A mixed methods exploration of antibiotic prescribing and stewardship
Morgan, Jake Roberts
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Unnecessary prescribing of antibiotics for viral respiratory tract infections is common and contributes to emerging antibiotic resistance and patient morbidity and mortality. Interventions aimed at promoting judicious use of antibiotics, such as prescribing guidelines, are often ineffective. Approaching the problem of overprescribing from new perspectives is key to making progress towards more effective antimicrobial stewardship. Exploring characteristics shared between patients and providers, attitudes of new antibiotic stewards, and the role of prescribing on subsequent use offer opportunities to better understand antibiotic stewardship and overprescribing at a time when new perspectives are needed to inform better interventions. This dissertation contains three studies that incorporate novel perspectives to investigate the patient, provider, and practice factors that promote judicious use of antibiotics and solicit a better understanding of the current state of stewardship from future antibiotic stewards. Study 1. A Qualitative Study of the Knowledge and Attitudes of Infectious Disease Fellows, sought to understand the attitudes and beliefs of infectious disease fellows on the front line of antibiotic stewardship. Fellows highlighted the importance of formal and informal education, explained the challenges faced when practicing stewardship, and suggested improvements to fellowship programs to encourage better antibiotic stewardship training. Study 2. Patient-Provider Race and Sex Concordance in Prescribing, explored how race and sex concordance between patients and providers predicted overprescribing. Results showed that racial concordance was one of the most important predictors of overprescribing, suggesting that concordance can be more important to the prescribing outcome than some clinical indicators and that improving cross-cultural communication may be a way to combat overprescribing. Study 3. Early Prescribing Behavior as a Predictor of Future Antibiotic Exposure and Resource Utilization, described how the decision whether or not to prescribe antibiotics at a child’s first acute bronchitis visit affected that child’s likelihood of returning for an additional acute bronchitis complaint and being prescribed an antibiotic. The results of this study suggested that the prescribing behavior of providers can affect future visits and subsequent prescribing.