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Antibiotics
Volume 9
Issue 12
10.3390/antibiotics9120859
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Article

Social and Contextual Influences on Antibiotic Prescribing and Antimicrobial Stewardship: A Qualitative Study with Clinical Commissioning Group and General Practice Professionals

by
Aleksandra J. Borek
1,*,
Sibyl Anthierens
2,
Rosalie Allison
3,
Cliodna A. M. Mcnulty
3,
Philip E. Anyanwu
4,5,
Ceire Costelloe
4,
Ann Sarah Walker
6,7,8,
Christopher C. Butler
1,6,
Sarah Tonkin-Crine
1,6 and
on behalf of the STEP-UP Study Team
†
1
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
2
Department of Family Medicine and Population Health, University of Antwerp, 2610 Antwerp, Belgium
3
Primary Care and Interventions Unit, Public Health England, Gloucester GL1 1DQ, UK
4
Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
5
School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff CF14 4XN, UK
6
National Institute for Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford OX3 9DU, UK
7
National Institute for Health Research Biomedical Research Centre, Oxford OX3 9DU, UK
8
Nuffield Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
*
Author to whom correspondence should be addressed.
†
Members are listed in the Acknowledgments section.
Antibiotics 2020, 9(12), 859; https://doi.org/10.3390/antibiotics9120859
Submission received: 6 November 2020 / Revised: 20 November 2020 / Accepted: 26 November 2020 / Published: 1 December 2020
(This article belongs to the Special Issue Antibiotics Use in Primary Care)
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Abstract

Antibiotic prescribing in England varies considerably between Clinical Commissioning Groups (CCGs) and general practices. We aimed to assess social and contextual factors affecting antibiotic prescribing and engagement with antimicrobial stewardship (AMS) initiatives. Semi-structured telephone interviews were conducted with 22 CCG professionals and 19 general practice professionals. Interviews were audio-recorded, transcribed, and analyzed thematically. Social/contextual influences were grouped into the following four categories: (1) Immediate context, i.e., patients’ social characteristics (e.g., deprivation and culture), clinical factors, and practice and clinician characteristics (e.g., “struggling” with staff shortage/turnover) were linked to higher prescribing. (2) Wider context, i.e., pressures on the healthcare system, limited resources, and competing priorities were seen to reduce engagement with AMS. (3) Collaborative and whole system approaches, i.e., communication, multidisciplinary networks, leadership, and teamwork facilitated prioritizing AMS, learning, and consistency. (4) Relativity of appropriate prescribing, i.e., “high” or “appropriate” prescribing was perceived as relative, depending on comparators, and disregarding different contexts, but social norms around antibiotic use among professionals and patients seemed to be changing. Further optimization of antibiotic prescribing would benefit from addressing social/contextual factors and addressing wider health inequalities, not only targeting individual clinicians. Tailoring and adapting to local contexts and constraints, ensuring adequate time and resources for AMS, and collaborative, whole system approaches to promote consistency may help promote AMS.
Keywords: antibiotic prescribing; antimicrobial stewardship; primary care; qualitative antibiotic prescribing; antimicrobial stewardship; primary care; qualitative

Share and Cite

MDPI and ACS Style

Borek, A.J.; Anthierens, S.; Allison, R.; Mcnulty, C.A.M.; Anyanwu, P.E.; Costelloe, C.; Walker, A.S.; Butler, C.C.; Tonkin-Crine, S.; on behalf of the STEP-UP Study Team. Social and Contextual Influences on Antibiotic Prescribing and Antimicrobial Stewardship: A Qualitative Study with Clinical Commissioning Group and General Practice Professionals. Antibiotics 2020, 9, 859. https://doi.org/10.3390/antibiotics9120859

AMA Style

Borek AJ, Anthierens S, Allison R, Mcnulty CAM, Anyanwu PE, Costelloe C, Walker AS, Butler CC, Tonkin-Crine S, on behalf of the STEP-UP Study Team. Social and Contextual Influences on Antibiotic Prescribing and Antimicrobial Stewardship: A Qualitative Study with Clinical Commissioning Group and General Practice Professionals. Antibiotics. 2020; 9(12):859. https://doi.org/10.3390/antibiotics9120859

Chicago/Turabian Style

Borek, Aleksandra J., Sibyl Anthierens, Rosalie Allison, Cliodna A. M. Mcnulty, Philip E. Anyanwu, Ceire Costelloe, Ann Sarah Walker, Christopher C. Butler, Sarah Tonkin-Crine, and on behalf of the STEP-UP Study Team. 2020. "Social and Contextual Influences on Antibiotic Prescribing and Antimicrobial Stewardship: A Qualitative Study with Clinical Commissioning Group and General Practice Professionals" Antibiotics 9, no. 12: 859. https://doi.org/10.3390/antibiotics9120859

APA Style

Borek, A. J., Anthierens, S., Allison, R., Mcnulty, C. A. M., Anyanwu, P. E., Costelloe, C., Walker, A. S., Butler, C. C., Tonkin-Crine, S., & on behalf of the STEP-UP Study Team. (2020). Social and Contextual Influences on Antibiotic Prescribing and Antimicrobial Stewardship: A Qualitative Study with Clinical Commissioning Group and General Practice Professionals. Antibiotics, 9(12), 859. https://doi.org/10.3390/antibiotics9120859

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