Table 2 Influences on antibiotic prescribing and optimisation
Types of influences | Influences on antibiotic prescribing & optimisation (identified and fully reported in [26, 34, 35]) | Intervention components |
|---|---|---|
Evidence & education | 1. Clinician awareness of evidence & guidelines 2. Peer discussion & learning 3. Clinician training/education on antibiotic prescribing 4. Advice from & influence of relevant experts | Website Practice meetings, champion Website Website |
Clinical experience & confidence | 5. Clinical experience & confidence | Website, training |
Clinical assessment | 6. Clinical uncertainty about illness aetiology, severity and/or progression 7. Additional diagnostic information from testing | POC-CRPT POC-CRPT |
Perceptions of patient’s expectations & satisfaction | 8. Perceptions of patient expectations of antibiotics 9. Preserving a good relationship with patient, patient satisfaction & avoiding conflict | 3 AMS strategies 3 AMS strategies |
Communication skills & strategies | 10. Ability to elicit & manage patient’s concerns & expectations 11. Ability to reassure & safety-net 12. Perceived importance of shared decision making 13. Ability & motivation to educate patients in consultations | Comms 3 AMS strategies Comms, DP Website |
Time & workload | 14. Time pressure & workload (e.g. wanting to save time & prevent future consultations) 15. Consultation length (& not wanting to lengthen consultations) | Website Website |
Professional role & ethos | 16. Perceptions of professional role & ethos | Website, champion |
Awareness & perceptions of responsibility for AMS | 17. Clinician awareness/knowledge of & attitude to AMS | Champion |
Monitoring, feedback & accountability | 18. Receiving feedback on prescribing | Practice meeting |
Perceptions of own & others’ prescribing | 19. (In)Consistent approach to antibiotic prescribing between clinicians/organisations | Practice meeting, champion |
Attitudes to & use of AMS strategies* | 20. Views on & use of strategies 21. Access to resources to use strategies | 3 AMS strategies 3 AMS strategies, resources |
Additional influences identified in the focus groups in relation to POC-CRPT and DP [26] | 22. Perceived fit of strategies with clinical roles and experience 23. Perceived usefulness of strategies as social tools to negotiate treatment and educate patients 24. Ambiguities about strategies (incl. evidence, when and how to use them, impact on antibiotic prescribing/use) 25. Practice context (incl. ease of access, availability of dispensary, deprivation, patient characteristics, time pressures, costs, logistics/workflows) | Website 3 AMS strategies Website, practice meeting Practice meeting, champions, resources |