Effect of Physicians' Attitudes and Knowledge on the Quality of Antibiotic Prescription: A Cohort Study.
Resistance increases with the use and abuse of antibiotics. Since physicians are primarily responsible for the decision to use antibiotics, ascertaining the attitudes and knowledge that underlie their prescribing habits is thus a prerequisite for improving prescription. Three-year follow-up cohort study (2008-2010) targeting primary-care physicians (n = 2100) in Galicia, a region in NW Spain. We used data obtained from a postal survey to assess knowledge and attitudes. A physician was deemed to have demonstrated Appropriate Quality Prescription of Antibiotics (dependent variable) in any case where half or more of the indicators proposed by the European Surveillance of Antimicrobial Consumption had values that were better than the reference values for Spain. The mail-questionnaire response rate was 68·0% (1428/2100). The adjusted increase in the interquartile OR of displaying good prescribing of antibiotics for each attitude was: 205% for fear ("When in doubt, it is better to ensure that a patient is cured of an infection by using a broad-spectrum antibiotic"; 95%CI: 125% to 321%); 119% for better knowledge ("Amoxicillin is useful for resolving most respiratory infections in primary care"; 95%CI: 67% to 193%); and 21% for complacency with patients' demands ("Antibiotics are often prescribed due to patients' demands"; 95%CI: 0% to 45%). Due to the fact that physicians' knowledge and attitudes are potentially modifiable, the implementation of purpose-designed educational interventions based on the attitudes identified may well serve to improve antibiotic prescription.
Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.
Cristian
C
Gonzalez-Gonzalez
Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.
Paula
P
López-Vázquez
Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.
Juan Manuel
JM
Vázquez-Lago
Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain.
María
M
Piñeiro-Lamas
Polytechnic and University Teaching Institute (Cooperativa de Ensino Superior Politécnico e Universitário-CESPU), Gandra PRD, Portugal; Institute for Advanced Research and Training in Health Sciences and Technologies, Gandra PRD, Portugal; Northern Pharmacovigilance Unit, Faculty of Medicine, University of Porto, Porto, Portugal.
Maria Teresa
MT
Herdeiro
Subdirectorate-General of Pharmacy, Galician Health Service (Servicio Gallego de Salud-SERGAS), Santiago de Compostela, Spain.
Pilar Chávarri
PC
Arzamendi
Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain.
Adolfo
A
Figueiras
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D058007:Physicians, Primary Care; D010818:Practice Patterns, Physicians'; D055656:Prescriptions / Q000592:standards*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D013030:Spain; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents