Background: Many studies have investigated the ways in which physicians decide whether to prescribe antibiotics, but very few studies have focused on the reasons for which general practitioners (GPs) choose to prescribe a particular antibiotic in a specific clinical situation. Improvements in our understanding of the rationale behind GPs' decisions would provide insight into the reasons for which GPs do not always prescribe the antibiotic recommended in clinical practice guidelines and facilitate the development of appropriate interventions to improve antibiotic prescription. The objective of the study was to understand the rationale used by GPs to decide which antibiotic to prescribe in a specific clinical situation, and to propose a model representing this rationale.
Methods: We used a three-step process. First, data were collected from interviews with 20 GPs, and analysed according to the grounded theory approach. Second, data were collected from publications exploring the factors used by GPs to choose an antibiotic. Third, data were used to develop a comprehensive model of the rationale used by GPs to decide which antibiotic to prescribe.
Results: The GPs considered various factors when choosing antibiotics: factors relating to microbiology (bacterial resistance), pharmacology (adverse effects, efficacy, practicality of the administration protocol, antibiotic class, drug cost), clinical conditions (patient profile and comorbid conditions, symptoms, progression of infection, history of antibiotic treatment, preference), and personal factors (GP's experience, knowledge, emotion, preference).
Conclusions: Various interventions, targeting all the factors underlying antibiotic choice, are required to improve antibiotic prescription. GP-related factors could be improved through interventions aiming to improve the GPs' knowledge of antibiotics (e.g. continuing medical education). Factors relating to microbiology, pharmacology and clinical conditions could be targeted through the use of clinical decision support systems in everyday clinical practice.
Keywords: Antibacterial agents; Clinical decision-making; General practice; Primary care.