Antibiotic prescribing in long-term care facilities: a qualitative, multidisciplinary investigation.
OBJECTIVE
To explore healthcare professionals' views of antibiotic prescribing in long-term care facilities (LTCFs). To use the findings to recommend intervention strategies for antimicrobial stewardship in LTCFs.


METHODS
Qualitative semistructured interviews were conducted. The data were analysed by thematic content analysis. After the interviews, the emerging findings were mapped to the theoretical domains framework (TDF), and the behaviour change wheel and behaviour change technique (BCT) taxonomy were used to recommend future intervention strategies.


METHODS
Interviews were conducted with 37 healthcare professionals who work in LTCFs (10 general practitioners, 4 consultants, 14 nurses, 9 pharmacists) between December 2012 and March 2013.


METHODS
Interviews were conducted in the greater Cork region.


RESULTS
The main domains from the TDF which emerged were: 'Knowledge', 'Environmental context and resources', 'Social influences', 'Beliefs about consequences', 'Memory, attention and decision making', with the findings identifying a need for 'Behavioural regulation'. Many participants believed that antibiotic prescribing was satisfactory at their LTCF, despite the lack of surveillance activities.


CONCLUSIONS
This study, using the TDF and BCT taxonomy, has found that antibiotic prescribing in LTCFs is influenced by many social and contextual factors. The challenges of the setting and patient population, the belief about consequences to the patient, and the lack of implementation of guidelines and knowledge regarding antibiotic prescribing patterns are significant challenges to address. On the basis of the study findings and the application of the TDF and BCT taxonomy, we suggest some practical intervention functions for antimicrobial stewardship in LTCFs.
Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Ireland.
Aoife
A
Fleming
Department of General Practice, University College Cork, Ireland.
Colin
C
Bradley
Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Ireland.
Shane
http://orcid.org/0000-0003-0648-1477
S
Cullinan
Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Ireland.
Stephen
S
Byrne
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005069:Evaluation Studies as Topic; D005260:Female; D006282:Health Personnel; D006801:Humans; D008134:Long-Term Care; D008297:Male; D012866:Skilled Nursing Facilities
D000900:Anti-Bacterial Agents
GERIATRIC MEDICINE; PUBLIC HEALTH; QUALITATIVE RESEARCH