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JAC Advance Access published online on August 2, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl323
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Received March 21, 2006
Revised June 9, 2006
Accepted July 13, 2006

Antimicrobial practice

A qualitative study of factors influencing antimicrobial prescribing by non-consultant hospital doctors

Valerie De Souza 1, Anne MacFarlane 2, Andrew W. Murphy 2, Belinda Hanahoe 3, Andrew Barber 4, and Martin Cormican 1 *

1 Department of Bacteriology, National University of Ireland Galway, Newcastle Road, Galway, Ireland
2 Department of General Practice National University of Ireland Galway, Newcastle Road, Galway, Ireland
3 Department of Medical Microbiology, Galway University Hospital, Newcastle Road, Galway, Ireland
4 Department of Pharmacy, Galway University Hospital, Newcastle Road, Galway, Ireland

* To whom correspondence should be addressed.
Martin Cormican, E-mail: martin.cormican{at}mailn.hse.ie


  Abstract

Objectives: To determine the factors that influence non-consultant hospital doctors (NCHDs) in their decision to prescribe antimicrobial agents.

Methods: A qualitative study using semi-structured interviews centred on a life grid tracking the medical career of 22 NCHDs employed by a university teaching hospital in the west of Ireland.

Results: Early in their careers NCHD prescribing is based primarily on the immediate influence of more senior colleagues. Recollection of formalized undergraduate teaching and hospital guidelines are a very minor influence. As their career progressed and they exercise greater autonomy, personal experience becomes the major influence on prescribing decisions. Hospital guidelines are a minor influence. Participants consider that undergraduate teaching needs to be more practical and taught in a way that is easier to apply to on-ward situations and that hospital prescribing guidelines need to be presented in a ‘user-friendly’ format and adherence to the guidelines needs to be promoted.

Conclusions: The key influences on antimicrobial prescribing by NCHDs are informal. New approaches are required to ensure that formal training and hospital guidelines on antimicrobial prescribing are more influential in shaping antimicrobial prescribing practice.

Keywords: antibiotic policy; antimicrobial policy; antimicrobial stewardship.
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