Improving physician antibiotic prescribing behaviours: empowering infectious diseases physicians to influence change in practice among their peers
Implementation & Integration
TOH-16-003 We have greater insight regarding local factors (barriers and facilitators) that influence physician antibiotic prescribing in our facility, and a better understanding of the perceived roes and self-reported behaviours of subject matter experts (infectious diseases physicians) when advising their peers. Using these results, a behaviour change toolkit for infectious diseases physicians is currently being developed, with strategies that they can use to influence others’ prescribing behaviour. The methods used in our study can be applied to understand other physician (and other healthcare worker) behaviours, and inform interventions and behaviour change techniques that may be used by other subject matter experts to influence behaviours among peers. While the approach used in this project should be adaptable to other clinical settings, the most relevant BCTs may be expected to differ depending on the clinical circumstances. One major deliverable of this project is the behaviour change toolkit and training modules, which may also be adopted for use in other clinical settings.
TOH-16-003 Inappropriate use of antibiotics in healthcare facilities contributes to the development of antibiotic resistance and adverse patient outcomes such as Clostridioides difficile infection. Infectious diseases (ID) physicians, experts in antibiotic prescribing, can act as change agents who can influence and improve appropriate prescribing behaviours among their peers. 16 non-ID physicians were interviewed to assess barriers and facilitators of their antibiotic prescribing behaviours. Using the Theoretical Domains Framework (TDF), these barriers and facilitators were themed into 14 TDF domains. Knowledge, beliefs about consequences, intention, skills, beliefs about capabilities, and social influence were common themes. 12 ID physicians were interviewed to identify behavioural approaches that can complement those currently used during their interactions with non-ID physicians. BCTs that ID physicians could feasibly apply to effect behaviour change among non-ID physicians were mapped to the barriers and facilitators identified by non-ID physicians, and grouped into five main categories: knowledge (what to do), beliefs about consequences (worried about this patient), social influence (someone else prescribed), automatic actions (how I do things), social role and identity (this is not my role/job). Our BCT toolkit and training curriculum are currently being developed for delivery to ID physicians and will include situational role-playing and practice. The impact of these tools will be assessed following their delivery, with the goals of a) empowering ID physicians with new BCTs, b) increasing their use of learned BCTs and strategies, and c) improved antibiotic prescribing practices among non-ID physicians, based on outcomes such as antibiotic use and appropriate discontinuation of therapy.