title: Factors influencing antibiotic prescribing in long-term care facilities: a qualitative in-depth study.
abstract: BACKGROUND
  Insight into factors that influence antibiotic prescribing is crucial when developing interventions aimed at a more rational use of antibiotics. We examined factors that influence antibiotic prescribing in long-term care facilities, and present a conceptual model that integrates these factors.
  
  
  METHODS
  Semi-structured qualitative interviews were conducted with physicians (n = 13) and nursing staff (n = 13) in five nursing homes and two residential care homes in the central-west region of the Netherlands. An iterative analysis was applied to interviews with physicians to identify and categorize factors that influence antibiotic prescribing, and to integrate these into a conceptual model. This conceptual model was triangulated with the perspectives of nursing staff.
  
  
  RESULTS
  The analysis resulted in the identification of six categories of factors that can influence the antibiotic prescribing decision: the clinical situation, advance care plans, utilization of diagnostic resources, physicians' perceived risks, influence of others, and influence of the environment. Each category comprises several factors that may influence the decision to prescribe or not prescribe antibiotics directly (e.g. pressure of patients' family leading to antibiotic prescribing) or indirectly via influence on other factors (e.g. unfamiliarity with patients resulting in a higher physician perceived risk of non-treatment, in turn resulting in a higher tendency to prescribe antibiotics).
  
  
  CONCLUSIONS
  Our interview study shows that several non-rational factors may affect antibiotic prescribing decision making in long-term care facilities, suggesting opportunities to reduce inappropriate antibiotic use. We developed a conceptual model that integrates the identified categories of influencing factors and shows the relationships between those categories. This model may be used as a practical tool in long-term care facilities to identify local factors potentially leading to inappropriate prescribing, and to subsequently intervene at the level of those factors to promote appropriate antibiotic prescribing.
authors.affiliation: EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands. l.vanbuul@vumc.nl.
authors.forename: Laura W
authors.initials: LW
authors.lastname: van Buul
authors.forename: Jenny T
authors.initials: JT
authors.lastname: van der Steen
authors.forename: Sarah M M M
authors.initials: SM
authors.lastname: Doncker
authors.forename: Wilco P
authors.initials: WP
authors.lastname: Achterberg
authors.forename: François G
authors.initials: FG
authors.lastname: Schellevis
authors.forename: Ruth B
authors.initials: RB
authors.lastname: Veenhuizen
authors.forename: Cees M P M
authors.initials: CM
authors.lastname: Hertogh
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003657:Decision Making; D005260:Female; D006282:Health Personnel / Q000592:standards*; D006707:Homes for the Aged / Q000592:standards*; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008134:Long-Term Care / Q000379:methods / Q000592:standards; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes / Q000592:standards*; D009740:Nursing Staff / Q000592:standards; D010820:Physicians / Q000592:standards; D036301:Qualitative Research; D012112:Residential Facilities / Q000379:methods / Q000592:standards
chemical_list: D000900:Anti-Bacterial Agents