Barriers to guideline-concordant antibiotic use among inpatient physicians: A case vignette qualitative study

Daniel Livorsi; Amber R Comer; Marianne S Matthias; Eli N Perencevich; Matthew J Bair

doi:10.1002/jhm.2495

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Barriers to guideline-concordant antibiotic use among inpatient physicians: A case vignette qualitative study

Journal article

Peer reviewed

Barriers to guideline-concordant antibiotic use among inpatient physicians: A case vignette qualitative study

Daniel Livorsi, Amber R Comer, Marianne S Matthias, Eli N Perencevich and Matthew J Bair

Journal of hospital medicine, Vol.11(3), pp.174-180

03/2016

DOI: 10.1002/jhm.2495

PMCID: PMC4779411

PMID: 26443327

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http://doi.org/10.1002/jhm.2495View

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Abstract

Greater adherence to antibiotic-prescribing guidelines may promote more judicious antibiotic use, which could benefit individual patients and society at large. To assess physician knowledge and acceptance of antibiotic-prescribing guidelines through the use of case vignettes. We conducted semistructured interviews with 30 inpatient physicians. Participants were asked to respond to 3 hypothetical case vignettes: (1) a skin and soft tissue infection (SSTI), (2) suspected hospital-acquired pneumonia (HAP), and (3) asymptomatic bacteriuria (ASB). All participants received feedback according to guidelines from the Infectious Diseases Society of America (IDSA) and were asked to discuss their level of comfort with following these guidelines. Two acute care teaching hospitals for adult patients. None. Data from transcribed interviews were analyzed using emergent thematic analysis. Participants were receptive to guidelines and believed they were useful. However, participants' responses to the case vignettes demonstrated that IDSA guideline recommendations were not routinely followed for SSTI, HAP, and ASB. We identified 3 barriers to guideline-concordant care: (1) physicians' lack of awareness of specific guideline recommendations; (2) tension between adhering to guidelines and the desire to individualize patient care; and (3) skepticism of certain guideline recommendations. Case vignettes may be useful tools to assess physician knowledge and acceptance of antibiotic-prescribing guidelines. Using case vignettes, we identified 3 barriers to following IDSA guidelines. Efforts to improve guideline-concordant antibiotic prescribing should focus on reducing such barriers at the local level. Original research

Attitude of Health Personnel

Guideline Adherence - standards

Humans

Male

Inappropriate Prescribing - prevention & control

Practice Patterns, Physicians

Medical Staff, Hospital - standards

Anti-Bacterial Agents - therapeutic use

Pneumonia - drug therapy

Adult

Female

Interviews as Topic

Qualitative Research

Practice Guidelines as Topic

Details

Title: Subtitle: Barriers to guideline-concordant antibiotic use among inpatient physicians: A case vignette qualitative study
Creators: Daniel Livorsi - Iowa City VA Health Care System, Iowa City, Iowa
Amber R Comer - Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
Marianne S Matthias - Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana
Eli N Perencevich - Division of General Internal Medicine and Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Matthew J Bair - Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana
Resource Type: Journal article
Publication Details: Journal of hospital medicine, Vol.11(3), pp.174-180
DOI: 10.1002/jhm.2495
PMID: 26443327
PMCID: PMC4779411
NLM abbreviation: J Hosp Med
ISSN: 1553-5606
eISSN: 1553-5606
Publisher: United States
Grant note: UL1TR001108 / NCATS NIH HHS UL1 TR001108 / NCATS NIH HHS
Language: English
Date published: 03/2016
Academic Unit: Epidemiology; Internal Medicine
Record Identifier: 9983779493802771

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