it is basically the quick fix. If the GP writes the script they can get through more patients quickly. Convincing a patient that they do not need antibiotics will take time.

3. Patient Factors.
Pressure from patients who expect to be given antibiotics can be a challenge. Patients who are not educated to understand what antibiotics are for and what they are use for are difficult to refuse so they are just given antibiotics. The don't understand virus versus bacteria...

The findings of this paper show the need for regular GP update training to emphasise the importance of antibiotic resistance and the need to change behaviour to reduce unnecessary prescribing. Improved guidelines, providing consistency could offer GPs more power to refrain from prescribing, having the support of professional regulations. As well as many ideas to promote public awareness around antibiotics and their use via social media campaigns and triage systems  to relieve the pressure from GPs. To read the full article contact your Librarian. MNCLHD staff can request this article through the Library website.