title: A national cross-sectional study on socio-behavioural factors that influence physicians' decisions to begin antimicrobial therapy.
abstract: OBJECTIVE
  Current efforts to prevent antimicrobial resistance include limiting antimicrobial use, providing education about appropriate use, and developing better point-of-care tests, but what do physicians actually think of rational prescribing and potential interventions? We tried to ascertain which factors can influence a physician's decision to start antimicrobial therapy on a patient, and their opinions on measures to promote rational prescribing.
  
  
  METHODS
  We conducted a nationwide, cross-sectional survey of 10,600 physicians from medical registries of all known board-certified physicians in Germany.
  
  
  RESULTS
  Among respondents (n = 3,492; 33%; detailed non-response bias analysis included), 90% indicated that they decide to start antimicrobial therapy on a patient at least weekly, and 66% reported that they decide daily. We identified correlates for deciding to start antimicrobial therapy on a patient. Predictors were status as a hospital physician (odds ratio (OR) 1.29 (95% confidence interval (CI) 1.00-1.68)), male physician (OR 1.81 (95% CI 1.42-2.31)), being age 50-59 (OR 1.56 (95% CI 1.10-2.21)), and practising in states in the former East Germany (OR 1.60 (95% CI 1.15-2.21)). Each specialist was significantly less likely to decide to start a course of antimicrobial therapy than ENTs and urologists. Other predictors were agreeing to prescribe to be on the safe side (OR 1.34 (95% CI 1.03-1.76)), believing that the quality of prescribing practice improves after receiving continuing education from pharmaceutical companies (OR 1.43 (95% CI 1.11-1.84)), and having experience with failed therapy for resistant pathogens (OR 2.42 (95% CI 1.83-3.19)).
  
  
  CONCLUSIONS
  Physicians in our sample decide to start antimicrobial therapy on a patient, and they value intervention to support prudent use, for example continuing education, practice guidelines and implementation of surveillance measures. Socio-behavioural factors, regional variation, gender, and age merit further research to promote rational antimicrobial prescribing and explore related influencing factors.
authors: Department for Infectious Disease Epidemiology, Robert Koch Institute, DGZ-Ring 1, 13086 Berlin, Germany. velascoe@rki.de
authors: E
authors: E
authors: Velasco
authors: W
authors: W
authors: Espelage
authors: M
authors: M
authors: Faber
authors: I
authors: I
authors: Noll
authors: A
authors: A
authors: Ziegelmann
authors: G
authors: G
authors: Krause
authors: T
authors: T
authors: Eckmanns
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D005858:Germany; D019538:Health Care Surveys; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010820:Physicians / Q000145:classification / Q000523:psychology* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
chemical_list: D000890:Anti-Infective Agents