See the published version of this preprint at Archives of Public Health.
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Research
Gosha Wojcik
Edinburgh Napier University
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3857-2090
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Antimicrobial resistance poses a serious global public health threat. Hospital misuse of antibiotics has contributed to this problem and evidence-based interventions are urgently needed to change inappropriate prescribing practices. This paper reports the first theoretical stage of a longer-term project to improve antibiotic prescribing in hospitals through design of an effective behaviour-change intervention.
Methods
Qualitative synthesis using meta-ethnography of primary studies reporting doctors’ views and experiences of antibiotic prescribing in hospitals for example, their barriers to appropriate prescribing. Twenty electronic databases were systematically searched over a 10-year period and potential studies screened against eligibility criteria. Included studies were quality-appraised. Original participant quotes and author interpretations were extracted and coded thematically into NVivo. All study processes were conducted by two reviewers working independently with findings discussed with the wider team and key stakeholders. Studies were related by findings into clusters and translated reciprocally and refutationally to develop a new line-of-argument synthesis and conceptual model. Findings are reported using eMERGe guidance.
Results
Fifteen papers (13 studies) conducted between 2007–2017 reporting the experiences of 336 doctors of varying seniority working in acute hospitals across seven countries, were synthesised. Study findings related in four ways which collectively represented multiple challenges to appropriate antibiotic medical prescribing in hospitals: loss of ownership of prescribing decisions, tension between individual care and public health concerns, evidence-based practice versus bedside medicine, and diverse priorities between different clinical teams. The resulting new line-of-argument and conceptual model reflected how these challenges operated on both micro- and macro-level, highlighting key areas for improving current prescribing practice, such as creating feedback mechanisms, normalising input from other specialties and reducing variation in responsibility for antibiotic decisions.
Conclusions
This first meta-ethnography of doctors` experiences of antibiotic prescribing in acute hospital settings has enabled development of a novel conceptual model enhancing understanding of appropriate antibiotic prescribing. That is, hospital antibiotic prescribing is a complex, context-dependent and dynamic process, entailing the balancing of many tensions. To change practice, comprehensive efforts are needed to manage failures in communication and information provision, promote distribution of responsibility for antibiotic decisions, and reduce fear of consequences from not prescribing.
Keywords
antimicrobial resistance, antibiotic decision-making, prescribing behaviour, doctors, acute hospitals, meta-ethnography, qualitative synthesis
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
- BMCAdditionalfile1.doc
Additional file 1: • File format: DOC (Microsoft Word) • Title of data: Details of applied methodology as informed by the eMERGe meta-ethnography reporting guidance. • Description of data: This file provides details of the applied methodology, including the seven-stage interpretive meta-ethnography approach originally developed by Noblit and Hare`s [21].
- BMCAdditionalfile2.docx
Additional file 2: • File format: DOC (Microsoft Word) • Title of data: Relating studies by reported concepts and developing higher conceptual categories (Phase 4) • Description of data: This file provides the outcome of Phase 4 of the analysis (determining how studies are related), including the higher conceptual categories with descriptions, the reported concepts within each category and whether they were represented by direct quotes from the studies (first order constructs) and/or author`s interpretations (second order constructs).
- BMCAdditionalfile3.doc
Additional file 3: • File format: DOC (Microsoft Word) • Title of data: Key emerging themes with exemplar quotes • Description of data: This file provides examples of direct quotes (first-order data) used to illustrate the findings of the meta-ethnography.
- PRISMA2009checklist.doc
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CURRENT STATUS: Published
View the published article at Archives of Public Health.
Version 1
Posted 11 Feb, 2021
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Review #1 received
Received 20 Apr, 2021
Editorial decision: Minor Revision
On 20 Apr, 2021
Reviewer #1 agreed
On 21 Mar, 2021
Reviewers invited
Invitations sent on 12 Feb, 2021
Editor assigned
On 01 Feb, 2021
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On 01 Feb, 2021
Editor invited
On 01 Feb, 2021
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On 28 Jan, 2021
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at Archives of Public Health.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Gosha Wojcik
Edinburgh Napier University
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3857-2090
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Archives of Public Health.
Version 1
Posted 11 Feb, 2021
No community comments so far
Review #1 received
Received 20 Apr, 2021
Editorial decision: Minor Revision
On 20 Apr, 2021
Reviewer #1 agreed
On 21 Mar, 2021
Reviewers invited
Invitations sent on 12 Feb, 2021
Editor assigned
On 01 Feb, 2021
Submission checks complete
On 01 Feb, 2021
Editor invited
On 01 Feb, 2021
First submitted
On 28 Jan, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Archives of Public Health.
Background
Antimicrobial resistance poses a serious global public health threat. Hospital misuse of antibiotics has contributed to this problem and evidence-based interventions are urgently needed to change inappropriate prescribing practices. This paper reports the first theoretical stage of a longer-term project to improve antibiotic prescribing in hospitals through design of an effective behaviour-change intervention.
Methods
Qualitative synthesis using meta-ethnography of primary studies reporting doctors’ views and experiences of antibiotic prescribing in hospitals for example, their barriers to appropriate prescribing. Twenty electronic databases were systematically searched over a 10-year period and potential studies screened against eligibility criteria. Included studies were quality-appraised. Original participant quotes and author interpretations were extracted and coded thematically into NVivo. All study processes were conducted by two reviewers working independently with findings discussed with the wider team and key stakeholders. Studies were related by findings into clusters and translated reciprocally and refutationally to develop a new line-of-argument synthesis and conceptual model. Findings are reported using eMERGe guidance.
Results
Fifteen papers (13 studies) conducted between 2007–2017 reporting the experiences of 336 doctors of varying seniority working in acute hospitals across seven countries, were synthesised. Study findings related in four ways which collectively represented multiple challenges to appropriate antibiotic medical prescribing in hospitals: loss of ownership of prescribing decisions, tension between individual care and public health concerns, evidence-based practice versus bedside medicine, and diverse priorities between different clinical teams. The resulting new line-of-argument and conceptual model reflected how these challenges operated on both micro- and macro-level, highlighting key areas for improving current prescribing practice, such as creating feedback mechanisms, normalising input from other specialties and reducing variation in responsibility for antibiotic decisions.
Conclusions
This first meta-ethnography of doctors` experiences of antibiotic prescribing in acute hospital settings has enabled development of a novel conceptual model enhancing understanding of appropriate antibiotic prescribing. That is, hospital antibiotic prescribing is a complex, context-dependent and dynamic process, entailing the balancing of many tensions. To change practice, comprehensive efforts are needed to manage failures in communication and information provision, promote distribution of responsibility for antibiotic decisions, and reduce fear of consequences from not prescribing.
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
- BMCAdditionalfile1.doc
Additional file 1: • File format: DOC (Microsoft Word) • Title of data: Details of applied methodology as informed by the eMERGe meta-ethnography reporting guidance. • Description of data: This file provides details of the applied methodology, including the seven-stage interpretive meta-ethnography approach originally developed by Noblit and Hare`s [21].
- BMCAdditionalfile2.docx
Additional file 2: • File format: DOC (Microsoft Word) • Title of data: Relating studies by reported concepts and developing higher conceptual categories (Phase 4) • Description of data: This file provides the outcome of Phase 4 of the analysis (determining how studies are related), including the higher conceptual categories with descriptions, the reported concepts within each category and whether they were represented by direct quotes from the studies (first order constructs) and/or author`s interpretations (second order constructs).
- BMCAdditionalfile3.doc
Additional file 3: • File format: DOC (Microsoft Word) • Title of data: Key emerging themes with exemplar quotes • Description of data: This file provides examples of direct quotes (first-order data) used to illustrate the findings of the meta-ethnography.
- PRISMA2009checklist.doc
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