title: Determinants of physician antibiotic prescribing behavior: a 3 year cohort study in Portugal.
abstract: Objectives Antibiotic misprescription is a major driver of resistance, which is a worldwide public health problem. Therefore, our aim is to assess the influence of the determinants of physician prescribing on the quality of antibiotic use. Methods A 3 year cohort study including all primary-care physicians working in Portugal's Central Regional Health Administration (n = 1094) was conducted. We assessed the determinants of prescribing using a pre-validated, personally addressed, reply-paid, self-administered questionnaire (sent four times to non-responders, between September 2011 and February 2012) designed to collect information on physicians' attitudes to and knowledge of antibiotic prescribing as well as their socio-demographic and professional data. To evaluate antibiotic prescribing, we've calculated ESAC 12 quality indicators per physician per year, allowing us to stratify them as good or poor prescribers according to their performance on those indicators. Associations between determinants and outcomes were fitted with generalized linear mixed models. Results The overall response rate was 46.1%. Emergency activity (OR [95% CI] = 0.29 [0.16-0.54]; p < 0.05) and workload (number of patients seen per day: OR [95% CI] = 0.97 [0.94-1.00]; p < 0.05; number of patients seen per week in emergencies: OR [95% CI] = 0.98 [0.97-0.99]; p < 0.05) were both related to poor quality of antibiotic prescribing. Statistically significant odds ratios were also obtained for ignorance (IqOR [95% CI] = 2.14 [1.31-3.52]), complacency (1/IqOR [95% CI] = 1.19 [1.01-1.41]) and responsibility of others (1/IqOR [95% CI] = 1.78 [1.10-3.06]). Conclusions The above results serve to emphasize workload, working at emergency departments and physicians' attitudes identified as critical factors affecting antibiotic prescribing. This provides new insights for clinicians, researchers and policy makers when it comes to developing and improving the clinical and economic outcomes of antibiotic use. Key limitations of the study included the difficulty of results extrapolation and the limitations of the stratification method based on the antibiotic prescribing quality indicators.
authors.affiliation: a Department of Medical Sciences and Institute for Biomedicine - iBiMED , University of Aveiro , Aveiro , Portugal ;|b Faculty of Pharmacy , University of Coimbra (Faculdade de Farmácia da Universidade de Coimbra - FFUC) , Coimbra , Portugal ;
authors.forename: António
authors.initials: A
authors.lastname: Teixeira Rodrigues
authors.affiliation: a Department of Medical Sciences and Institute for Biomedicine - iBiMED , University of Aveiro , Aveiro , Portugal ;
authors.forename: Mónica
authors.initials: M
authors.lastname: Ferreira
authors.affiliation: c Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP) , Santiago de Compostela , Spain ;
authors.forename: Maria
authors.initials: M
authors.lastname: Piñeiro-Lamas
authors.affiliation: b Faculty of Pharmacy , University of Coimbra (Faculdade de Farmácia da Universidade de Coimbra - FFUC) , Coimbra , Portugal ;|d Centre for Neuroscience and Cell Biology, University of Coimbra (CNC/UC) , Coimbra , Portugal ;
authors.forename: Amílcar
authors.initials: A
authors.lastname: Falcão
authors.affiliation: c Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP) , Santiago de Compostela , Spain ;|e University of Santiago de Compostela , Santiago de Compostela , Spain ;
authors.forename: Adolfo
authors.initials: A
authors.lastname: Figueiras
authors.affiliation: a Department of Medical Sciences and Institute for Biomedicine - iBiMED , University of Aveiro , Aveiro , Portugal ;|f CESPU, IINFACTS, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde , Gandra , Portugal.
authors.forename: Maria T
authors.initials: MT
authors.lastname: Herdeiro
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011174:Portugal; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial resistance; Attitudes; Knowledge; Misprescription; Physician antibiotic prescribing behavior