To better understand physicians' views on factors of influence for the prescribing of antibiotics and on antibiotic resistance in the Berlin region, Germany.
Qualitative study with focus groups.
Outpatient care and hospital care practice in the Berlin region, Germany.
7 General practitioners, two urologists, one paediatrician from outpatient care and eight internists, two paediatricians, two ear, nose and throat specialists and two urologists from hospital care.
Physicians showed differential interest in topics related to antibiotic prescribing and antibiotic resistance. Outpatient care physicians were interested in topics around their own prescribing, such as being able to diagnose and prescribe precisely, and topics about patient demand and non-compliance. Hospital care physicians were interested in hygiene challenges, limited consult time and multi-resistant pathogens.
Physicians considered the development of resistance to be more in the domain of clinical treatment than that of the patient. Major challenges related to antibiotic resistance for this group of physicians are access to and clarity of treatment recommendations, implementation of hygienic measures, as well as increased outsourcing of laboratory services. Results raise questions about whether meeting physicians' expectations should be a focus when developing intervention that aims to influence antibiotic resistance in this and other areas of Germany.
Overuse of antibiotics across many specialities and in some of the most common diagnoses remains a driving force for antibiotic resistance.
While much attention has focused on limiting use and addressing clinical concerns like improving point-of-care diagnostic tests, prior literature has largely left out the consideration of socio-behavioural factors that influence physicians' decisions to prescribe antibiotics.
Focus group discussions were used to show physicians' views on factors that influence their prescribing of antibiotics and antibiotic resistance.
Berlin area physicians are interested in receiving help to make informed decisions on the appropriate measures for mitigating patient discomfort and risk.
In this group, well-informed prescribing practice appears to be influenced by non-patient-oriented factors that are both structural (eg, overcrowding in hospitals) as well as non-structural in nature (eg, access to feedback from microbiologists or time allowed for patient consult).
Physicians desire intervention activities that address their own skills, like assessment of patient needs, time management for consult and navigation of pharmaceutical consulting.
Strengths and limitations of this study
Modern methodologies for focus group data analysis, including a comprehensive plan for ensuring validity in data-making and data reduction were used in the study.
Presented study methodology allows replication by other research groups.
The number of participating physicians was limited; however, they were recruited from diverse backgrounds with respect to age, sex, size of practice, care setting and number of years in practice.