A total of 815 physicians from 16 general hospitals were included in this study. The characteristics of the participants and the hospitals were presented in Table 1. Over half of the respondents were males (n=459, 56.32%). Most of the respondents were under 45 years old (n=728, 89.33%). Almost all of them had a bachelor’s degree or above (n=802, 98.40%). With regard to the working department, 37.18% (n=303) were from internal medicine and 34.97% (n=285) were from the surgery department. Regarding hospital characteristics, the samples consisted of 12 tertiary hospitals and 4 secondary hospitals. And 6 hospitals were in the eastern, 5 in the central and 5 in the western of China.
Current Status of the Utilization of CPG on Antimicrobial
The utilization of CPG on antimicrobial was assessed by three items, which had average scores of 3.95±0.62, with 1 being the minimum scores and 5 being the maximum scores. Of the statements “In the past year, I have strictly followed the CPG on antimicrobial in practice”, 81.23% (n=662) of physicians strongly agreed or agreed on it, 16.69% (n=136) were in neutral, and 2.09% (n=17) against or strongly against it. Eighty percent of physicians (n=652) reported their agreement or strong agreement on the item “In the past year, I have actively participated in the study or training of CPG on antimicrobial”, 18.04% (n=147) declared their neutrality, and 1.96% (n=16) have an objection or strongly objection to it. Regarding the statement of “In the past year, I have actively recommended the CPG on antimicrobial to colleagues”, 71.90% (n=586) of physicians reported they have recommended the CPG on antimicrobial to other medical staff, 25.89% (n=211) showed their neutrality, and 2.21% (n=18) were opposed or strongly opposed to this statement.
Perceptions and Beliefs towards the Utilization of CPG on Antimicrobial
Physicians’ perceptions and beliefs towards the utilization of CPG on antimicrobial consisted of four dimensions, namely attitude, subjective norm, perceived risk, and behavioral intention. The mean score for each dimension was 4.29±0.56, 4.15±0.61, 2.24±0.85, 4.13±0.56, respectively (see Table 2). Most physicians reported that following the CPG on antimicrobial in clinical practice was the right thing (91.66%, n=747), a wise choice (90.43%, n=737) and good for all (93.99%, n=766). Similarly, most physicians reported that people who were important to them (e.g. colleagues and superiors) were tended to follow CPG on antimicrobial (86.38%, n=704), had a positive evaluation of CPG on antimicrobial (88.10%, n=718), thought it was a right thing to use CPG on antimicrobial (89.82%, n=732). The proportion of physicians who were afraid the implementation of CPG on antimicrobial would take their extra time, reduce revenue and lower efficiency, was 19.75% (n=161), 9.20% (n=75), 12.15% (n=99), respectively. And regarding behavioral intention, the majority of physicians said they were willing to use CPG on antimicrobial (92.39%, n=753), recommend it to other doctors (86.63%, n=706), follow CPG on antimicrobial in the future (87.24%, n=711).
Traits of the CPG on Antimicrobial
The traits of the CPG on antimicrobial were measured by two dimensions as relative advantage and ease of use. The mean value for each dimension was 3.95±0.68 and 3.86±0.65, respectively. With respect to the dimension of relative advantage, the items “reducing medical costs”, “improving prescribing efficiency” and “contributing to better clinical outcomes” were appreciated by 71.66% (n=584), 76.93% (n=627) and 78.65% (n=641) of physicians, respectively. And there were also about a fifth of physicians reported their neutral stance on these items. Concerning the dimension of ease of use, 75.21% (n=613) of the respondents deemed their incapability in mastering the knowledge of CPG on antimicrobial in a short time. After grasping the CPG on antimicrobial, 80.61% (n=657) of the physicians perceived that they can quickly put it into practice, while 69.33% (n=565) of them had a view that the CPG was simple and easy to use.
Hospital Practice in Promoting the Utilization of CPG on Antimicrobial
The dimensions of “top management support” and “organization & implementation” were applied to depict the hospital practice in promoting the utilization of CPG on antimicrobial. The average score for each dimension was 3.99±0.63 and 4.01±0.64, respectively (see Table 2). Concerning the dimension of “top management support”, 83.07% (n=677) and 84.05% (n=685) of the physicians agreed or strongly agreed on the statements of “Administrators promoted the widely use of CPG on antimicrobial in various departments” and “Administrators attached great importance to the promotion of CPG on antimicrobial”, respectively. And three-quarters of physicians thought the administrators of the hospital had provided supports in training, funding and other aspects. A similar situation also existed in the dimension of “organization & implementation”. The proportion of the physicians reported that their working hospitals have provided information about CPG on antimicrobial, held regular feedback on the CPG use, and performed a daily inspection, supervision, and evaluation, was 81.10% (n=661), 80.49% (n=656) and 85.03% (n=693), respectively.
Correlations to the Utilization of CPG on Antimicrobial
The result of correlation analysis (Table 3) showed physicians’ utilization of CPG on antimicrobial was significantly correlated (P<0.001) with the dimensions of attitude, subjective norm, perceived risk, behavioral intention, relative advantage, ease of use, top management support and organization & implementation, respectively. In addition, it also showed that age, professional title, years in practice and region were significantly associated with physicians’ utilization of CPG on antimicrobial.
Multilevel Linear Regression Analysis
Table 4 presented the two-level linear regression results of the utilization of CPG on antimicrobial. The ICC coefficient of the null model was 0.062 (P<0.05), suggesting the utilization of CPG on antimicrobial by individuals was clustered among the same organizations, and the two-level hierarchical structure was suitable for multilevel model analysis . At the individual level, the utilization of CPG on antimicrobial was significantly associated with subjective norm (P<0.001), perceived risk (P=0.016), behavioral intention (P<0.001) at the domain of physician beliefs, ease of use (P<0.001) at the domain of CPG traits, and top management support (P<0.001), organization & implementation (P<0.001) at the domain of hospital practice (Model 1). Additionally, with regard to the demographic characteristics, physicians who worked at the department of ophthalmology and otorhinolaryngology had a significant reduction in the utilization behavior of CPG on antimicrobial than the ones working in other departments (Model 2).
As for the organizational level, the multilevel regression analysis showed that the utilization of CPG on antimicrobial was less among the physicians in the eastern hospitals, while compared with their peers in the western hospitals (P=0.001).