Increased Focus on Prescriber Role Needed to Improve Antibiotic Prescribing in Nursing Homes

The perceived professional role and identity of nursing home physicians significantly influences their antibiotic prescribing, according to a study published online in BMJ Open Quality.

“Appealing to the role that prescribers see themselves offers a unique opportunity to encourage desired changes, such as providing tools for physicians to be educators and facilitating, particularly medical directors, to be change drivers,” researchers wrote. 

The study focused on antibiotic prescribing of nursing home physicians and, specifically, the influence of an individualized antibiotic prescribing audit-and-feedback report available to long-term care physicians in Ontario, Canada. Eighteen nursing home physicians who received a personalized report participated in phone interviews, which were transcribed and analyzed. 

Among the physicians interviewed, 78% were men. They averaged 27 years in practice and 18 years in nursing homes. The number of facilities physicians worked in ranged from one to six, and more than half of the physicians were medical directors at one or more nursing homes. 

A physician’s professional role and identity drove all aspects of antibiotic prescribing, the study found. Although all physicians considered themselves appropriate prescribers, only some viewed themselves as educators and change drivers. 

Barriers to role fulfillment included time constraints, high staff turnover, lack of access to diagnostic equipment, and caring for residents at several homes with different staffs, researchers reported.  

“Even among those who were motivated to improve their prescribing, few had the capabilities and opportunities needed to work with team members to achieve this practice change in a sustainable way,” researchers wrote. “While the audit-and-feedback report supported physicians to understand their own prescribing practices, it did not appear to reinforce behavior change, suggesting that audit-and-feedback may provide more benefit when applied with other strategies.” 

—Jolynn Tumolo

Reference

Laur C, Sribaskaran T, Simeoni M, et al. Improving antibiotic initiation and duration prescribing among nursing home physicians using an audit and feedback intervention: a theory-informed qualitative analysis. BMJ Open Qual. 2021;10(1):e001088. doi:10.1136/bmjoq-2020-001088