title: Medical and psychosocial factors associated with antibiotic prescribing in primary care: survey questionnaire and factor analysis.
abstract: BACKGROUND
  Acute upper respiratory infections (AURI) are the leading causes of antibiotic prescribing in primary care although antibiotics are often not indicated.
  
  
  OBJECTIVE
  To gain an understanding of the knowledge, attitudes, and practices (KAP) of GPs in Singapore and the associated latent factors to guide the implementation of an effective programme to reduce antibiotic use in primary care.
  
  
  METHODS
  An anonymous survey on the KAP of antibiotic use in AURI of GPs in Singapore.
  
  
  METHODS
  KAP survey questionnaires were posted to all GPs from a database. To ascertain the latent factors affecting prescribing patterns, exploratory factor analysis was performed.
  
  
  RESULTS
  Among 427 responses, 351 (82.2%) were from GPs working in private practice. It was found that 58.4% of GPs in the private versus 72.4% of those in the public sector recognised that >80% of AURIs were caused by viruses (P= 0.02). The majority of GPs (353/427; 82.7%) felt that antibiotics were overprescribed in primary care. Significant factors associated with low antibiotic prescribing were good medical knowledge and clinical competency (adjusted odds ratio [aOR] 3.2, 95% confidence interval [CI] = 2.4 to 4.3), good clinical practice (aOR 2.7 [95% CI = 2.0 to 3.6]), availability of diagnostic tests (aOR 1.4 [95% CI = 1.1 to 1.8]), and desire to improve clinical practice (aOR 1.5 [95% CI = 1.2 to 1.9]). The conservative practice of giving antibiotics 'to be on the safe side' is significantly less likely to be associated with low antibiotic prescribing (aOR 0.7 [95% CI = 0.5 to 0.9]).
  
  
  CONCLUSIONS
  This is the first KAP survey on antibiotic prescribing for AURI among GPs in Singapore. With the latent factors identified, future interventions should be directed at addressing these factors to reduce inappropriate antibiotic prescribing.
authors.affiliation: Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.
authors.forename: Tau-Hong
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.
authors.forename: Joshua Gx
authors.initials: JG
authors.lastname: Wong
authors.affiliation: Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital; Yong Loo Lin School of Medicine, Singapore.
authors.forename: David Cb
authors.initials: DC
authors.lastname: Lye
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore; Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.
authors.forename: Mark Ic
authors.initials: MI
authors.lastname: Chen
authors.affiliation: Division of Family Medicine, Department of Medicine, University Medicine Cluster, National University Hospital System, Singapore.
authors.forename: Victor Wk
authors.initials: VW
authors.lastname: Loh
authors.affiliation: Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Yee-Sin
authors.initials: YS
authors.lastname: Leo
authors.affiliation: Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.
authors.forename: Linda K
authors.initials: LK
authors.lastname: Lee
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore; Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.
authors.forename: Angela Lp
authors.initials: AL
authors.lastname: Chow
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005163:Factor Analysis, Statistical; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D012846:Singapore / Q000453:epidemiology; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents
keywords: acute upper respiratory infections; antibiotics; factors; knowledge, attitudes and practices; primary care