Table 1

Network-associated system factors influencing clinicians’ antibiotic prescribing

FeatureNetworkExtractExtract number
Access to antibioticsBarcelonaIt happens very often, ‘Doctor, I've already taken Clamoxyl’. Well then you tell him, ‘Very well, if you decide that…I would tell you not to take it, but well’. Or the great majority has antibiotics at home and in the chemist, they can go there directly and …the chemist will prescribe antibiotics…it happens very often (Barcelona 31)1
MilanSelf-prescriptions. This is an important issue. Many patients call you saying they've been taking an antibiotic for the past three days… maybe given by the chemist, or something they had at home. In these cases, based on the symptoms, you wouldn't have given an antibiotic (Milan 51)2
Systems to reduce patient expectationsAntwerpThat government campaign against antibiotics, that sure is terrific, because before that you really had to put a lot more energy in the people, and now, the young people, they are all up-to-date uh […] They really come in and say like: “if it is not necessary, no antibiotics”, uh. Like that uh, that's really easy (Antwerp 35)3
SouthamptonFor many years we've tried to explain to patients that having antibiotics won't necessarily get them better… I think what's changed is that patients are starting to understand that more (Southampton 29)4
Lack of consistent guidelinesBalatonfüredThere are...  five types of protocol, but this is the minimum. Let's say there's one by the IBR ((special Hungarian health care association)), there is an advice by the Infektológiai Társaság ((Infectologists’ Association)), according to this there is this National Guideline, but which should be followed can depend on the pharmaceutical firm giving let's say training about antibiotics. […] National guideline?…I couldn't tell which is equivalent to that one (Balatonfüred 370)5
BalatonfüredProtocols, should be elaborated, which let's say would give national guidelines, and to make these available for everyone. The physicians, the GPs, the doctors from different fields, the ones working on pulmonological departments (should know) which steps to follow (Balatonfüred 384)6
ŁódźI try to manage according to guidelines […] I would like always to apply to them, but not always I succeed […]These data from which I probably use refer to some foreign populations, and this is not, let us say, my population, Polish or mine here local. So here I perceive this deficiency (Łódź 78)7