Factors influencing antibiotic prescribing behavior among clinicians in selected public and private-not-for-profit hospitals in the Central Region of Uganda

Abstract

The emergence and spread of antibiotic resistance (AMR) is one of the biggest threats to public health. Current efforts are geared towards optimal use of antibiotics. However, very few are directed towards addressing the prescribing behavior of clinicians. This study aimed to identify the factors that influence antibiotic prescribing behavior among clinicians in public and private-not-for profit facilities in the central region of Uganda. To describe the factors influencing antibiotic prescribing behavior among clinicians in public and private-not-for profit facilities in the central region of Uganda. Inpatient and outpatient antibiotic prescriptions in two public and two private-not-for-profit facilities at general and regional referral hospital levels were reviewed to describe antibiotic prescribing behavior. A semi structured questionnaire was administered to clinicians to ascertain their level of awareness of AMR. A chi-square test for independence and other non-parametric tests were used to identify differences in awareness and behavior between the facilities, and groups by level of care and ownership. In-depth interviews were conducted among the clinicians to identify the factors that influence the intention to prescribe antibiotics and the choice of antibiotics. Inductive thematic analysis was applied to identify the emerging themes. Five hundred ninety-four (594) antibiotic prescriptions were reviewed in all four hospitals. There was a significant difference in the adherence to the 2016 UCG among the individual facilities (p=0.002). Adherence to these guidelines was higher in public facilities than the PNFPs (p=0.012) and higher for the regional referral hospitals than the general hospitals (p=0.004). Twenty-eight clinicians participated in the survey; the mean awareness score was highest for the regional referrals and lowest for general hospitals. There was, no significant difference among the individual facilities (p=0.0816) or by level of care (p=1.039) and by ownership (0.9617). The factors influencing antibiotic prescribing included aspects of the individual clinician such as access to information during pre-service and in-service training, approval by their colleagues and seniors, perceived risks to the patient and their perceived ability to address irrational antibiotic use

and their attitude towards change given the environment in which they work. The factors fostered by the facility and the health system at large included: availability of diagnostic services, availability platforms for continuous medical education, availability of enough staff to manage the patient load. Overall, this study shows that despite being aware of AMR, the prescribing behavior of clinicians in the central region is largely irrational and there are no evident differences in prescribing behavior among facilities by level of care or by ownership. The main factors influencing prescribing behavior are associated with the individual’s ability to diagnose and treat a patient based on their training, influence from peers, and the availability of diagnostic services and essential medicines