title: Factors Influencing Antibiotic-Prescribing Decisions Among Inpatient Physicians: A Qualitative Investigation.
abstract: OBJECTIVE
  To understand the professional and psychosocial factors that influence physician antibiotic prescribing habits in the inpatient setting.
  
  
  METHODS
  We conducted semi-structured interviews with 30 inpatient physicians. Interviews consisted of open-ended questions and flexible probes based on participant responses. Interviews were audio recorded, transcribed, de-identified, and reviewed for accuracy and completeness. Data were analyzed using emergent thematic analysis.
  
  
  METHODS
  Two teaching hospitals in Indianapolis, Indiana
  
  
  METHODS
  A total of 30 inpatient physicians (10 physicians-in-training, 20 supervising staff) were enrolled in this study.
  
  
  RESULTS
  Participants recognized that antibiotics are overused, and many admitted to prescribing antibiotics even when the clinical evidence of infection was uncertain. Overprescription was largely driven by anxiety about missing an infection, whereas potential adverse effects of antibiotics did not strongly influence decision making. Participants did not routinely disclose potential adverse effects of antibiotics to inpatients. Physicians-in-training were strongly influenced by the antibiotic prescribing behavior of their supervising staff physicians. Participants sometimes questioned their colleagues' antibiotic prescribing decisions, but they frequently avoided providing direct feedback or critique. These physicians cited obstacles of hierarchy, infrequent face-to-face encounters, and the awkwardness of these conversations.
  
  
  CONCLUSIONS
  A physician-based culture of prescribing antibiotics involves overusing antibiotics and not challenging the decisions of colleagues. The potential adverse effects of antibiotics did not strongly influence decision making in this sample. A better understanding of these factors could be leveraged in future efforts to improve antibiotic prescribing practices in the inpatient setting.
authors.affiliation: 1Division of Infectious Diseases,Indiana University School of Medicine,Indianapolis,Indiana.
authors.forename: Daniel
authors.initials: D
authors.lastname: Livorsi
authors.affiliation: 2Richard M. Fairbanks School of Public Health,Indiana University,Indianapolis,Indiana.
authors.forename: Amber
authors.initials: A
authors.lastname: Comer
authors.affiliation: 3Veterans Affairs Health Services Research and Development Service Center for Health Information and Communication,Richard Roudebush VA Medical Center,Indianapolis,Indiana.
authors.forename: Marianne S
authors.initials: MS
authors.lastname: Matthias
authors.affiliation: 5Division of General Internal Medicine and Infectious Diseases,Department of Internal Medicine,University of Iowa Carver College of Medicine,Iowa City,Iowa.
authors.forename: Eli N
authors.initials: EN
authors.lastname: Perencevich
authors.affiliation: 3Veterans Affairs Health Services Research and Development Service Center for Health Information and Communication,Richard Roudebush VA Medical Center,Indianapolis,Indiana.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bair
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003657:Decision Making; D011307:Drug Prescriptions; D005260:Female; D020445:Hospitalists / Q000523:psychology*; D006784:Hospitals, Teaching; D006801:Humans; D057970:Inappropriate Prescribing / Q000523:psychology*; D007396:Internship and Residency; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research
chemical_list: D000900:Anti-Bacterial Agents