Table 1

Influences on antibiotic prescribing

Types of influencesInfluences on antibiotic prescribing
(1) Evidenceandeducation
  1. Evidenceandguidelines

  2. Peer discussionandlearning

  3. GP training on antibiotic prescribing

  4. Advice fromandinfluence of relevant experts

(2) Clinical experienceandconfidence
  1. Clinical experienceandconfidence

  2. Experience of and concern about adverse events resulting from prescribing decisions

  3. GP’s preference for certain antibiotics

(3) Clinical assessment
  1. Clinical assessment of signsandsymptomsandmaking a diagnosis

  2. Clinical uncertainty about illness aetiology, severity and/or progression

  3. Patient’s risk of complications or poor outcomes

  4. Patient’s perceptionandpresentation of illness

  5. Access to patient’s medical records or history

  6. ‘Gut feeling’ (intuition) about patientandillness

  7. Additional diagnostic information from testing

(4) Knowledgeandperceptions of the patient
  1. Prior knowledge ofandfamiliarity with the patient

  2. Perceptions of the patient

  3. Ability to reassess or follow-up the patient (or lack of it)

  4. Patient’s social factors

(5) Perceptions of patient’s expectationsandsatisfaction
  1. Perceptions of patient’s expectations of antibiotics

  2. Preserving a good relationship with patient, patient satisfactionandavoiding conflict

  3. Patient’s preference for certain antibiotics

(6) Communication skillsandstrategies
  1. Ability to elicitandmanage patient’s concernsandexpectations

  2. Ability to reassureandsafety-net

  3. Perceived importance of shared decision making

  4. Abilityandmotivation to educate patients in consultations

(7) Timeandworkload
  1. Timing of consultationandaccess to GP/medical services

  2. Time pressureandworkload (eg, wanting to save timeandprevent future consultations by educating patients; prescribing as a quicker way to close consultations than educating patients)

  3. Consultation length

(8) Professional roleandethos
  1. Perceptions of professional roleandethos

(9) Awarenessandperceptions of responsibility for AMS
  1. Prioritising immediate pressures vs long-term consequences of inappropriate prescribing

  2. Awareness/knowledge ofandattitude to AMS

(10) Monitoring, feedbackandaccountability
  1. Use of monitoringandaudit

  2. Receiving feedback on prescribing

  3. Accountability for own prescribing (or its lack)

(11) Perceptions of ownandothers’ prescribing
  1. Perceptions of own prescribing as compared with others

  2. Consistent approach to antibiotic prescribing between HCPs or organisations (or lack of it)

(12) Costs associated with prescribing
  1. Perception of costs related to antibiotic prescribing

(13) Legal issues
  1. Concern with legal issues (or patient complaints) resulting from not prescribing antibiotics

(14) Attitudes toanduse of AMS strategies
  1. Views onanduse of delayed antibiotic prescriptions

  2. Access toanduse of patient leaflets

  3. Use of financial incentives

  • AMS, antimicrobial stewardship ; GP, general practitioner; HCP, healthcare professional.