title: Barriers to uptake of antimicrobial advice in a UK hospital: a qualitative study.
abstract: BACKGROUND
  The role of infectious diseases (ID) and clinical microbiology (CM) in hospital settings has expanded in response to increasing antimicrobial resistance, leading to widespread development of hospital antimicrobial stewardship (AMS) programmes, the majority of which include antibiotic approval systems. However, inappropriate antibiotic use in hospitals continues, suggesting potential disjunctions between technical advice and the logics of antibiotic use within hospitals.
  
  
  OBJECTIVE
  To examine the experiences of doctors in a UK hospital with respect to AMS guidance of antibiotic prescribing, and experiences of a verbal postprescription antibiotic approval process.
  
  
  METHODS
  Twenty doctors in a teaching hospital in the UK participated in semi-structured interviews about their experiences of antibiotic use and governance. NVivo10 software was used to conduct a thematic content analysis systematically.
  
  
  RESULTS
  This study identified three key themes regarding doctors' relationships with ID/CM clinicians that shaped their antibiotic practices: (1) competing hierarchical influences limiting active consultation with ID/CM; (2) non-ID/CM consultants' sense of ownership over clinical decision-making and concerns about challenges to clinical autonomy; and (3) tensions between evidence-based practice and experiential-style learning.
  
  
  CONCLUSIONS
  This study illustrates the importance of examining relations between ID/CM and non-ID/CM clinicians in the hospital context, indicating that AMS models that focus exclusively on delivering advice rather than managing interprofessional relationships may be limited in their capacity to optimize antibiotic use. AMS and, specifically, antibiotic approval systems would likely be more effective if they incorporated time and resources for fostering and maintaining professional relationships.
authors.affiliation: Department of Medicine, Sunshine Coast Hospital and Health Service, Nambour, QLD, Australia; School of Medicine, The University of Queensland, QLD, Australia. Electronic address: jennifer.broom@health.qld.gov.au.
authors.forename: J
authors.initials: J
authors.lastname: Broom
authors.affiliation: School of Social Sciences, The University of New South Wales, Sydney, NSW, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Broom
authors.affiliation: School of Social Sciences, The University of New South Wales, Sydney, NSW, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Plage
authors.affiliation: Department of Infectious Diseases, Hull and East Yorkshire NHS Trust, Kingston upon Hull, UK.
authors.forename: K
authors.initials: K
authors.lastname: Adams
authors.affiliation: Department of Infectious Diseases, Prince of Wales Hospital and Prince of Wales Clinical School, The University of New South Wales, Sydney, NSW, Australia.
authors.forename: J J
authors.initials: JJ
authors.lastname: Post
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003141:Communicable Diseases / Q000188:drug therapy*; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006784:Hospitals, Teaching; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D006113:United Kingdom
chemical_list: D000890:Anti-Infective Agents
keywords: Antimicrobial resistance; Antimicrobial stewardship; Clinical microbiology; Infectious diseases; Qualitative research