Promoting rational antibiotic prescribing for non-complicated infections: understanding social influence in primary care networks in Germany

BMC Fam Pract. 2020 Mar 14;21(1):51. doi: 10.1186/s12875-020-01119-8.


Background: Primary care networks in Germany are formalized regional collaborations of physicians and other healthcare providers. Common goals are optimized healthcare processes and services for patients, enhanced communication, agency for professional concerns and strengthened economic power. In the ARena study (Sustainable reduction of antibiotic-induced antimicrobial resistance), 14 primary care networks in two federal German states aimed to promote appropriate antibiotics use for acute non-complicated infections by fostering awareness and understanding. Factors related to the role of primary care networks were to be identified.

Methods: For this study, audio-recorded telephone interviews were conducted with physicians, non-physician health professionals and stakeholder representatives. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was based on the inductive categories 'social support', 'social learning', 'social normative pressures' and 'social contagion' to reflect social influence processes. Data generated through a survey with physicians and non-physician health professionals were analyzed descriptively to foster understanding of the networks' potential impact on antibiotic prescribing.

Results: Social influence processes proved to be relevant regarding knowledge transfer, manifestation of best-practice care and self-reflection. Peer communication was seen as a great asset, the main reason for membership and affirmative for own perspectives. All interviewed physicians (n = 27) considered their network to be a strong support factor for daily routines, introduction of new routines, and continuity of care. They utilized network-offered training programs focusing on best practice guideline-oriented use of antibiotics and considered their networks supportive in dealing with patient expectations. A shared attitude combined with ARena intervention components facilitated reflective management of antibiotic prescribing. Non-physician health professionals (n = 11) also valued network peer exchange. They assumed their employers joined networks to offer improved and continuous care. Stakeholders (n = 7) expected networks and their members to be drivers for care optimization.

Conclusion: Primary care networks play a crucial role in providing a platform for professional peer exchange, social support and reassurance. With regards to their impact on antibiotic prescribing for acute non-complicated infections, networks seem to facilitate and amplify quality improvement programs by providing a platform for refreshing awareness, knowledge and self-reflection among care providers. They are well suited to promote a rational use of antibiotics.

Trial registration: ISRCTN, ISRCTN58150046. Registered 24 August 2017.

Keywords: Appropriate antibiotics use; Mixed-methods; Peer exchange; Primary care networks; Quality improvement; Social influence processes.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Infective Agents / therapeutic use*
  • Antimicrobial Stewardship* / methods
  • Antimicrobial Stewardship* / organization & administration
  • Drug Resistance, Microbial*
  • Female
  • Germany
  • Humans
  • Infections* / drug therapy
  • Infections* / epidemiology
  • Interprofessional Relations
  • Male
  • Practice Patterns, Physicians' / standards
  • Primary Health Care* / methods
  • Primary Health Care* / standards
  • Quality Improvement / organization & administration
  • Social Network Analysis
  • Social Validity, Research
  • Stakeholder Participation


  • Anti-Infective Agents

Associated data

  • ISRCTN/ISRCTN58150046