Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-09T03:09:52.178Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of clinicians’ knowledge, attitudes, and planned behaviors related to an intervention to improve acute respiratory infection management

Published online by Cambridge University Press:  17 March 2020

Hayli R. Hruza ,
Tania Velasquez ,
Karl J. Madaras-Kelly Open the ORCID record for Karl J. Madaras-Kelly [Opens in a new window] ,
Katherine E. Fleming-Dutra ,
Matthew H. Samore  and
Jorie M. Butler
Hayli R. Hruza
Affiliation:
Boise Veterans’ Affairs Medical Center, Boise, Idaho
Tania Velasquez
Affiliation:
Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah
Karl J. Madaras-Kelly
Affiliation:
Boise Veterans’ Affairs Medical Center, Boise, Idaho College of Pharmacy, Idaho State University, Meridian, Idaho
Katherine E. Fleming-Dutra
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Matthew H. Samore
Affiliation:
Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah
Jorie M. Butler*
Affiliation:
Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah Geriatric Research, Education, and Clinical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
*
Author for correspondence: Jorie M. Butler, Emails: jorie.butler@psych.utah.edu; Jorie.Butler@va.gov
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Acute respiratory tract infections (ARIs) are commonly diagnosed and major drivers of antibiotic prescribing. Clinician-focused interventions can reduce unnecessary antibiotic prescribing for ARIs. We elicited clinician feedback to design sustainable interventions to improve ARI management by understanding the mental framework of clinicians surrounding antibiotic prescribing within Veterans’ Health Administration clinics.

Methods:

We conducted one-on-one interviews with clinicians (n = 20) from clinics targeted for intervention at 5 facilities. The theory of planned behavior guided interview questions. Interviews were audio recorded and transcribed for qualitative analysis. An iterative coding approach identified 6 themes.

Results:

Emergent themes: (1) barriers to appropriate prescribing are multifactorial and include challenges of behavior change; (2) antibiotic prescribing decisions are perceived as autonomous yet, diagnostic uncertainty and perceptions of patient demand can make prescribing decisions difficult; (3) clinicians perceive variation in peer prescribing practices and influences; (4) clinician-focused interventions are valuable if delivered with sensitivity; (5) communication strategies for educating patients are preferred to a shared decisions process; and (6) team standardization of practice and communication are key to facilitate appropriate prescribing. Clinicians perceived audit-and-feedback with peer comparison, academic detailing, and enhanced patient communication strategies as viable approaches to improving appropriate prescribing.

Conclusion:

Implementation strategies that enable clinicians to overcome diagnostic uncertainty, perceived patient demand, and improve patient education are desired. Implementation strategies were welcomed, and some were more readily accepted (eg, audit feedback) than others (eg, shared decision making). Implementation strategies should address clinicians’ perceptions of antibiotic prescribing practices and should enhance their patient communication skills.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 6 , June 2020 , pp. 672 - 679
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Fleming-Dutra, KE, Hersh, AL, Shapiro, DJ, et al.Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA 2016; 315:1864–1873.10.1001/jama.2016.4151CrossRefGoogle ScholarPubMed
Harris, AM, Hicks, LA, Qaseem, A. Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med 2016;164:425–434.10.7326/M15-1840CrossRefGoogle ScholarPubMed
Chow, A, Benninger, M, Brook, I, et al.IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis 2012;54:e72–e112.CrossRefGoogle ScholarPubMed
Havers, FP, Hicks, LA, Chung, JR, et al.Outpatient antibiotic prescribing for acute respiratory infections during influenza seasons. JAMA Netw Open 2018;1:e180243.10.1001/jamanetworkopen.2018.0243CrossRefGoogle ScholarPubMed
Jones, B, Sauer, B, Jones, M, et al.Variation in outpatient antibiotic prescribing for acute respiratory infections in the veteran population: a cross-sectional study. Ann Intern Med 2015;163:73–80.10.7326/M14-1933CrossRefGoogle ScholarPubMed
Ajzen, I. From intentions to actions: a theory of planned behavior. In: Kuhl, J, Beckmann, J, editors. Action Control: From Cognition to Behavior. New York: Springer-Verlag; 1985: 11–39.CrossRefGoogle Scholar
Ajzen, I. The theory of planned behavior: organizational behavior and human decisions processes. Science Direct 1991;50:179–211.Google Scholar
Limbert, C, Lamb, R. Doctors’ use of clinical guidelines: two applications of the theory of planned behaviour. Psychol Health Med 2002;7:301–310.CrossRefGoogle Scholar
Millstein, SG. Utility of the theories of reasoned action and planned behavior for predicting physician behavior: a prospective analysis. Health Psychol 1996;15:398–402.CrossRefGoogle ScholarPubMed
Hardcastle, SJ, Kane, R, Chivers, P, et al.Knowledge, attitudes, and practice of oncologists and oncology healthcare providers in promoting physical activity to cancer survivors: an international survey. Support Care Cancer 2018;26:3711–3719.CrossRefGoogle Scholar
Persell, SD, Friedberg, MW, Meeker, D, et al.Use of behavioral economics and social psychology to improve treatment of acute respiratory infections (BEARI): rationale and design of a cluster randomized controlled trial [1RC4AG039115-01] study protocol and baseline practice and provider characteristics. BMC Infect Dis 2013;13:290.CrossRefGoogle ScholarPubMed
Tonkin-Crine, SKG, Tan, PS, van Hecke, O, et al.Clinician-targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in primary care: an overview of systematic reviews. Cochrane Database Syst Rev 2017;9: CD012252.Google ScholarPubMed
Drekonja, DM, Filice, GA, Greer, N, et al.Antimicrobial stewardship in outpatient settings: a systematic review. Infect Control Hosp Epidemiol 2015;36:142–152.CrossRefGoogle ScholarPubMed
Linder, JA, Meeker, D, Fox, CR, et al.Effects of behavioral interventions on inappropriate antibiotic prescribing in primary care 12 months after stopping interventions. JAMA 2017;318:1391–1392.10.1001/jama.2017.11152CrossRefGoogle ScholarPubMed
Hemkens, LG, Saccilotto, R, Reyes, SL, et al.Personalized prescription feedback to reduce antibiotic overuse in primary care: rationale and design of a nationwide pragmatic randomized trial. BMC Infect Dis 2016;16:421.10.1186/s12879-016-1739-0CrossRefGoogle ScholarPubMed
Gjelstad, S, Hoye, S, Straand, J, Brekke, Me, Ingvild, D, Lindaek, M. Improving antibiotic prescribing in acute respiratory tract infections: cluster randomised trial from Norwegian general practice. BMJ 2013;347: f4403.CrossRefGoogle ScholarPubMed
Mangione-Smith, R, McGlynn, EA, Elliott, MN, Krogstad, P, Brook, RH. The relationship between perceived parental expectations and pediatrician antimicrobial prescribing behavior. Pediatrics 1999;103:711–718.10.1542/peds.103.4.711CrossRefGoogle ScholarPubMed
Coxeter, P, Del Mar, CB, McGregor, L, Beller, EM, Hoffmann, TC. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. Cochrane Database Syst Revs 2015;11:1–89.Google Scholar
Sanchez, GV, Fleming-Dutra, KE, Roberts, RM, Hicks, LA. Core elements of outpatient antibiotic stewardship. MMWR Recomm Rep 2016; 65:1–12.CrossRefGoogle ScholarPubMed
McKay, R, Mah, A, Law, M, McGrail, K, Patrick, D. Systematic review of factors associated with antibiotic prescribing for respiratory tract infections. ASM 2016;60:4106–4118.Google ScholarPubMed
Yates, TD, Davis, ME, Taylor, YJ, et al.Not a magic pill: a qualitative exploration of provider perspectives on antibiotic prescribing in the outpatient setting. BMC Fam Pract 2018;19:96.10.1186/s12875-018-0788-4CrossRefGoogle ScholarPubMed
van Esch, TEM, Brabers, AEM, Hek, K, van Dijk, L, Verheij, RA, de Jong, JD. Does shared decision-making reduce antibiotic prescribing in primary care? J Antimicrob Chemother 2018;73:3199–3205.CrossRefGoogle ScholarPubMed
Meeker, D, Knight, TK, Friedberg, MW, et al.Nudging guideline-concordant antibiotic prescribing: a randomized clinical trial. JAMA Intern Med 2014;174:425–431.CrossRefGoogle ScholarPubMed
Communication training: a key to improving outpatient antibiotic prescribing and use. Centers for Disease Control and Prevention website. https://www.train.org/cdctrain/course/1076989/. Published 2018. Accessed August 25, 2019.Google Scholar
Antibiotic prescribing audit workbook for upper respiratory infections and acute bronchitis. Telligen Quality Improvement Network Quality Improvement Organization website. https://www.telligenqinqio.com/resource/our-work/core-element-3-tracking-and-reporting/core-element-3-tracking-and-reporting-resources/antibiotic-prescribing-audit-workbook-upper-respiratory-infections-acute-bronchitis/. Published 2019. Accessed August 25, 2019.Google Scholar
National Resource Center for Academic Detailing website. https://www.narcad.org/. Published 2010. Accessed August 25, 2019.Google Scholar