title: Barriers to guideline-concordant antibiotic use among inpatient physicians: A case vignette qualitative study.
abstract: BACKGROUND
  Greater adherence to antibiotic-prescribing guidelines may promote more judicious antibiotic use, which could benefit individual patients and society at large.
  
  
  OBJECTIVE
  To assess physician knowledge and acceptance of antibiotic-prescribing guidelines through the use of case vignettes.
  
  
  METHODS
  We conducted semistructured interviews with 30 inpatient physicians. Participants were asked to respond to 3 hypothetical case vignettes: (1) a skin and soft tissue infection (SSTI), (2) suspected hospital-acquired pneumonia (HAP), and (3) asymptomatic bacteriuria (ASB). All participants received feedback according to guidelines from the Infectious Diseases Society of America (IDSA) and were asked to discuss their level of comfort with following these guidelines.
  
  
  METHODS
  Two acute care teaching hospitals for adult patients.
  
  
  METHODS
  None.
  
  
  METHODS
  Data from transcribed interviews were analyzed using emergent thematic analysis.
  
  
  RESULTS
  Participants were receptive to guidelines and believed they were useful. However, participants' responses to the case vignettes demonstrated that IDSA guideline recommendations were not routinely followed for SSTI, HAP, and ASB. We identified 3 barriers to guideline-concordant care: (1) physicians' lack of awareness of specific guideline recommendations; (2) tension between adhering to guidelines and the desire to individualize patient care; and (3) skepticism of certain guideline recommendations.
  
  
  CONCLUSIONS
  Case vignettes may be useful tools to assess physician knowledge and acceptance of antibiotic-prescribing guidelines. Using case vignettes, we identified 3 barriers to following IDSA guidelines. Efforts to improve guideline-concordant antibiotic prescribing should focus on reducing such barriers at the local level.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.|Iowa City VA Health Care System, Iowa City, Iowa.
authors.forename: Daniel
authors.initials: D
authors.lastname: Livorsi
authors.affiliation: Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana.
authors.forename: Amber R
authors.initials: AR
authors.lastname: Comer
authors.affiliation: VA Health Services Research and Development Service Center for Health Information and Communication, Richard Roudebush VA Medical Center, Indianapolis, Indiana.|Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Marianne S
authors.initials: MS
authors.lastname: Matthias
authors.affiliation: Iowa City VA Health Care System, Iowa City, Iowa.|Division 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: VA Health Services Research and Development Service Center for Health Information and Communication, Richard Roudebush VA Medical Center, Indianapolis, Indiana.|Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bair
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D007407:Interviews as Topic; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards*; D011014:Pneumonia / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research
chemical_list: D000900:Anti-Bacterial Agents