Antibiotic Prescribing Decisions for Upper Respiratory Tract Infections Among Primary Healthcare Physicians in China: A Mixed-Methods Approach Based on the Theory of Planned Behavior
<b>Objectives:</b> In China, primary healthcare (PHC) facilities have high antibiotic prescribing rates for upper respiratory tract infections (URTIs), which are primarily viral and self-limited. This study aimed to identify the main factors influencing PHC physicians’ antibiotic decisio...
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MDPI AG
2024-11-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/13/11/1104 |
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| author | Muhtar Kadirhaz Yushan Zhang Nan Zhao Iltaf Hussain Sen Xu Miaomiao Xu Chengzhou Tang Wei Zhao Yi Dong Yu Fang Jie Chang |
| author_facet | Muhtar Kadirhaz Yushan Zhang Nan Zhao Iltaf Hussain Sen Xu Miaomiao Xu Chengzhou Tang Wei Zhao Yi Dong Yu Fang Jie Chang |
| author_sort | Muhtar Kadirhaz |
| collection | DOAJ |
| description | <b>Objectives:</b> In China, primary healthcare (PHC) facilities have high antibiotic prescribing rates for upper respiratory tract infections (URTIs), which are primarily viral and self-limited. This study aimed to identify the main factors influencing PHC physicians’ antibiotic decisions for URITs based on the theory of planned behavior. <b>Methods:</b> A convergent mixed-methods study was conducted at 30 PHC facilities across Shaanxi Province, China. A total of 108 PHC physicians completed a five-point Likert Scale questionnaire focused on behavioral components of antibiotic prescribing, including attitudes, subjective norms, perceived behavioral control, belief in past experiences, and prescribing intentions. Twenty-two physicians participated in semi-structured interviews. <b>Results:</b> Respondents had a good awareness of AMR (Mean = 4.49) and a weak belief regarding the benefit of antibiotics (Mean = 2.34). The mean score for subjective norms was 3.36, and respondents had good control over their prescribing behavior (Mean = 4.00). A reliance on past prescribing experiences was observed (Mean = 3.34), and physicians’ antibiotic prescribing intention was 3.40 on average. Multiple linear regression revealed that physicians showing a more favorable attitude towards antibiotics (<i>p</i> = 0.042) and relying more on their past experiences (<i>p</i> = 0.039) had a higher antibiotic prescribing intention. Qualitative interviews indicated that most physicians would consider prescribing antibiotics when facing diagnostic uncertainty. Low utilization of diagnostic tests, limited effectiveness of training programs, inadequate knowledge of guidelines, and lack of feedback on antibiotic prescriptions all contributed to antibiotic overprescribing. <b>Conclusions:</b> PHC physicians in China demonstrated strong intentions to prescribe antibiotics for URTIs when facing diagnostic uncertainty. Beliefs about antibiotics and previous prescribing behavior were significantly linked to prescribing intentions. Multifaceted interventions that focus on facilitating diagnostic tests, improving the quality of training, effectively implementing clinical guidelines, and providing practical feedback on antibiotic prescriptions may help reduce antibiotic overprescribing in China’s PHC facilities. |
| format | Article |
| id | doaj-art-ec3b4010935741caa374f071656e807d |
| institution | OA Journals |
| issn | 2079-6382 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj-art-ec3b4010935741caa374f071656e807d2025-08-20T02:08:11ZengMDPI AGAntibiotics2079-63822024-11-011311110410.3390/antibiotics13111104Antibiotic Prescribing Decisions for Upper Respiratory Tract Infections Among Primary Healthcare Physicians in China: A Mixed-Methods Approach Based on the Theory of Planned BehaviorMuhtar Kadirhaz0Yushan Zhang1Nan Zhao2Iltaf Hussain3Sen Xu4Miaomiao Xu5Chengzhou Tang6Wei Zhao7Yi Dong8Yu Fang9Jie Chang10Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, ChinaDepartment of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, ChinaDepartment of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, ChinaDepartment of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, ChinaDepartment of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, ChinaDepartment of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, ChinaDepartment of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, ChinaDepartment of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, ChinaDepartment of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, ChinaDepartment of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, ChinaDepartment of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China<b>Objectives:</b> In China, primary healthcare (PHC) facilities have high antibiotic prescribing rates for upper respiratory tract infections (URTIs), which are primarily viral and self-limited. This study aimed to identify the main factors influencing PHC physicians’ antibiotic decisions for URITs based on the theory of planned behavior. <b>Methods:</b> A convergent mixed-methods study was conducted at 30 PHC facilities across Shaanxi Province, China. A total of 108 PHC physicians completed a five-point Likert Scale questionnaire focused on behavioral components of antibiotic prescribing, including attitudes, subjective norms, perceived behavioral control, belief in past experiences, and prescribing intentions. Twenty-two physicians participated in semi-structured interviews. <b>Results:</b> Respondents had a good awareness of AMR (Mean = 4.49) and a weak belief regarding the benefit of antibiotics (Mean = 2.34). The mean score for subjective norms was 3.36, and respondents had good control over their prescribing behavior (Mean = 4.00). A reliance on past prescribing experiences was observed (Mean = 3.34), and physicians’ antibiotic prescribing intention was 3.40 on average. Multiple linear regression revealed that physicians showing a more favorable attitude towards antibiotics (<i>p</i> = 0.042) and relying more on their past experiences (<i>p</i> = 0.039) had a higher antibiotic prescribing intention. Qualitative interviews indicated that most physicians would consider prescribing antibiotics when facing diagnostic uncertainty. Low utilization of diagnostic tests, limited effectiveness of training programs, inadequate knowledge of guidelines, and lack of feedback on antibiotic prescriptions all contributed to antibiotic overprescribing. <b>Conclusions:</b> PHC physicians in China demonstrated strong intentions to prescribe antibiotics for URTIs when facing diagnostic uncertainty. Beliefs about antibiotics and previous prescribing behavior were significantly linked to prescribing intentions. Multifaceted interventions that focus on facilitating diagnostic tests, improving the quality of training, effectively implementing clinical guidelines, and providing practical feedback on antibiotic prescriptions may help reduce antibiotic overprescribing in China’s PHC facilities.https://www.mdpi.com/2079-6382/13/11/1104primary healthcareantibiotic useupper respiratory tract infections |
| spellingShingle | Muhtar Kadirhaz Yushan Zhang Nan Zhao Iltaf Hussain Sen Xu Miaomiao Xu Chengzhou Tang Wei Zhao Yi Dong Yu Fang Jie Chang Antibiotic Prescribing Decisions for Upper Respiratory Tract Infections Among Primary Healthcare Physicians in China: A Mixed-Methods Approach Based on the Theory of Planned Behavior Antibiotics primary healthcare antibiotic use upper respiratory tract infections |
| title | Antibiotic Prescribing Decisions for Upper Respiratory Tract Infections Among Primary Healthcare Physicians in China: A Mixed-Methods Approach Based on the Theory of Planned Behavior |
| title_full | Antibiotic Prescribing Decisions for Upper Respiratory Tract Infections Among Primary Healthcare Physicians in China: A Mixed-Methods Approach Based on the Theory of Planned Behavior |
| title_fullStr | Antibiotic Prescribing Decisions for Upper Respiratory Tract Infections Among Primary Healthcare Physicians in China: A Mixed-Methods Approach Based on the Theory of Planned Behavior |
| title_full_unstemmed | Antibiotic Prescribing Decisions for Upper Respiratory Tract Infections Among Primary Healthcare Physicians in China: A Mixed-Methods Approach Based on the Theory of Planned Behavior |
| title_short | Antibiotic Prescribing Decisions for Upper Respiratory Tract Infections Among Primary Healthcare Physicians in China: A Mixed-Methods Approach Based on the Theory of Planned Behavior |
| title_sort | antibiotic prescribing decisions for upper respiratory tract infections among primary healthcare physicians in china a mixed methods approach based on the theory of planned behavior |
| topic | primary healthcare antibiotic use upper respiratory tract infections |
| url | https://www.mdpi.com/2079-6382/13/11/1104 |
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